Clinical Scenario Analysis - Essay Example

Clinical Scenario Analysis From this clinical scenario, identify and critically discuss 2 or 3 of the professional nursing issues and their significance for the graduate nurse. (eg. clinical, ethical, psychosocial issues) The new graduate finds a wide gap between professional and actualised environment, the theory- practice gap. The conflict results in physical and emotional exhaustion, feeling of inadequacy and loss of ideals. Main issues, where new nurse finds itself in confusion are limited proficiency in technical procedure , time management, drug administration, accurate assessment, report writing skills and tackling unexpected events Chang & Daly (2008: 5-6) . In the present case the new nurse was facing clinical and ethical problem of time management and tackling the issues of error in drug administration by previous nurse . Besides, there was emotional turmoil of the family of patient. She went for 'special' John duty to rectify the harm and must be having confusion and guilt of leaving her other patients. She should turn to the ethics of advocacy for support. The new nurse can raise staffing issue since a negligent attitude of other nurse has done damage to her well cared patient and his family. As Cherry & Daly (2005:275) state that the staffing issue may be raised for safe care. Since mandatory overtime and adequate staffing issues are legislative rules in many countries. The new California rules state that nurses will not have to care for more than eight patients at a time, five for medical-surgical units and four specialty patients. The common details of nursing advocacy follow for her help. The principles of nursing advocacy emphasise that patient is best judge of his/her own life. He /She has right to information about the treatment and may decide to go or not to go for the treatment. The nursing advocacy requires that any decision should be informed decision and taking into view the patient's preferences (Vaartio, 2009:10). The roles of nursing advocacy are also to inform about the misconduct, misuse of public property, violation of rules and inadequate staffing (Vaartio, 2008:12). Various professional codes allow nurses to perform advocate's duty on behalf of patient, family and organisation (Vaartio, 2008:13). Vaartio et al (2008: abstract) found advocacy that prompts counseling and responding activities, which in turn lead to some degree of empowerment on the part of both patient and nurse. Thus it could be expected that for the role of advocate the nurse should have clinical, professional experience and ethical and interpersonal skills (Vaartio, 2008:15). In John's case the nurse provided good clinical care and won the trust of his daughters. However, in her absence the new nurse probably erred in medication which is serious yet common error. Cherry & Daly (2005:281) found it putting a very high cost as number of patients die due to these errors. Medication errors occur due to many reasons and adequate staffing issue can resolve this problem. They find other reasons as failure of management in following safety practices, poor staffing without adequate training and interdisciplinary skills, long hours of work, insufficient technology for drug administration, undue time commitment to patient information leaving little time for care (282). Looking at the damages of erred medication, the new nurse should report misconduct under advocacy. However, at times, despite it being legitimate, grievance against colleagues or seniors is considered against socialisation principle so the seriousness of deed must be ascertained. The new nurse may have to encounter aggressive emotional outburst very often, she needs a good level of emotional intelligence as well. Since, in John's case the deteriorated condition may be an outcome of his disease and not the wrong medication. Codier, Kooker and Shoultz, (2008:11) explored the role of emotional intelligence (EI) on nursing performance. The nurses scoring higher in EI owed less vulnerability to emotions of patient's family and were better able to control their own emotions. Jordan and Troth (2002) also indicated that individuals with high emotional intelligence prefer to seek collaborative solutions when confronted with conflict thus enhanced team spirit is at work again. 2. As the inexperienced graduate in this scenario, justify the resources and support structures needed to best manage the issues to ensure quality patient (and family) care. (eg. policy, knowledge, support persons) Huston (2006) clarifies that to be a registered nurse the requirement is just the minimum entry level qualifications. However, nurses can improve care ,and develop competencies beyond entry level by differentiated nursing practice supported by employer funded programmes. According to Chang & Daly (2005:20) there are transitional programmes for new nurse including mentorship, preceptor ship, new graduate transition orientation, residency, internship. These aim to: Gradually increase the confidence and competence of new entrant Facilitate an inter- and intra-personal relationship between nurse and her multidisciplinary team. Maintain a healthy work culture Encourage evidence based clinical practice Transfer expert practical expertise through mentoring Huston (2006: 71) finds mentoring by a senior highly effective facilitating integration of new entrant into clinical setting. Mentoring has four steps beginning with initiation- the relationship between mentor and mentee is formed, followed by cultivation which is a phase of coaching, counseling and protection giving a sense of competence. Separation when the mentee outgrows the need for coaching and redefinition when training takes a new form. Chang & Daly (2005: 9) found that new nurses are already good in communication and psychosocial skill. Peer support is another good and mutual support. However, at times the generational gap between nurses creates mentoring a strenuous exercise. As Carver and Candela. (2008:987-989) elaborated on this aspect in nursing system. They attributed many generations of nurses in single clinical setting to longer job period, reentry into profession. They advised nursing managers to deal with this generational gap on same lines as that of culture and ethnicity issues. The generations that the authors found are veterans, baby boomers, generation X and millennial generation. They felt that adequate understanding about these generations by management would give higher output and lower turnover. The new nurse finds it difficult to make a report against senior nurse for fear being labeled a traitor. During the practice, there are, sometimes, issues that catch a new nurse unprepared as happened with the present case where the new graduate encountered distressed family and alarming condition of her patient. She needed to collect herself emotionally, manage the patient and soothe the family all at a time. In such a situation, the new nurse must acknowledge the role of peers and role models in the formulation of career expectations and decisions (Price, 2009). Brisley and Wood (2004: 106) found that new graduate nurses were unable to cope well with the death of the patient they were giving nursing care. Their study involved prior exposure to death issue resulted in better coping with it and so they suggest that it should be made a part of graduating nurses. A previous knowledge helps them to take better care of patient and provide support to family. . References: Brisley, P & Wood, Lynda-Mary (2004). The impact of education and experience on death anxiety in new graduate nurses. Contemporary Nurse, vol.17, no. 1-2, pp.102-108. Carver, L and Candela, L (2008). Attaining organisational commitment across different generations. Journal of Nursing Management, 16 (8), 984-991. Chang , EML, Chang, E, Daly, C & Daly, J 2008. Transitions in Nursing: Preparing for Professional Practice, 2ND ED, Elsevier Australia Cherry , B & Jacob, SR 2005, Contemporary nursing: issues, trends, & management, 3rd ed, Elsevier Health Sciences Codier, E, Kooker, B. M. & Shoultz, J (2008). Measuring the Emotional Intelligence of Clinical Staff Nurses: An Approach for Improving the Clinical Care Environment, Nursing Administration Quarterly, vol.32, no.1, pp. 8-14. Huston, C J 2006. Professional Issues in nursing: challenges and opportunities. Lippincott Williams & Wilkins. Philadelphia. Jordan, P and Troth, A (2002). Emotional Intelligence and conflict resolution in nursing Contemporary Nurse, 13 (1), 94-100. Price, S L (2009). Becoming a nurse : a meta-study of early professional socialization and career choice in nursing, Journal of Advanced Nursing, vol.65, no. 1, pp.11-19. Vaartio, Heli; Leino-Kilpi, Helena; Suominen, Tarja; Puukka, Pauli 2008 The content of advocacy in procedural pain care - patients' and nurses' perspectives, Journal of Advanced Nursing, vol. 64, no.5, pp.282-292. Vaartio, H. 2008. NURSING ADVOCACY: A concept clarification in context of procedural pain care. https://oa.doria.fi/bitstream/handle/10024/42558/D826.pdfsequence=1 [13 Mar 2009] Relates to Learning Outcomes: 1 & 2. Due Date: Monday 30th March, 2009 4.30pm. Chang & Daly. 2008 Transitions in Nursing. preapring for Professional Practice. Churchill Livingstone. Elsevier. Sydney. Blais et.al. 2006. Professional Nursing Practice: concepts adn perspectives. Pearson/Prentice Hall. N.J. Cherry & Jacob. 2008. Contemporary Nursing: issues, trends and Management. Mosby/Elsevier. Mo. By Barbara, Susan R. Edition: 3, illustrated Published by, 2005 (2005). 153-172 ; 193-206 in Nunnery, Rose, Advancing your career : concepts of professional nursing, Philadelphia: FA Davis, Swerissen, Hal. (2009). 61-70, 179-187 in Willis, Eileen ; Reynolds, Louise and Keleher, Helen, Understanding the Australian health care system, Chatswood NSW: Churchill Livingston, Journal Article -. (2008). Focus needs to be on skill mix Nursing Review, (December), -. (2006). Alarming statistics on workplace violence Nursing review, (October), Alphonso, C. (2007). Reflection on a critical incident Contemporary Nurse, 24 (1), 89-92. Brisley, Patricia and Wood, Lynda-Mary. (2004). The impact of education and experience on death anxiety in new graduate nurses Contemporary Nurse, 17 (1-2), 102-108. Anecdotal evidence suggests that new graduate nurses are ill prepared for their experiences with death. This study explores death anxiety and coping skills in registered nurses during their first year of practice. Participating nurses were undertaking a transition support program; the subject group attended a Death Issues Workshop while the control group did not receive any formal education on death issues during their program. Data collection was by semi-structured interviews and use of the Nurses' Attitude to Death Scale, a questionnaire developed by the researchers. Results indicate that the control group showed a greater reduction in death anxiety while the subject group demonstrated better coping skills in caring for themselves and their colleagues and were better equipped in providing care to patients and relatives. Recommendations are made for death issues to be explored more extensively during both undergraduate and postgraduate nurse education. Author(s): Patricia Brisley 1 | Lynda-Mary Wood 2 Buchan, J. and Aiken, L. (2008). Solving nursing shortages : a common priority. Journal of Clinical Nursing, 17 (24), 3262-3268. Carver, L. and Candela, L. (2008). Attaining organisational commitment across different generations. Journal of Nursing Management, 16 (8), 984-991. November 2008, 16:8 > Attaining organizational commitment... < Previous| Next > ARTICLE LINKS: Fulltext|PDF (87K)|Request Permission Journal of Nursing Management:Volume 16(8)November 2008p 984-991 Attaining organizational commitment across different generations of nurses [Original article] CARVER, LARA PhD, RN1; CANDELA, LORI Ed.D, RN2 1Doctoral Student and Assistant Professor, 2Associate Professor, School of Nursing, University of Nevada, Las Vegas, NV, USA Correspondence Lara Carver National University 2850 West Horizon Ridge Parkway Ste #301 Henderson, NV 89052 USA. E-mail: lcarver@nu.edu Accepted for publication: 2 April 2008 Abstract Aim: To inform nurse managers about the generational differences that exist among nurses, how it affects the work environment and how this information can be used to encourage organizational commitment. Background: Every person is born into a generational cohort of peers who experience similar life experiences that go on to shape distinct generational characteristics. Thanks to delayed retirements, mid-life career changes, job re-entry and a small but significant group of younger graduates, the nursing profession is now experiencing four generations in the workforce: Veterans, Baby Boomers, Generation X and the Millennial Generation. At the same time, the literature on organizational commitment is expanding and can provide a compelling context through which to view generational differences among nurses. Implications for nursing management: As part of an overall strategy to increase organizational commitment, consideration of generational differences in nurses can be helpful in leading to increased job satisfaction, increased productivity and decreased turnover among staff. In the face of the global nursing shortage, managers should increase their knowledge of generational diversity just as they have with ethnic and cultural diversity in the past. Understanding how to relate to the different generations and tap into their individual strengths can lead to improved nursing Codier, Estelle; Kooker, Barbara M. and Shoultz, Jan. (2008). Measuring the Emotional Intelligence of Clinical Staff Nurses: An Approach for Improvng the Clinical Care Environment Nursing Administration Quarterly, 32 (1), 8-14. Background: Significant correlations have been demonstrated between emotional intelligence (EI) and high levels of performance and other organizational variables related to retention and workplace environment. Although these variables are also important for safe care and healthy work relationships, there is little research on the EI of clinical staff nurses. The purpose of this study was to measure EI as related to performance level of clinical staff nurses, and to collect data on important related career/organizational variables. Methods: Thirty-six nurses in 3 urban hospitals in Honolulu, Hawaii, participated. EI, nursing performance level, and career/organizational variables were measured. Discussion: Significant positive correlations between clinical performance level and EI scores were observed. However, a large percentage of the clinical staff demonstrated below average total EI scores and subscores (perceiving emotions, experiencing emotions). Conclusions: Findings from this study offer the first evidence that the performance level of clinical staff nurses correlates positively with EI. A high percentage of nurses in this study scored below average on both total EI score and important subscores. These findings warrant further investigation. EI may offer a framework and specific skills to enhance collaboration, positive conflict behaviors, and healthy relationships in the clinical care environment. Daly J., Kearney G., Homer, C. (2008). Reflections on the Australia 2020 summit long-term national health strategy Collegian, 15 (4), 123-124. Deans, Cecil. (2005). Medication errors and professional practice of registered nurses Collegian, 12 (1), 29-33. Fero, Laura. J et al. (2009). Critical thinking ability of new graduate and experienced nurses Journal of Advanced Nursing, 65 (1), 139-148. Jordan, P and Troth, A. (2002). Emotional Intelligence and conflict resolution in nursing Contemporary Nurse, 13 (1), 94-100. . Impli Kelsey-Sugg, Anna. (2009). Violence in healthcare : prevention is better than cure Nursing Review, (January), Kooker, B., Shoultz, J. and Codier, E. (2007). Identifying emotional intelligence in professional nursing practice Journal of Professional Nursing, 23 (1), 30-36. Levett-Jones, T. and FitzGerald, M. (2005). A review of graduate nurse transition programs in Australia. Autstralian Journal of Advanced Nursing, 23 (2), 40-46. Mallik, Maggie. (1997). Advocacy in nursing - a review of the literature Journal of Advanced Nursing, 25 (1), 130-138. Patient/client advocacy has been claimed as a new role for the professional nurse. This paper presents a critical review of the literature on advocacy in nursing. After briefly outlining the conditions which may have instigated the need for patient advocacy, meanings and models of advocacy role in health care, models proposed for the nurse as advocate are indeterminate which leads to multiple interpretation and lack of clarity in operationalizing advocacy. Much of the literature focuses on justification arguments for claiming the advocacy role. Key themes are outlined and include: patient advocacy as a traditional role, nurses are in the best position in the health care team, nurses have the knowledge to advocate and finally nurses and patients can be partners in advocacy. However, critical examination reveals many counter-arguments to the above claims and finally concludes that advocacy is a potentially risky role to adopt. It is argued that support systems are inadequate except in low-risk situations and ultimately acts of advocacy remain a moral choice for the individual nurse. Finally the need to conduct research into the interpretation o the patient advocate role by nurses in the United Kingdom is highlighted Meehan, T.; McIntosh, W. and Bergen, H. (2006). Professional boundaries in the clinical setting Nursing Review, (10), 10-11. New South Wales nurses association. (2008). A bigger role for nurses The Queensland Nurse, 27 (6), 7-7. A bigger role for nurses; Federal Health Minister Nicola Roxon says her health reforms include a bigger role for nurses and a change in priority towards prevention and primary care, Lamp, The , Nov, 2008 Health Care Industry Favourite saved http://findarticles.com/p/articles/mi_m5QVR/is_10_65/ai_n30981942 Our health system, including funding for health services, is organised almost entirely around doctors, despite the fact that many services are now safely and ably provided by other health professionals--nurses, psychologists, physiotherapists, dieticians and others,' she said. Nicola Roxon said it was possible for nurses and other health professionals to take on some of those responsibilities and suggested Labor would make it attractive for them to do so. 'In doing so, we will not only be redressing the historical bias towards medical intervention and acute care, we will be redressing the historical bias against the traditionally female nursing workforce,' she said. Price, Sheri L.. (2009). Becoming a nurse : a meta-study of early professional socialization and career choice in nursing Journal of Advanced Nursing, 65 (1), 11-19. Becoming a nurse: a meta-study of early professional socialization and career choice in nursing. Aim. This paper is a report of a meta-study of early professional socialization and career choice in nursing. Background. The current and growing shortage of nurses is a global issue, and nursing recruitment and retention are recognized priorities internationally. The future of nursing will lie in the ability to recruit and retain the next generation to the profession. Data sources. Studies were identified through a search of the CINAHL, PsycInfo, Sociological Abstracts, PubMed; Medline and Embase databases from 1990 to 2007. Review methods. Studies were included if they gave insight into the experience of choosing nursing as a career, used qualitative methodology and methods, and were published in English. Analysis was undertaken using Paterson et al.'s framework for qualitative meta-synthesis. Results. Ten primary studies were included in the review. Their methodologies included: ethnography (4); descriptive qualitative (3); grounded theory (2); and phenomenology (1). The location of the research was Canada (3), United Kingdom (2), United States of America (2), Australia (1), Japan (1) and Sweden (1). Three main themes were identified: influence of ideals; paradox of caring and role of others. Conclusion. Career choice and early professional socialization are influenced by multiple factors. In future recruitment and retention strategies to address the critical nursing shortage, Price,(2009) it is important to consider the role of mentors, peers and role models in the formulation of career expectations, and career choice decisions. It is also necessary to consider the role of mentors, peers and role models in the formulation of career expectations, and career choice decisions Vaartio, Heli et al. (2006). Nursing advocacy : how is it defined by patients and nurses, what does it involve and how is it experienced Scandinavian Journal of Caring Sciences, 20 (3), )December 2008p 504-513 Vaartio, Heli; Leino-Kilpi, Helena; Suominen, Tarja; Puukka, Pauli 2008The content of advocacy in procedural pain care - patients' and nurses' perspectives, Journal of Advanced Nursing:Volume 64(5, 282-292. [RESEARCH PAPER: ORIGINAL RESEARCH] Heli Vaartio MNSc RN PhD Student Department of Nursing Science, University of Turku, Finland Helena Leino-Kilpi PhD RN Professor and Chair Department of Nursing Science, University of Turku, and Nurse Manager South-Western Hospital District, Finland Tarja Suominen PhD RN Adjunct Professor Department of Nursing Science, University of Turku, and Department of Nursing Science, University of Kuopio, Finland Pauli Puukka MsocSc Senior Research Statistician National Public Health Institute, Turku, Finland Correspondence to H. Vaartio: e-mail: heli.vaartio@sydvast.fi Accepted for publication 22 July 2008 Abstract Title: The content of advocacy in procedural pain care - patient' and nurses' Perspectives Aim: This paper is a report of an exploration of the content of nursing advocacy from the point of view of patients and nurses in the context of procedural pain care. Background: Nursing advocacy is every nurse's professional duty, grounded in patients' legal and moral rights. Nevertheless, earlier research has approached advocacy as a whistle-blowing event from the nurse's perspective. Method: This cross-sectional study was conducted with a cluster sample of otolaryngology patients (n = 405) and nurses (n = 118) in 11 hospital units in Finland during 2007. The data were collected using an instrument measuring the content of advocacy and analysed statistically. Results: Advocacy in procedural pain care is a process which takes place in the patient-nurse relationship through role identification in decision-making about pain care. This prompts counselling and responding activities, which in turn lead to some degree of empowerment on the part of both patient and nurse. However, advocacy is partly dependent on the nurse's own role identification: in the context of pain care it seems that the nurse's pain care skills and influence over pain care plans are important factors in the decision to advocate or not. At best, patients have some role in decision-making about their care; at worst, they are subjected to paternalism. Conclusions: Advocacy is an integral part of the nursing care process. It is important that this key ethical aspect of professional nursing is discussed in nursing education and systematically applied in nursing practice through on-the-job training, feedback and collaboration. Windle, Pamela E.; Mamaril, Yyrna and Fossum, Susan. (2008). Perianesthesia nursing advocacy : an influential voice for patient safety Journal of Perianesthesia Nursing : Official Journal of the American Society of PeriAnesthesia Nurses, 23 (3), 163-171. FROM NURSING ADV- Vaartio, H NURSING ADVOCACY: A concept clarification in context of procedural pain care, Heli Vaartio ) Affing.ent advocacy is integrated with that of professional advocacy to form what is referred to as nursing advocacy. Patient advocacy is here defined in terms of how patients' needs and interests (such as care preferences) and their rights to information and self-determination in care are taken into account. The principle of self-determination is based on the belief that each person is the best expert of his/her own life, and in order to make informed decisions about their own treatment they need to receive sufficient information about different services, alternative treatments and their effects 12- The most active role for the nurse as an advocate is that of a culture-broker (Jezewski 1993) or whistleblower, i.e. disclosing information about misconduct in the workplace that they feel that violates the law or endangers the welfare of others. This may involve the violation of rights, inadequate staffing, or misuse of public money, i.e. advocacy both on the patient, professional and societal level. (McDonald & Ahern 13-Advocacy in everyday nursing practice is guided and governed by various codes of nursing ethics. The introductory paragraph of the Code of Professional Conduct (United Kingdom Central Council for Nursing, Midwifery and Health Visiting 1992) identifies advocacy as 'a central role for nursing staff on behalf of patients who do not have the support of family or friends, and recommends that the best interests of patients ought to inform every act by practitioners'. The Irish Code states that 'the therapeutic relationship between nurse and patient serves to empower the patient to make life choices, and nursing practice involves advocacy for the individual patient and for his family, as well as advocacy on behalf of nursing in the organizational and management structures within which care is delivered. 15- Most antecedents of advocacy seem to be related to the individual nurse's characteristics and skills. In order to be able to advocate, nurses need to have a professional training, clinical experience and competence, as well as ethical and interactional skills. Furthermore, they should be reflective and have the emotional strength and willingness to serve as patients' advocates. It has been suggested that the development of advocacy skills requires the acknowledgment of one's own professional role, observation of other nurses advocating, and having the necessary confidence (Foley, Minick & Kee 2002). All this requires practical work experience (Kieffer 2000, Seal 2007) and systematic feedback Chang- 20 Read More