The Setting for Providing Nursing Service - Essay Example

A Management Issue in Practice A management issue in practice: With reference to your practice experience, write a critical analysis of an event within the practice setting where named principles of management were used or not used to resolve an issue within the healthcare team. Table Of Contents Introduction Page 2 Primary Nursing Page 2 The Management Issue involving Nurse Smith Page 3 The Slowing Down Page 4 Therapeutic nurse patient relationship Page 4 How the Issue was taken care of Page 5 Reorganising Nurse Smith’s duties Page 6 Psychopharmacology Page 6 Milieu management Page 7 Conclusion Page 7 Introduction In a setting of medical service providers for mental health treatment, psychiatric nurses have their duties that broadly encompass bio psychosocial assessment, administering and monitoring of psychopharmacologic medication, formulating nursing care method for the patient, and providing direct medical care, following the physicians orders for treatment strategy, interact with patients/family members to increase their awareness of the patient’s health needs, and at times identify and help formulate planes for community health units. (“Psychiatric Nurse”, 2004) The setting for providing nursing service may be the hospital, the patients’ home or the community center. The nurse can also work in voluntary health care centers, private health care center, or in primary health care offices in a military, academic, or School of Nursing setting. (“Mental Health Nursing”, 2003) Primary nursing: It is believed to have conceptualised from the need to reduce fragmentation of services nurses provide to patients. A pattern that provided opportunities for a nurse to care continuously for a patient was developed, as a consequence. (Gray R, Smedley N, 1998) Primary care nursing, made a significant impact on the nursing profession as no other change. It managed to redefine nurse-patient relationships, with the nurse being able to assess a patient’s nursing needs and address them with a structured approach. Primary care entails 1) assessment by the nurse who provides day-to-day care until the patient leaves the hospital 2) care is planned to include associate nurses, other co-workers and night duty nurses, for which, effective communication between health care providers, is essential 3) patient participation in spotting the goals, devising steps to reach it (keeping the patient’s lifestyle and present health profile) and planning his/her discharge. (Gray R, Smedley N, 1998) Several investigations attempt to research the impact of the change of hospitals to primary nursing care giving. As described by Manthey, it was conjectured that most nurses welcomed the change.“The impact of it was so powerful; it transformed the rest of my life, my career and the careers of hundreds of thousands of nurses. It is viewed by nurse leaders around the world, as a viable means to strengthening the role of the bedside staff nurse. It is a change that can be made from within the profession.“ (Manthey Marie, 2001). The primary nurse’s duty comprises of nursing duties towards a patient that provides her with autonomy, authority and accountability for performing the same. (Gray R, Smedley N, 1998) The Management Issue involving Nurse Smith We will now investigate a management issue concerning Nurse Smith (name changed to protect privacy) who was involved in outpatient care. Patient: Sam, (name changed), 20, was admitted to the hospital (for abuse of prescribed drugs) where Nurse Smith worked, following trauma after multiple injuries in a road accident.. Nurse Smith was allotted the primary care of Sam. In accordance, the duty for Nurse Smith and her co-workers was allotted in the following manner: Patient name -> Patient 1 – Sam Patient 2 – Thomas Patient 3 - Sara Primary Nurse -> Smith Jones Smith Associate Nurse-> Jones Smith Woods Co-worker -> Co-worker A Co-worker B Co-worker C Night duty nurse -> Murdoch Murdoch Stevens Allotting a primary nurse was to ensure “consistency and continuity of care”. The co-workers, in a treatment setting, include “psychologists, occupational therapists, social workers and doctors.” (Burns et al (2000)) The scheduling ensured an effective treatment for Sam from the health care providers. The treatment was designed to help cure him of his addiction to pain relievers (that had been prescribed to help him cope with the painful injuries. Smith was an efficient nurse who executed her duties in an admirable manner. Sam too was a relatively no-problem patient as he put in as a genuine effort as possible to kick off his drug habit. However, Smith was also scheduled as a primary nurse for another patient, whose discharge got delayed. She had developed a good rapport with both patients and both continued to regard her as the primary nurse allotted for their care. The Slowing down: Within a fortnight’s of Sam’s admittance, Smith seemed to slow down in her work. She took longer to reach the patient when called, she took longer to maintain the records than before and more importantly she could not maintain a cheerful demeanour all through her shift due to tiredness. This was not too unexpected a turn of events as there are also evidences of reduction in the satisfaction of the role among nurses. The reasons for this, in the face of strong endorsement and support for primary nursing, are understood to be due to “constraints surrounding contemporary nursing practice.” (Rigby A, et al. 2001) There is a crying need for strategies that can bring about the required change both in perception and in the structure of the primary nursing service. The strategies could call for “principal factors towards success, such as team building, presence of a clinical leader and effective planning.” . It is said that changing favorably to include best practices in nursing should include (1) externally focused efforts for effective change and (2) inner exploration of a nurse’s identity and scope for achievement and success in performance of duties. (Wright SG, 1999) It is known that to implement a successful strategy, nursing involves the principles of psychotherapeutic management. Psychotherapeutic management consists of three essential elements. They are “therapeutic nurse-patient relationship, psychopharmacology, and milieu management”. (Keltner et al, 1999). The consideration of these elements when planning for a holistic approach in nursing will ensure that services provided will be comprehensive and coordinated, while providing a personalised atmosphere of care for the patient. (Manthey, 2001) Therapeutic nurse patient relationship: “Trust, respect professional empathy and power comprise the positive outlook with which one begins a therapeutic nurse-patient relationship. The various aspects involved are therapeutic communication, client centred care, maintaining boundaries, and protecting the client from abuse, (“Therapeutic Nurse-client Relationship”, 2006). Nurses have to maintain an effective communication link to both establish and to terminate nurse-patient collaboration. In this case, Smith failed to terminate effectively the link she had with Sara. Thus she could neither devote enough time for Sam nor, Sara. A primary nurse is supposed to devote a large chunk of her tome for the patient she is assigned to, but Smith did not. She spent less than 40% of the duration of her shift with both her primary care patients. This was similar to the findings of a study in a Danish Psychiatric Hospital. Here too, some of the primary nurses in the study group did not consistently and continuously care for the patients due to inappropriate scheduling. (Pryce et al 2006) As far as maintaining boundaries were concerned, Smith, an overly friendly person, overstepped them, by encouraging a familiarity that gradually turned to dependence of the patient exclusively on her, for nursing care. Thus when she had to reschedule her duties, there were murmurs of dissent from both patients, especially Sara, as she did not want the time spent with Smith to be affected in any manner. How the Issue was taken care of: Management is the “art and science of coordinating the work of the people, equipment, materials, cost and time” to achieve the desired goal, both qualitative and quantitative. (“Basic Principles of Management”, Research in Education, Oklahoma State Release, retrieved on May 20, 2007 from http://72.14.235.104/search?q=cache:bdUMduhGxPoJ:cive.okstate.edu/Research/Basic%2520Principles%2520of%2520Management.ppt+basic+principles+of+management&hl=en&ct=clnk&cd=9) The major concern in Smith’s case was the downslide of her performance as she could not designate the right amount of time required for primary care and time management was a matter of major concern. The troubleshooting team which was made aware of the situation and which consisted of senior nurses and other health care providers in the supervisory designation advised Smith to place a high priority on her time sharing between patients so that she could enjoy a good work-life balance. She was asked to plan, and organise her upcoming schedules. The team helped in directing her and helped her formulate a course of action to develop a schedule that would give ample time to the patient she provided primary care. This schedule was prepared after Smith was helped to analyse her daily quota of work and identify areas of work where lack of time had been the essential reason for problems in providing health care. More importantly she had to effectively take on only one patient as a primary client. This was an exercise in communication that could not be accomplished satisfactorily as Patient 3- Sara remained disapproving of the change in schedule and resorted to abuse of the nurse. While rescheduling Smith took care to Integrate all involved in the cases for which she provided health care Keep in mind the constraints that prevented her from spending quality time with primary care patients Reorganising Nurse Smith’s duties: This is how Smith was helped to organise her work: Smith broke down her duties into definable and measurable parts and she now included the resources at her disposal for health care. The work break down structure helped her to focus on the essential work she had to perform. “Nursing is the art of making people feel better- as simple and as complex as this.” (Ingles Thelma, 1959). She has to work in tandem with variable parameters that were dynamic enough for her to constantly seek to improve and improvise. Within this broad definition it is understood that a psychiatric nurse also has to be competent, dependable honest and well versed in her work. These qualities should also be appropriate enough to reassure the patient that he is in good hands. The rescheduling of Smith’s tasks helped her do just that. Though, in the domains of psychopharmacology and milieu management, Smith was appreciably efficient, let us examine the two. Psychopharmacology: It is the study of the effect of drugs on mood, sensation, consciousness, or behavioural functions. (Web definition).“Individuals with co-occurring psychiatric and substance disorders (COD) represent a challenging population” (Psychopharmacology Practice Guidelines for Individuals with Co-occurring Psychiatric and Substance Use Disorders”, 2005) It is to the credit of Smith, that as an experienced Psychiatric nurse she was successfully able to prescribe and administer psychopharmacological medication. She as other health providers, was able to engage the patients under her care in a hopeful and integrated plan of treatment with continuity, in order to reinforce a successful intervention. Milieu management: Milieu therapy is defined as “the treatment by environment, physical surroundings, equipment and staff attitude are designed in such a way as to enhance the effectiveness of other therapies and foster the patient’s rehabilitation” (Web definition). This implies that a nurse must work in collaboration with other health providers and also solicit help from them in order to create an optimum environment for effective improvement in symptoms of the patient. This environment formed a few ripples with the rota scheduling of Smith, but to make amends she involved herself in the following manner to recreate and reestablish a cordial and effective health care unit. Significant in her attempt was the consideration of (1) external and internal factors of the cases allotted to her and (2) the behavioral tendencies of the patients. The hospital as a single unit, after Smith’s experience, got together to set-up milieu management design, much akin to that suggested by Nancy Briton, in her book, Informed Treatment: Milieu management in Psychiatric Hospitals and residential treatment Centres (Briton, Nancy, (1997). The techniques adopted included (1) regular community meetings for sharing of experience and opinions, (2) encouraging the patient’s family in the involvement of the treatment, (3) infusing a sense of light heartedness in dealing with the patients, (4) including pets for comfort therapy, (5) formulation of instructions for patients and family after the discharge, (6) providing a role model and above all (7) reassuring the patient with a sound medical service set-up. Conclusion: Medical treatment and administration, within the framework of management principles, provides for a structural approach to problems. It enables analysis of complex problems and disorders and facilitates investigation and identification of an optimum treatment procedure. There are few however, who tend to disagree with this and still remain loyal to concepts in Psychiatric nursing practised earlier. “The main emphasis seems to be on academic sociological and psychological principles with little teaching of the practical skills of psychiatric nursing, which not only preserve a patient’s dignity but also keep the patient alive”. (Short Jacqueline A, 1995) Conflicting opinions and conflicting situations are everyday challenges for psychiatric nurses. How they cope and how they emerge as efficient and caring health service providers is what effective psychiatric nursing is all about. References 1. “Basic Principles of Management”, (Online) Research in Education, Oklahoma State Release, available at http://72.14.235.104/search?q=cache:bdUMduhGxPoJ:cive.okstate.edu/Research/Basic%2520Principles%2520of%2520Management.ppt+basic+principles+of+management&hl=en&ct=clnk&cd=9 2. Gray, Richard & Smedley, Nicola, 1998,“Assessing primary nursing in mental health”, Nursing Standard, Vol. 12 No.21 (Online), available at http://www.nursing-standard.co.uk/archives/ns/vol12-21/research.htm 3. “Mental Health Nursing”, 2003) Nurses for a healthier tomorrow (Online) available at http://www.nursesource.org/psychiatric.html3 4 Minkoff, Kenneth, 2005,“Psychopharmacology Practice Guidelines for Individuals with Co-occurring Psychiatric and Substance Use Disorders”, (Online)Comprehensive Continuous Integrated System of Care (CCISC) available at http://www.bhrm.org/guidelines/psychopharmacology.pdf 5.“Psychiatric Nurse”, 2004. (Online) available at http://www.delmarhealthcare.com/pdf/careers/Psychiatric%20Nurse.pdf 6.“Therapeutic Nurse-client Relationship”, 2006. Practice Standard College of Nurses of Ontario, (Online) available at http://www.cno.org/docs/prac/41033_Therapeutic.pdf 7. Web definition of psychopharmacology available at http://www. Addiction.rehabilitation.com/glossary.html 8.Web definition of milieu management available at http://www.dphilpotlaw.com/html/glossary.html). Articles and Releases 1.Burns et al, 2000.“Effects of case-load size on the process of care of patients with severe psychotic illness - Report from the UK700 trial”, The British Journal of Psychiatry, Vol. 177 2. Ingles, Thelma, 1959. “What is good nursing?” The American Journal of Nursing, Vol 59, No.9 pp.1246-1249 3. Marie Manthey, 2001. “Two Miracles in One Career”, Nursing Administration Quarterly, Vol. 25, No. 2 pp 55-60 4. Pryce et al. 2006, “Evaluation of the Open Rota System in a Danish Psychiatric Hospital - A mechanism for improving job satisfaction and work life balance”. Journal of Nursing Management, Vol. 14, No. 4, pp 282-288 5. Rigby A, Leach C, & Greasely P 2001. “Primary Nursing: Staff perception of changes in ward atmosphere and role. Journal of Psychiatric and Mental Health Nursing, Vol. 8 Issue 6, pp 532 6. Short Jacqueline A 1995, “Has nursing lost its way? Dual Perspective”, British Medical Journal, 311 (7000) pp 303-304 7. Wright SG, 1996. “The need to develop nursing practice through innovation and practical change. International Journal of Nursing Practice, Vol. 2, No. 3 pp 142-148 Books 1. Briton, Nancy, 1997, Treatment: Informed Treatment: Milieu management in Psychiatric Hospitals and residential treatment Centres, ISBN New York 2. Keltner Norman, Schwecke H., Bostrom Carol. 1999, Psychiatric Nursing, (Third Edition) Elsevier, London Suggested reading Books 1. Cutcliffe John, Braithwaite David G., & Ward Martin (eds) 2006, Key debates in Psychiatric/ Mental Health Nursing, ISBN, London Preston John, Johnson James, 2003, Clinical Psychopharmacology Made Ridiculously Simple, Medmaster Incorporated, New York Kevin Gournay, Robert Newell, 1999, Mental Health Nursing: An Evidence Based Approach, Churchill Livingstone, London Shriver, Louise R., 2004, Basic Concepts of Psychiatrist-Mental Health Nursing – 7th Edition, Lippincot, William and Wilkins, New York Townsend, Mary C., 2004,Essentials of Psychiatric Mental Health Nursing - 3rd Edition, F A Davis and Company, New York Articles 1. Clinton M & Hazeltron M., 2000, “Scoping Mental Health Nursing Education”, Australian and New Zealand Journal of Mental Health, Vol.9, No.1, pp 2 – 10 2. Rea, Marcy, E 2001, “Fluid Group: Concept and Clinical Application in he Therapeutic Milieu, Journal of American Psychiatric Nurses Association. Vol. 7, No. 2, pp39 to 44 3. Wysoker Ami, 2001, “Confidentiality”, Journal of the American Psychiatric Nurses Association, Vol. 7, No. 2, pp 39-44 Recommended websites http://www.nimhe.org.co.uk http://nimhe.org.uk http://www.cebm.net/ http://nice.org.uk http://www.bmj.com http://www.ncbi.nlm.nih.gov/entries/query.fegi? http://www.who.int/en/ http://www.ssw.umich.edu/shared/course_outlines/20073/mh790-004w07-SSWR_Mini-Course.pdf Read More