Nursing in the United Kingdom: A Patient-Centered Approach - Personal Statement Example

Reflective Essay - Nursing in the United Kingdom: A Patient Centered Approach The nursing/ medical profession in the UK has undergone many changes in the past two decades. The role of the theatre nurse has expanded greatly with demands for more flexibility, versatility and expertise than ever before. This has been largely due to changes within the European Working Time Directive requirements. A reduction in junior doctors within the operating theatre has occurred, creating a shortfall in the numbers available to assist within the operating department. [NHSME 1991]. Kitson [2001] argues that "caring" in the traditional, personal sense needs to be a part of these new duties for nurses. I totally concur. This has allowed an opportunity for theatre nurses to expand their practice into those areas previously undertaken by medical staff. Theatre nurses are the obvious people to step into this role but as Thatcher [2003] demonstrates the nurse's role as an assistant needs to be recognised and standardised, so the role of advanced scrub practitioner can be developed. This essay will demonstrate how my development in a new role has impacted on my practice. The Gibbs[1988] model of reflection will help to illustrate my growth as an advanced scrub practitioner. The Gibbs model of reflection provides a structure for reflection and is less controlling than other models. As an experienced scrub nurse I initially found it very difficult to separate myself and concentrate solely on assisting within my own specialty. It has had the most profound impact on me as an individual. Having always been lead scrub within the spinal unit it was unsettling not just for me, but for the theatre team as the dynamics had changed. The NATN [1993] guideline states that nurses acting as assistants should focus on the intraoperative care required by the patient and this required me to separate myself from worrying about instruments and concentrate all my attention on assisting the surgeon. Developing in my role has helped me to question previous preconceptions regarding nursing. I have enhanced my knowledge of anatomy / physiology which has enabled me to become a more proficient assistant. This has helped me to appreciate the care needed for positioning the patient ready for surgery. The wound-healing process has been a revelation to me. It has benefited me enormously in the closure of wounds, tissue handling and in haemostasis. I have come to understand that all these factors contribute greatly to the healing process and also the choice of most suitable dressing. My role as an advanced scrub practitioner has at times been difficult especially when working within my own unit . There are times when feel that I am pulled in both directions with the surgeon as he seems to expect more from me : for example positioning the patient prior to and after surgery. This can cause difficulties all round as no more staff are allocated to the theatre thus my team leader skills are being fully explored in resolving these issues. The role of assisting for nurses has traditionally been within the remit of the scrub practitioner as Turner [2003] suggests, but she also states that greater definition and separation of the two roles are necessary. Thatcher [2003] demonstrates how all parties concerned with perioperative care established the creation of the Perioperative Care Collaborative in July 2002 did indeed define and identify the skills required for assisting as opposed to dual rolling and scrubbing. It has been suggested by Hind [1997] that if staff are expected to act in a role that requires new skills, then the employer should provide training and support. Fairchild [1993] suggests that whatever role nurses undertake in theatre a good understanding of anatomical structures and their location is essential. She also suggests that as all theatre staff are responsible for total patient safety throughout any surgical procedure a good understanding of how the body works can only be of benefit to all concerned. Davis [1999] also points out that good anatomical knowledge helps make retracting at surgery look easy. On undertaking this course and realising my deficiencies of knowledge of so much of the human body I feel I have made enormous strides forward to rectify this and even after such a short time it is rewarding that my clinical supervisor has commented favourably on my progress . As the surgeon's confidence in my ability to identify the clinical conditions necessary for wound healing grows, so he is happy for me to take on the role in dressing wounds on completion of surgery. Watret and Wtite [2001] have developed a chart that clearly demonstrates the criteria to be considered when selecting a dressing. I have found this tool informative and have enjoyed developing my knowledge in an area in which I was surprisingly ignorant. The delivery of quality healthcare for everybody is something all recent governments have striven for. During the 1990s the government introduced and then developed the concept of clinical governance as a way of improving healthcare provision. Clinical governance has been described by Scally and Donaldson [1998] as a way of making medical organisations accountable for continuous quality improvement of all the services that they provide and enable standards of clinical care to be audited, developed and flourish within a suitable environment. The document "Making a Difference" [Department of Health 1999] developed the New Labour government's thoughts on clinical governance and the need for leadership within primary health sector. It is important to include my team members as they can help me in developing the role of advanced scrub practitioner as I see the role as continually developing. This would be for the whole team as we strive to improve quality care for all our patients. All these factors add to the continuing development needed to comply with clinical governance My leadership skills have been called upon in my relationship with the surgeons in my role of assistant Their attitude has changed, sometimes positively as I have grown in confidence in my assisting skills, but also negatively in that they can be very unrealistic with demands on other team members while I am assisting. Developing my role has to run alongside with continuing development as a nurse. This will require me to keep myself professionally updated and competent in not one but two areas of practice. I feel confident that the roles can complement each other and even benefit the other. It has been suggested by Beesley [1998] that the expansion of the nurse's role in assisting "can only be a bonus for both nurses and patients, as they become more knowledgeable and dynamic." It is also leadership, [Dawes 2005], that is important within the nursing profession. As an advanced scrub practitioner I will be able to develop these leadership skills in order to provide better patient care. ________________________________________________ References Beesley J, [1998] The nurse as first assistant to the surgeon. British Journal of Thearte nursing 8 [1] 42-44 Davies N [1999] Providing Exposure, Retractors and Retraction. In Rothrock J, The RN First Assistant Third Edition Lippincott. Dawes, David. "A Literature Review on Team Leadership" The European Nursing Leadership Foundation. December 2005 Department of Health [1999] Making a Difference London The Stationery Office. Fairchild S, [1993] Perioperative Nursing. Principles and Practice Jones and Bartlett. Gibbs G, [1988] Learning by doing. A guide to teaching and learning methods. Further Education Unit, Oxford Polytechnic. Hind M, [1997] Clarifying accountability in the operating theatre Nursing Standard 12 [3] 44-46. Kitson, Alan. "Nursing Leadership: Bringing Caring Back to the Future". Quality in Healthcare. RCN, 2001. National Health Service Management Executive [1991] Junior Doctors: The New Deal. NHSME London. NATN [1993] National Association of Theatre Nurses. The role of the Nurse as First assistant Harrogate Preioperative Care Collaborative [2003] Position Statement: for the Provision of the Non-Medical Perioperative Practitioner Working as First Assistant to the Surgeon. PCC Thatcher J. [2003] Assistants in Surgical Practice. The British Journal of Perioperative Nursing 13[5]210-213. Turner S,& McLaughlan S, [2005] An In-House Course for first Assistants in Theatre. The British Journal of Perioperative Nursing 15 [2] 57-60 Watret L, & White R, [2001] In Gunnewicht B. and Dunford C. Fundamental Aspects of Tissue Viability Nursing Quay Books. Read More