Research Articles Base: Nursing Essay Samples

Nursing

The article argues that there are four fundamental patterns of knowing that have been identified from an analysis of the conceptual and syntactical structure of nursing knowledge. These four fundamental patterns are (1) empirics – the science of nursing, (2) esthetics – the art of nursing, (3) the component of a personal knowledge in nursing, and (4) ethics, the component of moral knowledge in nursing. These are the kinds of knowledge that are held to be of most value in the discipline of nursing.             The key ideas that the author Barbara Carper is trying to communicate in this article are (1) nurses have to aware of the four fundamental patterns of knowing, and (2) these four fundamental patterns are of utmost importance if one is to become a nurse. The four fundamentals of knowing as applied to the nursing discipline can be summarized in the succeeding sentences. Nursing as a science means that it is a body of knowledge systematically organized, and like all bodies of knowledge is dynamic and subject to change. New perspectives in health and illness appear. Nursing as an art pertains to the aspects of knowing in nursing that are not discovered by scientific investigation. Nursing is thus considered as both a science and an art. The third fundamental pattern, personal knowledge, is considered to be the most problematic, the most difficult to master and to teach. Yet it is also the most essential to understanding the meaning of health in terms of individual well-being. Why is this? The self is considered to be a major factor in the success of any therapeutic relationship. Knowing and actualizing one’s self can help a lot in the nursing discipline. The moral component of the nursing discipline is ethics. Everything in life involves ethics. Knowing what is morally right and what is morally wrong can help people make the right choices. The author considers them important because these patterns of knowing provide the nursing discipline its particular perspectives and significance. According to the author, understanding these four fundamental patterns of knowing makes possible an increased awareness of the complexity and diversity of nursing knowledge.             It is useful to identify these four patterns of knowing because the nursing discipline cannot be learned without reference to the structure of the discipline. Furthermore, each of these four fundamental patterns of knowing in nursing represents a necessary but not complete approach to the problems and questions in the nursing discipline. Lastly, all knowledge is subject to change and revision. As a student nurse, knowing and understanding these ideas are very important and it is my responsibility to know these. These four patterns of knowing relate to my discipline. It is also important to remember that although these patterns are independent, they also interact. Without one, the nursing discipline cannot be considered complete. Without being equipped with these, one cannot completely be a nurse.   Credit:ivythesis.typepad.com

Nursing

The article argues that there are four fundamental patterns of knowing that have been identified from an analysis of the conc...

QUALITY AND CARE GOVERNANCE

QUALITY AND CARE GOVERNANCE   INTRODUCTION The healthcare professions all involve life and death situations. In these situations, quality is crucial and quantity is irrelevant. In my place of employment, there is an increasing incidence of chest infection associated with the use of tracheostomy tubes. The blame is placed on the apparent lack of knowledge of the nursing staff regarding tracheostomy care. It is time to seriously rethink, redesign, redevelop and reinvigorate the way governance is practiced in my current place of employment. There is a need for better quality and care governance. Clinical governance provides a framework for a coherent, local program of quality improvement and an opportunity to share best practice. For nurses, clinical governance will be about building upon and linking together many of the activities that they are already involved in, which help to promote and improve standards of patient care (2002). This paper presents the problems of increasing incidence of chest infection in my current place of employment and how this problem can be solved by providing solutions designed for the apparent cause of the problem. These solutions will focus on quality and clinical governance. The tools to be used to explore the issue will include SWOT analysis. Theories to be used to resolve the issue will include shared governance and total quality management. A personal analysis on the presented problem will also be presented and as well as recommendations on how the quality of care can be improved in my place of employment regarding the particular problem.   CONTEXT Tracheostomy refers to an opening into the trachea where an artificial airway (the tracheostomy tube) is inserted. This is usually performed to protect the patient from accidentally inhaling food, fluid or saliva. Such an airway may be necessary for patients when prolonged ventilation is required, or when an extended coma is anticipated. It may also be placed surgically to maintain the structure of the trachea–when threatened by cancer, infection or trauma, Placement of a tracheostomy is mainly used during the acute phase of an illness and later removed (2005). A client may have a tracheostomy to bypass an upper airway obstruction, prevent aspiration, manage tracheobronchial secretions, or allow for prolonged mechanical ventilation. Whatever the reason for tracheostomy, the client should be provided standardized care in tracheostomy management. Lately, the rising incidence of chest infections in patients undergoing tracheostomy in my place of employment had been largely blamed on the part of the nurses. Such poor quality of practice is a no-no in the healthcare field. If nurses are not aware of the recommended and safe procedure, then the lives of clients are in jeopardy. Quality in healthcare service and practice provision is very important. The method of quality measurement used by health economists is the QALY. QALY stands for Quality Adjusted Life Year. It is a term developed by health economists for an approach that is concerned with evaluating both effectiveness of treatments and their cost-effectiveness. The outcomes are measured according to a generic scale whereby if a client’s treatment is felt to be effective and long-lasting as well as cost-effective, then the patient can increase his/her score on the quality-of-life measure. This technique supports treatments that show improved quality-of-life over a long time and for the least cost ( 2002). Since the late 1980s, the topics of quality and performance measurement have become important reporting areas for governance. Various “report card” “scorecard,” or “dashboard” measurement sets have been developed for routine reporting to governance on selected important performance areas. These balanced reporting sets may cover, for example, key clinical performance measures, financial performance summaries, satisfaction surveys, and measures related to human resources (such as turnover, time to fill vacancies). Progressive organizations also make the summary level information available for their employees and release the information to the community (2000). Clinical governance involves the development of a culture and ways of working that continually improve quality, allowing good practice to be shared, lessons to be learnt from mistakes, and encouraging patient participation. For many nurses, clinical governance will afford the opportunity to formally link together and enhance existing quality improvement activities such as implementing evidence-based practice and care pathway development (2002). Clinical governance can be divided into four key components: clinical effectiveness, human resources, professional self-regulation and risk management (2002). Clinical effectiveness is about doing the right thing at the right time for the right patient. It enables nurses to reflect on why they do what they do for patients and to systematically find and implement better ways of providing care. The activities involved in clinical effectiveness include finding out what is best known practice, appraising the available evidence, changing practice if necessary, and confirming through clinical audit that actual practice is consistent with best practice (2002). The human resources component of the clinical governance framework is about ensuring that healthcare professionals have the right education, adequate training and development, skills and competencies to provide quality patient care. It is also about workforce planning and lifelong learning (2002). Professional self-regulation protects the public as it requires registered practitioners to practice within a code of conduct and is supported by the promotion of good practice, prevention of poor practice, and intervention when practice is poor. Professional self-regulation supports the clinical governance framework by setting professional standards and guidelines that contribute to the creation of an environment in which clinical excellence will flourish (2002). In practice, many nurses have experienced real and substantial problems with regulation. Risk management is about identifying, measuring and controlling those risks that threaten quality or performance in the delivery of patient care (2002). Every day, nurses help patients through education, empowerment and expertise to avoid the recognized complications associated with tracheostomy care. They give practical advice and support to people with who underwent tracheostomy to manage risky situations such as an episode of chest infections, encouraging the patient and the family to learn from the event and employ tactics to prevent recurrence. This is a proactive risk management strategy that involves the recognition and identification of things that can go wrong as part of a systematic approach to patient care. Patients are empowered to respond appropriately in a risky situation. Implementation of shared governance initiatives or other structures that promote autonomy, control of practice, and empowerment of nurses have been identified as key strategies to continue to improve the work environment of nurses (2004). This could in turn improve how the nurse delivers care to the clients. In a shared governance model, each person has an obligation to ensure that his or her skills and knowledge make a positive contribution and to work efficiently and effectively ( 2004). Shared governance is a collaborative team process in which team members share key leadership roles ( 2004). Shared leadership is empowering employees to act autonomously, be decisive at the point-of-service, and create a shared vision aligned with organizational goals. Shared leadership development and autonomously practicing nurses appear to be the equation for success in delivering quality patient outcomes in today’s organized health care delivery systems. For a shared governance model to work, the nursing leaders must develop skills that go beyond facilitating team and group decision making and assume a transformational role of disrupting the status quo, particularly in situations where evidence-based practice clearly points to a need for rapid change and improvement. Nursing leaders must translate the demand for change into a clear, understandable plan, as well as help staff members handle the chaos and uncertainty that accompany rapid change ( 2004).   ANALYSIS   Strengths (internal) Weaknesses (internal) Competent staff Good clinical facilities Lack of education on tracheostomy care Opportunities (external) Threats (external) Health authority support Staff support Shortage of staff               The SWOT analysis table shows that although the hospital is equipped with competent staff, there is still an increase in chest infection in tracheostomy care since majority of the nursing staff are unaware of the recommended practice regarding tracheostomy care resulting to unsafe practice. Good clinical facilities for the tracheostomy procedure are also present in my place of employment.             Coming up with recommendations and implementing them at the place of employment is the most logical thing to do. An improvement for tracheostomy care and a decrease in chest infection incidence is expected as health authorities and the staff supports the programs that are designed for improvement of nursing services and quality of patient care.              Hong Kong’s healthcare profession is challenged by the shortage of healthcare professionals. This presents a threat to many areas of nursing practice. Not only that, this is a threat to patient care. If there is a decrease in the number of nursing staff that are competent enough to handle tracheostomy care, the problem regarding the increase in chest infection associated with tracheostomy would not be solved.             It seems that there is also an apparent poor quality of management and leadership in this case resulting to the poor quality of service. To improve quality, organizations have to apply ‘Total Quality Management’ (TQM) to their organizations to help them plan their efforts. The promise of superior performance through continuous quality improvement has attracted a wide spectrum of business to TQM, with applications reported in many domains including healthcare ( 2002).   RECOMMENDATIONS             Since the problem in itself roots on the apparent lack of knowledge on the part of the nursing professionals regarding the recommended practice of tracheostomy care, solutions must be also directed on them. The proper ways of performing tracheostomy care as well as the rationale behind each step are found in various medical literatures which can be provided to the nursing staff through educational programs.             In order for each and every staff to be educated and aware of this proper procedure, training or educational programs must be made available. Every nurse must be required to attend such educational training program. It will be an objective for the hospital for all nurses to attend a workshop on providing quality tracheostomy care as well as governance by the end of June 2006. Once all the nursing staff are thoroughly educated and properly equipped with the knowledge of the recommended practice regarding tracheostomy care, their performance has to be monitored every now and then. They will be assessed on how they perform such care and evaluated if there is a change on how they perform it. It is not enough that after the initial educating sessions they will then be left to do the procedure. Monitoring has to be done in order to ensure that there is a demonstration of safe and proper practice of tracheostomy care. From these educational programs designed to improve the quality of nursing care that is being offered, it is expected that standards for tracheostomy care will improve by reducing the incidence of chest infections following tracheostomy by the end of 2006.               As already presented in the analysis, there is an all-out support for this endeavor on the part of healthcare authorities and staff. That in itself would help make this project a success. Since they support the project of decreasing the incidence of chest infection, it follows that they would also support this plan of educating the nurses on how to properly perform tracheostomy care.             A one month time frame for properly educating the nursing staff on tracheostomy care is recommended. Granting that the nurses have their hearts in the education process, they will easily learn the recommended practice for tracheostomy care. Standards and objectives have also to be set as this is very important.             The period of monitoring would be the longer period in my recommended strategy. I propose a six-month to one year monitoring period. This would include assessing how each nurse performs the tracheostomy care and also observations on the incidence of client’s admission to intensive care unit because of chest infections.             To effectively carry out all of these, strategic planning has to be developed. Strategic planning is crucial in the management of healthcare organizations, even when the characteristics of the healthcare systems vary (2003).             Shared governance should be used as the nursing practice model for this. Shared governance is a dynamic process that promotes collaboration, shared decision making, and accountability for practice through workforce empowerment (2004). Although the principles of shared governance are universal, structure and process generally follow the needs of an organization based on its core values, mission, vision, and philosophy.             In moving to a shared governance model in my place of employment, ownership becomes both individual and team ownership because optimal outcomes cannot be achieved without integrated team effort. This transition requires new knowledge and behaviors at each level and results in a paradox as team members have to perform efficiently while practicing new skills that are unfamiliar and uncomfortable ( 2004).             Nursing leaders are needed to guide the nursing staff in the education or training process. They must be able to translate the demand for change in the particular field of tracheostomy care into a clear, understandable plan, as well as help nursing staff members handle the chaos and uncertainty that accompany the rapid change.             In achieving what is needed to be able to provide quality of care to the clients, the nursing staff should also act as a team. If a nurse learns something that is proven to be beneficial in the client’s care, then it is encouraged that they will share this with the other members of the nursing staff or if applicable, to the whole healthcare profession with the area of employment. Management also plays an integral part in all of these. The quality of care delivered after the education and monitoring period could be measured using QALY. Evaluations can be done after the proposed strategies have been implemented. Applying the four key components of clinical governance to the problem is helpful. The activities involved in clinical effectiveness will include finding out what is the best known practice regarding tracheostomy care, appraising the available evidence, changing the practice by educating the nursing staff, and confirming through monitoring or clinical audit that actual practice is consistent with best practice. The human resources component of the clinical governance framework would aim to ensure that the nursing staff has the right education, adequate training and development, skills and competencies to provide quality tracheostomy care to patients. There will be an all-out support for the promotion of good practice, prevention of poor practice, and intervention when practice is poor in tracheostomy care. Professional standards and guidelines that contribute to the creation of an environment where there will be less incidence of chest infections after tracheostomy will be set. To further improve quality care, nurses must help patients through education, empowerment and expertise to avoid the complications associated with tracheostomy care. The nurses must be able to recognize and identify the things that can go wrong as part of a systematic approach to patient care. The expected outcome of the recommendations should be a decrease in the incidence of tracheostomy clients developing chest infections within a period of at least six months from the time the educational programs are offered to the nurses. As already pointed out in the first few paragraphs of this paper, the reason why there is an increase in the incidence of clients developing chest infections is because of improper tracheostomy management on the part of the nurses. Therefore, the recommendations are more aimed at the nursing staff with emphasis on quality and care governance.   CONCLUSION             In my place of employment, there is a growing problem regarding the development of infection in tracheostomy patients. It has been found out that the reason for this is the apparent lack of knowledge of the majority of our nursing staff regarding the recommended and safe practice for tracheostomy care.             As part of the large whole of the healthcare organization, and as nurses who are in the frontline of delivering care to clients, it is our duty and responsibility to provide the best quality of care to our clients. But this has not been the case in my place of employment. To summarize, I have recommended a training or education program for the nursing staff. This program will educate the nurses on the recommended practice of tracheostomy care. Every procedure that is involved will be taught and the rationale behind the procedure will also be given. After the initial education program, the staff will be periodically monitored. The incidence of chest infection will likewise be monitored and observed if there is a significant decrease since implanting the recommended strategy. Monitoring the implementation of health policy and evaluating the impact of the outcome has to be well developed. To effectively carry out the recommendations and in the process improve the quality of care in tracheostomy patients, there should be a collaboration and support of healthcare professionals within my place of employment. Strategic planning should also be employed. Effective teamwork and good communication are essential to the success of quality and care governance. Change can result if there is unity within the organization. Clinical governance is about linking together many activities that affect the delivery of patient care.     Credit:ivythesis.typepad.com

QUALITY AND CARE GOVERNANCE

QUALITY AND CARE GOVERNANCE INTRODUCTION The healthcare professions all involve life and death situations. In these situations, qua...

Chronic Nursing Care

CHRONIC NURSING CARE       Chronic Nursing is usually attributed to especial attention for people who have a chronic disease to be able to help them and give proper medical and psychological attention while suffering from such condition. Usually the Nursing Care professionals are focused on the elderly people who have conditions of incurable and sensitive experiences of diseases not just medical aid but also humanitarian attention and intervention are needed in such cases. Sometimes nurses may need to listen to their needs; most elderly want someone to talk to, someone who can listen and motivate them to accept the condition in a later side of their life. Nurses are particularly prepared to handle this people with chronic disease.       Depending on the conditions of the patients but most chronic nursing care professionals are usually needing more patience in handling this situation it require a thorough intervention in order to get their attention. Some patients are not very cooperative they may even exercise resistance while being diagnosed, their behavior may sometimes show violence towards medical and nursing aid and somehow the management of their disease will even put to the test because of this reasons but usually the chronic nursing care do expect to handle this kind of situation. Patients with chronic diseases whether in the hospital or at home are given a structural and descriptive approach according to their psychological capacity in order to handle the treatment. They require proper management, monitoring, recording and consistent follow ups in their conditions to be able to handle progress.       In the case of non participation of patients the chronic nursing care needs the help of the immediate family, usually during physical intervention the immediate family can be the one to conduct the cure while the nursing care personnel gives the instruction for example in taking the prescription, dressing up or taking a bath, bowel movement etc. the role of the nurses is of prime importance to chronic patients because they can see and measure variable adjustment necessary and still in this conditions chronic nurses are expected to be very helpful in meeting the demand of the patients they play the most important part in bringing a good suggestion and decision making to the doctor.       The role of the chronic nursing care professionals first and foremost is to take care of the patient’s physical and emotional conditions to be able to motivate them and uplift their spirit and create cooperation for proper treatment. Educate the patients and the member of the family in case of home aid to choose a healthier lifestyle rather than their usual pattern. If possible they also want to teach the patients to become independent in basic care or personal care such as basic hygiene, tooth-brushing, etc. and even accepting simple medicines etc. this will boost their confidence in order to eliminate unbearable and unhealthy problem that may arise. The truth is that if the patient is cooperative in medication almost fifty percent of their disease is partly cured.          The demand for chronic nurses in America and Europe is very high, people are aging more rapidly because of their lifestyle and the needs for chronic nursing professionals is even higher according to Patricia Stark Dean of University of Texas Health Science Center in Houston School of Nursing in Texas. Nearly fifty percent of adults may suffer from chronic disease if they do not comply with healthy living conditions during their youth or early aging. Another consideration of the elderly and people with chronic disease is the rising amount of medical services and the price of the medicine could hardly add up to the problem of the elderly, the cause of living condition of people living in America is high enough that if a member of the family could suffer this could mean another problem in their life through medical expenses instead of spending their money on such basic needs.       If the family member may not have enough resources to bring their patients and if they do not have any medical insurance they may be able to obtain the right available medical treatment. In America chronic disease patients can use the options of health reform bill known as the Patient’s Protection and Affordable Care Act. This law provides tremendous benefits and affordable care for health challenge Americans. Lastly, patients with chronic disease definitely need more individual attention and intervention in order to control their conditions and give them necessary cure. Julie Cherry RN, MSN, PHN believed that the chronic nursing care in America is ready to serve them.   References: http://www.nursezone.com/Nursing-News-Events/more-features/Nurses%E2%80%99-Growing-Role-in-Chronic-Care-and-Disease-Management_34326.aspx http://burgess.house.gov/UploadedFiles/hr3590_health_care_law_2010.pdf http://en.wikipedia.org/wiki/Chronic_care_management                    http://www.ncbi.nlm.nih.gov/pubmed/14521681                   Credit:ivythesis.typepad.com

Chronic Nursing Care

CHRONIC NURSING CARE Chronic Nursing is usually attributed to especial attention for people who have a chronic disease to be able t...

Personal Nursing Theory

Personal Nursing Theory What is health/illness?             Health and illness are defined in many different ways by the patient, the clinical setting, and the health care profession. The World Health Organization (WHO) defines health as a state of complete physical, mental, and social well-being, not merely as the absence of disease of infirmity (1947). Health is a state of being that people define in relation to their own values, beliefs, culture, personality, and lifestyle. This would mean to say that each person has a personal concept of health. (1996) explains that all people free of disease are not equally healthy. Illness, just like health, must be defined in terms of the individual. Health and illness are also phenomena embedded in a culture. Cultural contexts of health and illness are not the same in western and non-western countries. Take for example, the cause of illness in western countries are attributed to biomedical causes, whereas in the non-western countries, along with biomedical causes, these are also attributed to supernatural and imbalance between humans and nature. This shows that health cultures are part of the larger culture or tradition of a people. It may be a popular or folk system, or it may be a technical or scientific one.       Who is the patient?             The patient is the person who is the recipient of health care, like nursing care. The patient is central to the care being provided even though the care could affect not only the patient but families and communities as well. Because every person’s need is multidimensional, this also goes to say that every patient’s need is multidimensional. And for this reason, it is important that health care professionals such as nurses should provide care that is individualized to the needs of the patient.   What is the patient’s environment and how does it affect them?             The patient’s environment refers to all the possible conditions affecting the patient and the setting in which the health care needs occur. Take for example, people who live in an environment with distinct seasonal changes such as fall, winter, spring, and summer tend to act differently from those that live in geographical areas with stable temperatures and abundant sunlight and rain. As they act differently, it goes that their health cultures and status are also not the same and thus are affected differently from those living in other environments.   What is nursing?             Nursing is an art and a science. Nursing as an art means that a professional nurse learns to deliver care artfully with compassion, caring, and a respect for each patient’s dignity and personhood. As a science, nursing is based upon a body of knowledge that is always changing with new discoveries and innovations ( 2004). When nurses integrate the science and art of nursing into their practice, the quality of care provided to patients is at a level of excellence that benefits the clients in so many ways.             Nursing is a multidimensional profession which reflects the needs and values of society and implements the standards of professional performance and the standards of care, meets the needs of each patient, and integrates current research and evidence-based findings to provide the highest level of care. There are different theoretical nursing models which provide knowledge to improve practice, guide research and nursing curricula, and identify the domain and goals of nursing practice.              (1860) did not view nursing as a being limited to the administration of medications and treatments but rather as being oriented toward providing fresh air, light, warmth, cleanliness, quiet, and adequate nutrition. Another nursing theory developed by  and others (1960) emphasizes delivering nursing care for the whole person to meet the physical, emotional, intellectual, social, and spiritual needs of the patient.   What is nursing relationship and responsibilities with the patient?             The nurse-patient relationship is considered the foundation of nursing care, the context in which nurses practice. It is an interpersonal process that develops over time between patients and nurses. Elements of this process generally include a beginning or development of trust, middle or working phase, and an ending or termination phase within the context of caring, sharing, and goal orientation (2003). Credit:ivythesis.typepad.com

Personal Nursing Theory

Personal Nursing Theory What is health/illness? Health and illness are defined in many different ways by the patient, the ...

Clinical Leadership/Management Nursing Issue

Clinical Leadership/Management Nursing Issue The work environment is one of the domains which needed strategies in order for the nursing profession to move on to greater heights. The work environment is viewed as an area so basic to the future of the nursing profession. Improving the work environment of nurses can optimize the quality of patient care and there will also be retention of the professional nursing staff.             The deterioration of healthcare work environments is a major problem of concern to the nurse leader or manager. A healthy work environment is necessary to bring about quality healthcare service to the clients. An unhealthy work environment would create a devastating impact not only to the nurses and the clients but most importantly on the effectiveness of the entire healthcare system. This issue or problem is one which could be attributed to delegation.             The possible root causes for this apparent deterioration of healthcare work environments are outlined in the succeeding sentences. (1) The nurses are placed in leadership positions even if they are not adequately prepared and without adequate support for their roles. (2) Each individual nurse is assigned to handle many clients than they can handle. (3) Decision-making within the work environment is done only by one department, without consultation of all the other parties that are involved.             The resulting environment created by these situations brings about many negative results in the working environment. When inadequate leaders are placed in positions, there will be dissatisfaction and high turnover for nurse leaders and the staff as well. When each nurse is assigned to handle many clients, this would result in confusion and the clients are placed at risk for errors and injury. The nurses are also frustrated, angry and stressed out. Decisions that are made without consulting all the parties involved places everyone involved – clients, nurses, managers and other staff – at risk. The overall quality of care offered by the healthcare service would be diminished.   Action Taken The nursing staff and managers are the ones responsible for the problem. The lack of leadership skills is one major factor. In order to solve this problem, focus should be given to the nursing leaders and managers. Leadership training programs should be offered and nursing managers and leaders should be required to attend. These managers and leaders in turn should perform their responsibilities of teaching and guiding the rest of the staff in promoting a healthy work environment. With the particular problem concerning the deterioration of the work environment, a change is needed. This change would include on a large scale the leadership and management styles within the work environment. To start the action step in changing the work environment into a healthy one, there should first be mutual trust and encouragement in all the parties involved. Each and every opinion should be respected and given consideration in the decision-making process. There should also be an all-out support for this desire for change.             Effective leadership style is an integral part of creating an environment that nurtures the development of an empowered nursing staff. (1997) defines leadership as “a process of social influence in which one person is able to enlist the aid and support of others in the accomplishment of a common task.” The major points of this definition are that leadership is a group activity, is based on social influence, and revolves around a common task. Although this specification seems relatively simple, the reality of leadership is very complex. Intrapersonal factors (i.e., thoughts and emotions) interact with interpersonal processes (i.e., attraction, communication, influence) to have effects on a dynamic external environment (1997). In the current work environment, the people should be ready for a new way to share the power and the responsibility that goes with it. They should be ready for partnering relationships, collaborative work relationships and shared leadership. For this particular problem, shared leadership has to be employed. Shared leadership provides an organizational framework that offers the nursing staff maximal participation in decisions about work and the work environment. Every staff has to be given a chance what he or she thinks about a current situation and what they think can help such issues.   Analysis As previously mentioned, in order to achieve all these, the management style of shared leadership should be employed in the hospital setting for the nurses. Shared leadership is a nursing management model that supports staff nurses in extending their influence about decisions that affect their practice, work environment, professional development, and self-fulfillment (2001). As previously mentioned, leadership is a group activity. In shared leadership, every voice is heard and given consideration. Shared leadership is a collaborative team process in which team members share key leadership roles (2004). Shared leadership is empowering employees to act autonomously, be decisive at the point-of-service, and create a shared vision aligned with organizational goals. Shared leadership development and autonomously practicing nurses appear to be the equation for success in delivering quality patient outcomes in today’s organized health care delivery systems. Employees must develop or refine new behaviors and skills in empowerment, facilitation, negotiation, systems thinking, and accountability on behalf of patients (2002). Shared leadership is a way to strengthen continuous learning and enhance relationships between leaders/managers, staff and clients, which are the foundation upon which the nurses can develop a new type of relationship with management and with each other. This in turn could significantly improve the work environment. There is an emphasis on ‘relationships’ since these relationships can be tenuous at times as both managers and staff members adopt attitudes of contention and competition with each other. The demands of the health care environment have brought about changes that have not always contributed to positive work environments, and nurses have been concerned about the impact this has had on client care. Managers have had to develop ways to achieve expected outcomes and meet targets required by their organizations. To address all these issues, nurses need to focus on developing relationships that facilitate working with each other from strengths and not just criticizing weaknesses (2001).   Evaluation In the implementation of the new policies or rules, the staff was allowed to contribute to the decisions made. Goals have also been set. The nurses were mentored by the manager and clinical nurse specialist to apply the shared leadership skills during their daily work to achieve the goals that are set. This is to support the nurses’ use of shared leadership behaviors in the clinical setting. In every nurse is the individual’s willingness to see the vision and make the personal changes necessary to connect with that vision. It is how the concept of shared leadership works ( 2002). Evaluation of the plan showed that all management staff played an important role in leading the emergence of legitimacy of this “new professional authority.” The encouragement of individual nursing staff to establish individual goals that achieve more self-direction, more knowledge and self-confidence, and more networking ability by the process of shared leadership led to a more committed employee. A more committed employee in turn contributed to a positive and healthy work environment, solving the problem of deteriorating work environments for nurses.     Credit:ivythesis.typepad.com

Clinical Leadership/Management Nursing Issue

Clinical Leadership/Management Nursing Issue The work environment is one of the domains which needed strategies in order for the nursin...

AGED CARE NURSING

AGED CARE NURSING   1. Wellness – How do you distinguish between health & wellness?             In the past, most individuals and societies viewed good health, or wellness, as the opposite or absence of disease. This simple attitude ignores states of health between disease and good health. Health is multidimensional concept and should be viewed from a much broader perspective (2004). The World Health Organization (WHO) defines health as a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity. Many other aspects of health also need to be considered. Health is a state of being that people define in relation to their own values, personality, and lifestyle (2004). How health is viewed can actually vary among different individuals depending on age-groups, gender, race, and culture.             Wellness is actually just a part of a bigger thing which is health. It is a healthy state of well-being free from disease. Wellness is generally used to mean a healthy balance of the mind-body and spirit that results in an overall feeling of well-being. Wellness is just a state of good health whereas health can include conditions previously considered to be illness ( 2004). An example is a person with epilepsy who has learned to control seizures with medication and who functions at home and at work. This person may no longer consider himself or herself to be ill but he or she cannot also be considered to be well. The person is just in a state of health.             Health and wellness are not merely the absence of disease or illness. A person’s state of health, wellness, or illness depends on individual values, personality and lifestyle.   2. Demographics – Why is it important for nurses to understand demographics?             There are many external forces that can affect aged care nursing. One of these is demographics. Demographics is defined as the characteristics of a human population or part of it, especially its size, growth, density, distribution, and statistics regarding birth, marriage, disease, and death ( 2005). If there are demographic changes, it affects the population as a whole. Changes that have influenced healthcare in recent decades include the population shift from rural areas to urban centers; the increasing life span; the higher incidence of chronic, long-term illness; and the increased incidence of diseases such as alcoholism and lung cancer (2004).             Nursing as a profession responds to such changes by exploring new methods for providing care, by changing educational emphases, and by establishing practice standards in new areas (2004). Demographics can help determine both the supply of and the demand for health care facilities.             Rapid changes in demographics will require different approaches to manage quality. Nurses are positioned to play a pivotal role in delivering and managing quality outcomes while advocating for patients in an environment that is increasingly complex (2002).             Demographics include the changing population from the young one to adults to old people. At the same time that the population is aging, so are those in nursing. At the same time, nursing careers are becoming shorter. Nurses are finding opportunities for meaningful work in a variety of roles, some of which can take them far from clinical practice. Along with the demographic shift the cultural makeup of the nursing profession itself is becoming increasingly diverse and global ( 2002).   Credit:ivythesis.typepad.com

AGED CARE NURSING

AGED CARE NURSING 1. Wellness – How do you distinguish between health & wellness? In the past, most individuals and ...

Professional Nursing – Journal Article Annotation

Professional Nursing – Journal Article Annotation   Nurses face an endless variety of situations which involves clients, family members, health care staff, and peers. Each of the situations that nurses face pose new experiences and problems involving clients’ care, different approaches to resolving problems, and different results as to whether approaches were successful. Each clinical situation that nurses face everyday requires careful and thoughtful analysis for accurate and sound clinical decisions and plans to be developed for each client.             The article argues that critical thinking is indeed an essential part of the nursing profession. It is not enough that a nurse has abstract knowledge; he or she also has to develop the intellectual capacity to contextualize and to adjust what he/she knows in particular cases. The key ideas that the authors  and  are trying to communicate in this article are the relationship of critical thinking and intuitive practice to the expertise in nursing. It is true that aside for developing this while still a student nurse, nurses also gain knowledge through their experiences. Every clinical experience becomes a lesson which will serve as a guide and information for the nurse. It is not only the authors that consider critical thinking and intuitive practice as important, but other authors in the nursing discipline as well. In every clinical situation, it is important for a nurse to think critically and make sound judgments so that clients ultimately receive the very best nursing care. Critical thinking is not a simple step-by-step, linear process that can be learned overnight. It is a process acquired only through hard work, commitment, and an active curiosity toward learning. Nurses are responsible for making accurate and appropriate clinical decisions. Critical thinking is very important as no two clients have the same needs. The nurse after assessment and diagnosis has to employ critical thinking skills for a client’s particular condition. Intuition is simply a result of common experiences and applied to new ones. After a nurse has been exposed to a certain situation and is exposed to another similar situation, the nurse uses her intuition along with her critical thinking skills to develop an approach for the client. Intuition in nursing thus develops as a nurse’s clinical experience increases. A nurse is always challenged to observe each of his or her clients closely, search for and examine ideas and judgments about the problems that the clients face. Additionally the nurse has to consider scientific principles that he/she have learned and relate this to the clients’ problem, recognize the problems, and develop the right approach to nursing care as appropriate to the situation and problem of the client. Intuition is thus considered by authors as a trigger which brings about in the nurse an analytical process that leads them in a search to acquire data that confirms what they have sensed in the client or in a particular situation. Intuition thus triggers the nurse to apply his/her critical thinking skills in a situation in order to come up with the right thing to do or the right answer to a problem being presented. Nurses must not make snap judgments just by their intuition alone. This could jeopardize the client’s situation and perhaps affect the nursing quality of care for the patient. As a student nurse, knowing and understanding what critical thinking is and its importance very important. The article points out that a student nurse has to develop this skill. Critical thinking begins for a student when the student seriously asks questions, and in continuing way attempts to answer questions like “what do I really know about this nursing care situation?” or “how do I know it?” This is actually a process which is developed within the student nurse with the aid of other individuals like the educators. Students in nursing must learn nursing by consciously practicing reasoning skills needed in nursing. Students in nursing must also critically reason their way through nursing principles, concepts and theories as much as possible so that appropriate and accurate application of knowledge occurs naturally in clinical practice. As stated in the article, the purpose of reflective, critical thinking is to ensure that the nurse has the depth of knowledge necessary to immediately comprehend the practice situation so that safe, effective, quality nursing care is provided to the clients. Intuitive practice and critical thinking can significantly affect the quality of care delivered by the nurses to their patients. It is important to remember that the quality of nursing practice depends on the nurse’s ability to use all types of cognitive and emotional cues associated with a situation to trigger critical thinking and then to select effective nursing interventions. A nurse cannot safely act on intuition alone that is why critical thinking and intuition both have to go together in order to achieve expertise in the nursing profession. Intuition requires critical thinking as much as critical thinking needs intuition.   Credit:ivythesis.typepad.com

Professional Nursing – Journal Article Annotation

Professional Nursing – Journal Article Annotation Nurses face an endless variety of situations which involves clients, family members...

CONTEMPORARY NURSING

CONTEMPORARY NURSING   Nursing practice is directed and guided by an understanding of the definition of health and the factors that impact a client’s health framework. In the relationship between the nurse and the client, nurses respect the client’s unique psychosocial, spiritual, and cultural needs and advocate for their health choices and decisions. Nurses support client participation in the process of actualizing a defined image of health and do not negate the ability of clients to form their own image of health.              The history of nursing is inextricably linked with caring activities–indeed, much of the early literature on nursing uses these terms interchangeably. Over the past 150 years, this relationship has been both exploited and actively rejected by nurses (, 2003).             While caring activities have been an integral part of any society over the ages, and have often been credited as the foundation of nursing, the nineteenth century witnessed a unique integration of nursing within Australia. It is not unreasonable to conclude that the nineteenth century was certainly an age of transition with regards to health provision as nurses increasingly distinguished themselves from other health care professionals (2003). Over the years nurses have responded to the frustrations of hospital work with a variety of revised and expanded forms of nursing practice. The development of a theory and practice of primary care has emphasized the need for continuity, and one nurse may now coordinate with all aspects of care for an individual patient.             Nursing has responded to and always will continue to respond to the needs of the clients. In times of war, nursing has responded by meeting the needs of those who are wounded in the combat zones and in military hospitals in some countries abroad. When communities face health care crises, such as those that occur from infectious diseases or a lack of health care resources, nursing is there to establish community-based immunization and screening programs, treatment clinics, and health promotion activities (2004). In today’s health care work environments, nursing roles are shifting dramatically in response to profound changes at system, organization, and individual levels. These changes may be influential to nurses’ quality of work life and intent to remain with their employers and in nursing. Professional autonomy is a highly desirable nursing role characteristic (2003). In this transformational time in health care here at the outset of the 21st century, the primary role of the nurse is to live fully aware of the unfolding potential of this journey. It is the skill sets of awareness, availability, and anticipation which now most defines the character of clinical leadership and calls the nurses’ understanding of the application of the role into a new arena for it (2003).             The changing patterns of health care delivery have increased complexity in all practice environments. Evidenced-based practice models have intensified rather than simplified nursing care delivery because they have been inserted into traditional practice patterns. Nursing lacks systems to plot its patterns of care delivery. Consequently, except in limited circumstances, nurses are unable to predict what activities make a difference in the outcomes and satisfaction levels of their patients. The inability to identify and control the processes, protocols, patterns, rituals, and tasks related to safe, compassionate care delivery and better health outcomes does not assure professional practice (2005). In response to change in health care delivery, how nurses perform their roles is open for interpretation. Although nurses’ roles still involve traditional bedside responsibilities for patient care, increasing numbers of RNs are enacting new roles that emphasize collaboration. Nurses’ scope of responsibilities is broadened as they coordinate care across the health care continuum, lead health care teams, and participate in health care decisions (2003).             Contemporary nursing requires that the nurse possess knowledge and skills for a variety of professional roles and responsibilities. In the past, the principal role of nurses was to provide care and comfort as they carried out specific nursing functions. However, changes in nursing have expanded the role to include increased emphasis on health promotion and illness prevention, as well as concern for the client as a whole ( 2004). It is essential that nurses be knowledgeable regarding health promotion and disease or illness prevention. When the nurse is providing total care, he or she should think beyond current health problems to the client’s general well-being and future risks for illness and injury ( 2004). Nursing today emphasizes specialized education to support the work in health care. Nurses teach preventive care and health maintenance, assist medical treatment, aid rehabilitation, and attend the dying. Most nurses work in hospitals and nursing homes, with others in public health agencies, offices, schools, and industries. Nurses are also educators, supervisors, administrators, and independent practitioners. Nurses have also tried to establish career ladders that affirm the value of bedside nursing; the nurse-clinician can advance in salary and authority without leaving her patients for supervisory position which is the traditional route for nurses upward. Nurse practitioners and nurse midwives have tried to carve out independent domains, challenging medical practice laws and reimbursement patterns that constrain autonomous nursing practice.             Expert clinical nursing practice is a result of commitment to the application of knowledge and clinical experience. The expertise required to interpret clinical situations and make complex decisions is the essence of nursing care and is the basis for the advancement of nursing practice and the development of nursing science (2004). As a contemporary nurse, the nurse also acts as a manager. The nurse coordinates the activities of other members of the health care team, such as nutritionists and physical therapists, when managing care for a group of clients. To effectively manage clients, the nurse should implement solid clinical decision-making skills. As a clinical decision maker, the nurse should use critical thinking skills throughout the nursing process to be able to provide effective care (2004). The nurse should make any decision involving client care in collaboration with other health care professionals, the client’s family, and the client too. Contemporary nurses are also involved in politics and this involvement is receiving greater emphasis in nursing curricula, professional organizations, and health care settings. Nurses are also becoming more involved in health care reform. Political activism and commitment are a part of professionalism, however, and politics are an important aspect of the delivery of health care ( 2004). This is not bad as long as nurses do not get misinformed of their political involvement. Outsiders, especially politics, should not impose their will on nursing and nursing practice.             Nursing practice can now be found in multiple care settings, including health care institutions and foundations, the community, and the home. In addition, nurses are active in political and lobbying groups, social and not-for-profit agencies, and work on establishing social health care policies. These activities increase nursing’s public viability and, at the same time, increase the public’s awareness of professional nursing (2004).             As contemporary societies become more developed and economically sound, the education of people in professional roles changes, often accompanied by increased status and empowerment. Concomitantly, the potential contributions of these people to society increase (Muc, 2000).             Nurses are complicit in perpetuating these stereotypes, if they will not talk to the media or promote their work in a credible and compelling manner. It is this failure to communicate that leaves the public, policymakers and bureaucrats in the dark about the value of nursing work, to the detriment of patient care (2005).             Nursing’s value and the efficacy of nursing care is slowly being documented by research (such as the study by  at the University of Pennsylvania, which found nurses with higher levels of education reduced mortality rates, and another which found that for every patient added to a nursing caseload there was a 7% rise in mortality) ( 2005).             According to an article, the failure of many doctors to listen to advice from experienced, often expert nurses, is threatening patient care (Armstrong, 2005). However, what the article has not pointed out that the situations that arte happening in hospitals are not always like this, as could be gauged from the newspaper article written by the doctor with a fictitious name – . There are also many nurses out there that have sort of overstepped their bounds and do not listen anymore to doctors. As quality and safety research is increasingly indicating, if doctors and nurses can’t talk to one another effectively, patient care suffers. ‘Policy makers, hospital administrators and doctors all need to realize that if they want to keep health care costs down, they had better create an infrastructure of communication between physicians and nurses and other people on the health care team and help them learn communication and negotiation skills ( 2005). However, more opportunities for collaborative activities, such as the one mentioned in the previous paragraph, does not necessarily mean that nurses have less bedside care responsibilities. Rather, nurses are often expected to take on collaborative roles in addition to their traditional patient care roles, thereby increasing their overall workload. Increasing the complexity of the nursing practice role, particularly without adequate preparation, may actually cause some nurses to leave their positions for other, less demanding jobs or even other professions ( 2003). I do not think that what is being exhibited by the doctor with the fictitious name in the article is a feeling of being threatened by the nurses’ claim for status and legitimacy. What the doctor felt was a lack of cooperation from the nurses, which could be a detriment to patient care. When there are errors that occur in patient care, these are often due to ‘barriers created by hierarchical power relationships’, and by the fact that many people have ‘little, if any, education in how to communicate effectively.’ In the article, the nurse can be accused of having poor communication skills as well as a seemingly lack of interest in her job.             It is easy in times of challenge and rapid change to present nursing as a troubled and embattled profession. Expressions of negative points of view about nursing practice and the profession of nursing, itself, gained public notice as many groups tried to convince the governments to re-authorize and adequately finance the nursing education (2005).             While nursing’s long history comes with a culture of downplaying nurses’ contribution to patient care, this attitude is counterproductive to nurses and misrepresents their role. The public need to know that nursing represents high quality cost-effective care; something the community can ill-afford to be without (2005). However, nurses such as the ones portrayed in the article bring the views of people to nurses on an all-time low. There is thus a need to call for excellence for the nursing profession. The call for excellence through reform and innovation can be enhanced and extended through identifying, describing, and increasing understanding of the common experiences and shared meanings of excellence in contemporary nursing education (2005). Furthermore, decisions about what should be learned, how students learn, and how students should be tested for competence are made by faculty rather than by the learner, based on the more traditional modes of learning. Often these faculty members remain removed from clinical practice, isolated from the realities of profound changes in the current work environments (2001). Nurses must be educated that although they are allowed to do a variety of things in their practice, even perform those that are performed by the doctors sometimes, they should not act as if they are the boss. This kind of behavior is just like the nurse in the article who has just been reading all the time the doctor was busy taking care of the patient. Whatever angle we view it, the nurse’s action is not professional and merits some careful attention. This should therefore serve as a lesson to nursing educators to instill in future nurses what constitutes professionalism.             Herein we see the value of identification of roles. Identification is a participative, dynamic process by which individuals are connected with or linked to other persons and elements of the social world. It is a process by which individuals communicate with others to create an identity for themselves and to become part of a larger social collective. Communication promotes a sense of belonging among individuals, allowing them to learn desirable identity characteristics and make decisions congruent with group norms, values, and ideals. For example, by communicating with senior nurses, less-experienced RNs “learn the ropes” of their jobs and understand what it means to be a nurse. Such interactions build strong relational connections and may influence a new nurse to have a strong professional affiliation ( 2003). Throughout the nursing profession’s history, nurses have studied and tested new and better ways to help their clients, their families, and their communities. Nurses have been leaders in expanding knowledge in nursing and other health care disciplines through health care research. Most nurses enter the profession with the goal of providing direct client care. The nurse providing direct client care accounts for the majority of practicing nurses, as could be seen in the situation presented in the article.             This paper has emphasized that nursing is not a static, unchanging profession but is continuously growing and evolving as society changes, as health care emphases and methods change, as lifestyles change – and as the nurses themselves change. Nursing at present continuously draws on the social sciences and other fields as the focus of nursing care expands. In conclusion, the nurse therefore has various responsibilities and roles. Aside from providing care and comfort to the patient, they also carry out other nursing functions. Over the years, the nursing profession has evolved to include many functions. Nurses are active in social policy and political arenas. Nurses and their professional organizations lobby for health care legislations to meet the needs of the clients, particularly those who are medically underserved. Nurses are also active in local government planning to ensure that health care resources are available in all client communities. However, although this is generally good, some nurses have sort of abused this power and overstepped their bounds. It is recommended that outcomes of complaints such as this article on the newspaper embody many new modalities to support the practice of nursing, the continuing professional development of practicing nurses, and the education of students and new faculty. This brings to mind that perhaps nurses have to be further educated regarding what constitutes professionalism and their limitations of functions. Nurses after all are just humans and also have to take into consideration the other individuals around them.     Credit:ivythesis.typepad.com

CONTEMPORARY NURSING

CONTEMPORARY NURSING Nursing practice is directed and guided by an understanding of the definition of health and the factors that im...