Introduction: Enhancing Nursing Care


 


Nursing is the process of caring for, or nurturing, for an individual known as the ‘patient’. More specifically, nursing refers to the functions and duties carried out by persons who have had formal education and training in the art and science of nursing. To promote the restoration and maintenance of health in their clients, nurses became more particular in enhancing their knowledge through integrating with health and biological sciences (1993).


 


            According to the Code of Professional Conduct (2002), a registered nurse, midwife or health visitor is accountable for what they practice. Furthermore it noted that the following should be followed when caring for patients and clients:


 


o        “respect the patient or client as an individual


o        Obtain consent before you give any treatment or care


o        protect confidential information


o        co-operate with others in the team


o        maintain your professional knowledge and competence


o        be trustworthy


o        act to identify and minimize risk to patients and clients”.


 


            On the other hand, according to the  (2003), the nursing profession has the following interrelated standards:


 


1)     Accountability – the registered nurse is accountable to the public for competent , safe and ethical nursing practice


2)     Continuing Competence – the registered nurse attains and maintains competencies relevant to own scope of nursing practice


3)     Application Knowledge, Skills and Judgment – the registered nurse demonstrates competencies relevant to own scope of nursing practice


4)     Professional Relationships and Advocacy – the registered nurse establishes professional therapeutic relationships with clients and advocates for clients in their relationship with the health system


5)     Professional Leadership – the registered nurse demonstrates professional leadership in the delivery of quality nursing and healthcare services to the public


6)     Self Regulation – the registered nurse assumes personal accountability to practice nursing competently and ethically.”


 


            According to an interview with a hospital lead nurse (assigned in older people’s acute care) people published in the  (2004, November 8) good nursing practice is defined as:


 


            “Good nursing practice is all about providing holistic, personalized care that is respectful of the individual and nurses are at their best when caring for older people”


 


The individual healthcare professional’s ability to do what is proposed with proper competence and skill is, of course, crucial in ensuring safe clinical care. But professional competence is only part of the picture. Good people, with good skills and good intentions, sometimes make mistakes. As part of this professional issue, to be a nurse is to observe a dynamic process of caring based on a theoretical body of knowledge.


 


The role of the nurse as a vital member of the healthcare team through collaborative professional practice must always give priority through caring its patient. The primary goal of being a nurse is to assist individuals in the achievement of an optimal level of wellness. The focus of nursing practice is on individuals’ specific needs based on their healthcare choices related to physiological, psychological, socio-cultural, developmental and spiritual dimensions of individual lifestyles.


 


            Therefore, a good nursing practice is one that involves the patient in his own care. The patient’s role in his own care must be acknowledged and given importance by the healthcare professional


 


A specific example of a good nursing practice I have witnessed is having an open (and effective) communication between the patient (and / or the patient’s family) and the healthcare professional. First and foremost, the healthcare professional consults the patient about what are his preferences regarding his care and / or treatment. This is of significance in the patient – healthcare professional relationship; because it will prevent any misunderstanding that might arise when a decision regarding the patient’s care and / or treatment must be made. The patient is also given accurate and / or truthful information of his condition. Furthermore, the information regarding the patient’s condition is not relayed on very technical terms but rather using terms and / or language that is easily understood by the patient. This provides a better understanding for the patient on his medical condition. If in case a patient refuses to accept or undergo a treatment, the patient’s wishes are respected and followed by the healthcare professional.


 


Furthermore, a patient’s consent is first obtained before any treatment (and / or operation) is performed on the patient. The patient is informed of the effects and / or benefits of the treatment.  And if the patient refuses the treatment and / or operation, his wishes are respected. And in cases such as that (a patient refuses treatment), the patient is informed of the consequences of the non-treatment and at the same time, possible alternative treatments (in place of the refused treatment) and the possible consequences and / or effects of the alternative treatments. In case, the patient was not able to give his consent an able (and legal) representative of the patient will be informed of the patient’s condition and asked for consent on the proposed treatment.


 


 This is significant so that the healthcare professional will not be made liable on possible unfortunate consequences of the treatment or non-treatment; since it is the patient’s decision that has been respected and obeyed. Aside from that, the patient will have a better understanding of his condition and would feel more responsible about his health. Furthermore, he would be able to think over his refusal of the treatment and might concede to the healthcare professionals’ opinion or decision.


 


Another aspect of patient’s consent is his consent regarding on his medical records. Not only a patient is informed of his medical records but at the same time, he is informed on who has access to it and / or who knows about his medical records and how the information on his medical records are used in relation to his care and / or treatment.  Furthermore, the patient’s consent is obtained regarding on who among his family members or other relations should learn of his medical condition and / or have access on his medical records.


 


Aside from that, the healthcare professional works as a team. Each and every healthcare professional that works in relation to a patient’s care and / or treatment coordinates with one another. Each and every one of them respects each other’s abilities, skills and opinions regarding the patient’s medical condition. A harmonious relationship lessens if not totally avoid misunderstandings, conflicts and tensions within the healthcare institution. Thus, a harmonious relationship in the medical team produces better results in the patient’s medication. Aside from that, a harmonious relationship amongst the healthcare professionals improves their performance which leads to better service and / or care to the patient.


 


Hand Washing as an Infection Control


In the healthcare surroundings, hand washing is frequently referred to as the main weapon in the disease control arsenal. The principle of hand washing in the healthcare setting is microbial diminution in an attempt to diminish the risk of nosocomial infections.


Hand sanitation can also be a dilemma in demanding health centers and clinics where patients are seen both in growing numbers and taken care of in rapid series.  Deterrence and control of communicable actions are intended to limit the increase of contamination and give protected surroundings for all patients, in spite of the locale.In light of the materialization of antibiotic defiant organisms, useful infection control measures, such as hand washing, are necessary to avoidance.


Hand sanitation is commonly recognized to be the only most essential activity for reducing the spread of illness, however facts imply that many health care professionals do not disinfect their hands as frequently as they require to or utilize the right method which means that spots of the hands can be missed. Hands should be disinfected before direct contact with patients and after any activity or contact that infects the hands, as well as following the removal of gloves. While alcohol hand gels and rubs are a practical alternative to soap and water, alcohol is not a cleaning agent. Hands that are visibly dirty or potentially grossly contaminated must be washed with soap and water and dried thoroughly. Hand preparation increases the effectiveness of decontamination. Adequate hand washing facilities must be available and easily accessible in all patient areas, treatment rooms, sluices and kitchens. Basins in clinical areas should have elbow or wrist lever operated mixer taps or automated controls and be provided with liquid soap dispensers, paper hand towels and foot-operated waste bins ( 2002).Alcohol hand gel must also be available at ‘point of care’ in all primary and secondary care settings (2004). All health care workers should bring any lack of, or inappropriately placed facilities to the notice of their managers (or matron). They also have a duty of care to patients and themselves and must use facilities provided to prevent cross infection.


 


Infection control is significantly significant to the successful condition and organization of healthcare services. On the other hand, it is a locale of nursing theory and practice that has been inadequately studied and has gone nearly uncontested (1996). Contamination control needs a vital understanding of the epidemiology of diseases caused by frequently encountered micro-organisms, of the danger that augment patients’ vulnerability to infection by these micro-organisms, and the exercises, measures and cures that encourage infections (1981). In the study of (1983) a small number of nurses inquire about principles, clinical practices or educational programs in infection control. Paradoxically, this took place at a time when disease control teams are progressively more moving away from the everyday gathering of hospital infection rates towards target observation programs.


Nurses have the opportunity to practice infection control as an integral part of patient care on a day-to-day basis (1983). However, the results of several studies suggest an overall lack of understanding of the components that make up informed infection control care (1992). Hospital-acquired infections are often related to inappropriate patient care practices. This may be due largely to non-compliance with infection control policies, which in turn is attributed to poor knowledge, a lack of motivation and low awareness of the need for infection control. It is important, therefore, that infection control personnel understand what factors influence compliance and how compliance can best be achieved (1988). A review of nosocomial infection control indicated that the incidence and subsequent cost of hospital infections can be reduced significantly by implementing an active infection control program (1993).


One solution that could encourage change in infection control practice is the development of an infection control audit program. The aim of clinical audit is to improve the delivery of care to patients as well as promote multidisciplinary working in clinical teams. It involves simply taking note of what nurses do, learning from it and changing practices if necessary (1993). Clinically-based audits ensure that the infection control nurse can examine practices where care is actually being delivered. A standardized infection control audit tool could be used by all care providers. This would furnish purchasers with a measurable standard in relation to quality in infection control (1992).


The risk to patients of infection is much higher than for the general population, partly due to under- lying intrinsic risk factors and the need for invasive therapy. The spread of infection is also increased when patients with existing infections are in close proximity to other susceptible patients (1992). Assessment of infection status can be divided into two distinct categories, the patient who has an infection which could spread to another patient, and the patient who is at risk of acquiring infection. These findings reveal that the majority of hospitals included in the study assessed the risk of infection through the nursing process. However, the nursing process does not necessarily offer a framework for risk assessment for infection control. Only one hospital had an infection control risk assessment tool applied by the clinical nurses and evaluated by the infection control nurses. (1988) suggested that the rate of infection can be altered significantly by staff awareness and the risk of infection reduced by a number of recognized healthcare practices, including risk assessment.


Often guidelines for infection control precautions are standardized and based on a medical model of care (1991). Infection control is also perceived as ‘rules and routines’ that are grafted onto care plans. In reality, infection prevention and control is the basis of all care. Findings from this study demonstrate that the nurses’ approach to applying infection control precautions in the clinical setting was inconsistent. Infection control nurses in each of the six hospitals viewed the hand washing technique of nursing staff as poor, with insufficient time allowed for the procedure. The seriousness of this finding was reinforced by a study on compliance with treatment by patients undergoing isolation nursing. The researcher found, among other things, that a failure by nurses to wash their hands after contact with patients known to be potentially infectious meant that the acquisition of pathogens was highly likely (1992).


While no harm is likely to befall a patient as a result of hand washing, one potential adverse effect of hand washing for healthcare workers is skin irritation. Indeed, skin irritation constitutes an important barrier to appropriate compliance with hand washing guidelines (1985). Soaps and detergents can damage the skin when applied on a regular basis. Alcohol-based preparations are less irritating to the skin, and with the addition of emollients, may be tolerated better (1999).


Another potential harm of increasing compliance with hand washing is the amount of time required to do it adequately. Current recommendations for standard hand washing suggest 15-30 seconds of hand washing is necessary for adequate hand hygiene (1995). Given the many times during a nursing shift that hand washing should occur, this is a significant time commitment that could potentially impede the performance of other patient care duties. In fact, lack of time is one of the most common reasons cited for failure to wash hands.11 Since alcohol-based hand rubs require much less time, it has been suggested that they might resolve this concern. In fact, a recent study which modeled compliance time for hand washing as compared with alcoholic rubs, suggested that, given 100% compliance, hand washing would consume 16 hours of nursing time per standard day shift, while alcohol rub would consume only 3 hours (1991).


Conclusion


            Nursing a profession that has been around since the middle ages, that began from health restoration of ill and wounded persons in wars, is now an institutionalized profession that faces a lot of issues, but is never the less stable in enhancing their skills through training and studies.       Based on the analysis, we can conclude that nursing is a sacred profession for it aims to help patients/ clients gain insight and access to their subjective experience.


             Indeed it is no argument in saying that in time, the nurses have increased their roles in the society. This is proven by the numerous specializations that were made in the past years that were employed in the field. Through periods of rapid changes in industrialization, and in the present day information technology, nursing institutions have designed nursing care appropriate to expectations of the patients and clients. Theoretical and practical management has evolved in this institution from the time it was formed ( 1995).


            Even in the event of modern thinking and high technology, the latest gadgets that enhance medical practices and the theories taught in the universities cannot replace the effectiveness of actual and personal involvement of the nurses to their patients. The nurse-patient involvement is crucial for wellness of the patient for it is one of the few interactions of the patient to other people while recuperating. Human interaction avoids the patient from being depressed. Furthermore, nurse-patient interaction provides the nurse with additional experience and promotes professional growth.


Practical knowledge (1979) supports praxis for it is indispensable, in the nursing field. A nurse needs to integrate his skills, experience and technical knowledge to result into a better and effective performance. Praxis has many implications in the field of nurturing and caring. Despite criticisms and complex issues, the theory Clinical Effectiveness should be present in a nurse’s profile for him to handle situations with patients in distress. Technical knowledge supports evidence based practice, practical knowledge endorses practical knowledge and emancipatory knowledge gives both nurses and patients interaction and ease.


 All health care professionals who have a clinical responsibility for patients must include infection prevention and control as part of their every day practice. The RCN believes all health care staff should receive mandatory infection control training as part of their induction and on an ongoing annual basis. It is particularly important that knowledge and skills are continually updated. The training should cover all the general principles of infection prevention and control, to emphasize the key role that health care professionals play in minimizing the spread of infection; to highlight what can happen as a result of bad practice and underline the importance of good communication.


 


 


 


 


 


 


 


 


 


 


 


 



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