Critical Care Nursing Professional Leadership and Health Care Program Evaluation - Assignment Example

Running Head: Specialized Nursing Specialized Nursing Name Institute Date Critical Care Nursing Critical care nursing is a new specialty, which emerged in the 1950s and 60s in North America, Europe, South Africa and Australia and has been developing as a specialty within nursing for more than 30 years. As defined by the World Federation of Critical Care Nurses, critical care nursing is an advanced nursing care of critically sick patients who have evident disorder of crucial organ functions. It involves helping, supporting and reinstating the patient toward wellbeing, or to relieve the patients’ pain and to prepare them for a noble death. The intent of critical care nursing is to develop a therapeutic association with patients and their families and to build the patients’ physical, emotional, sociological, educational and religious potentials through preventive, therapeutic, and rehabilitative strategies. Critically sick patients are those who are at high danger of actual or possible acute health problems. Critical care nursing can be strongly linked to intensive care unit (Scribante, Schmollgruber, & Nel, 2005). The early stages of critical care nursing included mainly of coronary care unit, cardiothoracic units, and the general intensive care units. Coronary care units took care of cardiology patients, cardiothoracic units for postoperative patients whereas; general care unit took care for patients with respiratory problems. The principles of critical care nursing that exist today are as a result of later advance in renal, metabolic, and neurological management. Advancement in technology, such as the invention of machines like ventilators, cardiac monitors, pacemakers, defibrillators, dialysers and currently, intra-aortic balloon pumps have promoted the development of critical care as a specialty and of more expertise (Fairley, 2005). The recognition of the importance of the role of adequately trained and experienced nurses in these care units from an early stage have led to the development of nursing specialty of critical care (Keeling & Bigbee, 2005). The development of critical care nursing was exemplified by a number of features: the foundation of a new organization between nursing and clinical staff; the experience of a vertical learning curve for nursing and clinical staff in accord; the guts to work in unfamiliar location, caring for terminally ill patients- a task that needed development of high-level of competence; and a high demand for education specific to the specialty of critical care nursing, which was at first hard to meet owing to the lack of qualified nurses in the field (Hanley & McEwen, 2005). Critical Care nursing Education The specialty of critical care nursing education and professional organizations such as the Australian College of Critical Care Nurses (ACCCN) evolved with the evolvement of the practice of critical care nursing (ACCCN, 2005). Critical care nursing education involved the formalization of education for nurses to practice in critical care units and offer quality care to patients and their families. This formal education, together with practical learning, ongoing professional development and training and insightful medical practices provided the expertise, knowledge and attitudes essential for quality critical care nursing practice as articulated in the competency standards of the ACCCN (Hravnak Tuies & Baldisseri, 2005). Critical care nursing education originally consisted of ad-hoc training, which was provided by clinical officers as there were no professional nurses available to provide the training. In the 1990s, universities developed postgraduates curricula in which they offered university-based critical care courses to extend the knowledge and skills of nurses. This led to the discontinuation of hospital-based courses (American Association of Critical-Care Nurses 2006). Currently, most tertiary institutions offer postgraduate critical care nursing education at a Masters, Graduates, Diploma and Certificate level as preparation for specialty practice (American Association of Critical-Care Nurses 2006). An assessment of clinical competence remains an essential component of most university-based critical care nursing courses globally as relates to employment in critical care. The Declaration of Madrid, which was approved by the World Federation of Critical Care Nurses, offers a foundation for critical care nursing education globally (WFCCN, 2005). The recruitment, orientation, training and development process is designed to allow continued retention of competent critical care nurses as a way of promoting quality critical care nursing practice (Aitken, Currey, Marshall & Elliot, 2006). The clinical competence of the nurse is essential concerning offering quality critical care. Clinical competence involves a combination of knowledge, skills, and behaviors. The ACCCN developed a set of competency statements for specialist critical care practice, which consisted of 20 competency standards classified into six spheres: Professional practice; reflective practice; enabling; medical problem-solving; collaboration; and leadership (ACCCN, 2005). However, a current study has questioned the validity of this structure as numerous competency statements were associated with more than one sphere. Hence, it is imperative to carry out more research to develop a competency model with enhanced construct validity. Currently, more competency spheres, and evaluation tools have been developed (Hanley & Higgins, 2005). Credentialing as a critical care nurse is a process that has been there in United States for several years and is currently common in Australia and New Zealand. Credentialing is a process used to find if a person exhibits specialist critical care nurse practice. A critical care nurse is expected to fill a professional portfolio, which includes reflective practice in the form of a printed journal that concentrates on pertinent competency standards and evidently recognizes the individual’s professional attainment, like conference attendance, and proof of ongoing training (Cowan, Norman & Coopamah, 2005). Critical Care Nursing Professional Leadership Critical care nursing professional leadership has experienced remarkable development in the last 30 years. For example, the ACCCN in Australia was created from a number of prior state-based bodies: the Australian Society of Critical Care Nurses and the Clinical Nurse Specialists Association. These earlier bodies had been providing professional leadership for critical care nurses as early as 1970s. New Zealand professional interests in critical care nurses are represented by the New Zealand Nurses Organizations and by associations with the ACCCN. This college has strong professional associations with other nationwide peak nursing organizations, government organizations and individuals as well as the Australian and New Zealand Intensive care Society (ANZICS) and health care corporations. In USA, professional bodies representing critical care nurses were established as early as 1960s. Currently, most countries, such as Asia, South America, North America, Europe and Africa, have formed professional organizations. The World Federation of Critical Care Nurses was established in 2001 to offer professional leadership at a global level (Davidson, Elliot & Daly, 2006). The Roles of Critical Care Nurses The range of roles carried out by specialist critical care nurses have developed just as the discipline of critical care. For example, the range of critical sickness consists of proactive care, management of the critical sickness and follow-up care as well as the practice of palliative care in the ICU setting (Considine, 2005).The roles of critical care nurses included in nursing professionals involve; carer; educator; patient and family advocate; coordinator; advanced practice; consultant; researchers; and a leader. Nurses are expected to exhibit these roles in their own area of expertise (Lloyd-Jones, 2005). Conclusion and Recommendations Critical care nursing as a field in nursing has developed greatly in the past 30 years. Great development have been experienced in the sphere of critical care nursing technology, education, professional leadership as well as the roles of critical care nurses. Several critical care nurses and organizations have realized that the world is a global village. Internet accessibility has made global communication, consultation, and cooperation much easier. The ability of Critical Care Nursing Organizations to work cooperatively and collaboratively in tackling many problems affecting this field has improved greatly with the establishment of WFCCN. With these structures and alliances in place, critical care nursing practice will continue to develop for the provision of quality care to critically ill patient across the world. CCNOs should further explore key themes, such as workforce and education, in more details to uncover inventive solutions and actions to be used to solve the major issues affecting critical care nursing. The WFCCN structure should be reevaluated to guarantee it remains the most efficient way of identifying and addressing problems general to critical care nursing globally. References Aitken LM, Currey J, Marshall A, Elliot D. (2006). The range of critical care nursing education in Australian Universities. Australia Critical Care, 19(2): 46-52. American Association of Critical-Care Nurses (2008). General information regarding certification. Available at: http://www.aacn.org/WD/Certifications/Content/generalinfo.pcms American Association of Critical-Care Nurses (2006). Standards of Practice and professional performance for the acute and critical care medical nurse specialist. Available at: http://www.aacn.org/AACn/pubpolcy.nsf/vwdoc/pmp Australian College of critical Care Nurses. (2005). Australian College of critical care Nurses Website. Melbourne: Australian College of Critical Care Nurses. Available at: http://www.acccn.com.au Considine J. (2005). The responsibility of nurses in avoiding bad events related to respiratory dysfunction: literature evaluation. Journal of Advanced Nursing, 49: 624-32. Cowan DT, Norman I, Coopamah VP. (2005). Competence in nursing practice: a contentious notion: a focused evaluation of literature. Nurse Education Today, 25:355-62. Davidson PM, Elliot D, Daly J. (2006). Clinical leadership in contemporary clinical practice: implication for nursing in Australia. Journal of Nursing Management; 14: 180-7. Fairley D. (2005). Determine the kind of highly developed nursing practice in critical care: a critical care nurse consultant’s experience. Intensive Critical Care Nursing, 21: 140-8. Hanley E and Higgins A. (2005). Evaluation of practice in critical care; students’ opinion of a clinical competence evaluation tool. Intensive critical Care Nursing, 21:276-83. Hravnak M, Tuies P, Baldisseri M. (2005). Expanding acute care nurse practitioner and clinical nurse specialist education: invasive procedure training and human simulation in critical care. AACN Clinical Iss, 16:89-104). Hanley E, McEwen A. (2005). Evaluation of clinical practice in critical care: an evaluation of the literature. Intensive Critical Care Nursing; 21: 268-75. Keeling AW and Bigbee JL (2005). The record of highly developed practice nursing in the United States, In: Hamric AB, Spross JA, Hanson CM, (eds.), highly developed Practice Nursing: A cooperative Approach (3rd ed.). St. Louis: Elsevier Saunders. Lloyd-Jones M. (2005). Role advancement and efficient practice in specialist and highly developed practice roles in critical hospital situations: logical review and meta-synthesis. Journal of Advanced Nursing, 49: 191-209. Scribante J, Schmollgruber S, Nel E. (2005). Perspective on critical care nursing: South Africa. Connect: World Critical Care Nursing, 3(4):111-15. WFCCN (2005). WFCCN Position Statement on the Provision of Critical Care Nursing Education--Declaration of Madrid, 2005. Available at http://en.wfccn.org/pub_education.php. Program Evaluation Program evaluation is a logical process for collecting, assessing, and using the information, which is essential for answering fundamental questions about projects, policies, and programs (Encyclopedia of Public Health, 2008). Individuals from different backgrounds such as sociology, psychology, economics, and social work perform program evaluation. An evaluation is a systematic assessment, which follows a systematic and mutually agreed plan. This plan will include the following: ways of determining the goal of the evaluation, methods of how questions of evaluation shall be answered, how the results will be useful and how the results shall be reported so that they can be used by a health care organization to make improvements (Royse, Thyer, & Padgett, 2009). When determining the evaluation question, the evaluator should develop a good report of what the results should be, how the program will arrive there and the reason about why the program directs to that outcome. This method is called a program theory. This theory explains how and why a program is believed to work. Moreover, it provides a rational and sensible description of the program activities (World Health Organization, 2007). Health care program evaluations are usually carried out to determine if a particular project has achievement the outcomes expected. The following are the basic types of evaluation, which are performed in the health care field: the evaluation of health programs, evaluation of health care system, and evaluation of health services (Melnyk & Fineout-Overholt, 2005). Health program are implemented to achieve particular health objectives, such as minimizing a health problem. For example, water fluoridation programs are executed to enhance oral health whereas exercise programs are aimed at boosting physical activity. This evaluation process is aimed at assessing the performance of programs implemented to achieve quality heath care in that area and other areas (Smith, 2010). Evaluation of health care system is planned to generate knowledge about the performance of the health care system. The system has an organization defined by the national, government and local rules and regulations, the availability of staffs, facilities, and other resources. Moreover, the structure also contains the physical, social, and economic surroundings where they reside as well as the features of the population that the system serves (Frechtling, 2007). Although this system affects the procedure or the delivery of health services, which in turn generates results that are both intermediate and ultimate. Intermediate results ultimately generate excellence in health and well being or a quality life. Intermediate results of system performance have three benefits; they define what development in health and satisfaction were produced by health services at what price and for what population groups. It therefore ensures effectiveness, efficiency and equity in the provision of health care services. Evaluation of health care system typically examines the impact of the structural element on the process of care and the process elements on the outcomes of care (Lewis, 2006). Health service evaluation assesses the cost–efficacy of particular health services offered to patients in the system. This evaluation focuses on the measurement of the benefits or health results, of a clinical technology comparative to the costs of generating them. In case of shortage of resources, technologies that generate relatively more benefits at low price have greater value than technologies that provide few benefits and more costs (Gray, 2007). The trends towards cost-effectiveness and evidence-based health care has led to the increase in the number of cost-containment evaluations of clinical technologies in various medical field, such as preventive, behavioral, diagnostic, reparative and pharmaceutical, in the past two decade. To ensure quality and observance of essential components of the method, specific standards for carrying out cost-effectiveness studies of clinical technologies have emerged. It is expected that health services will continue to be a major area of evaluation because of advancement in technologies experienced today (Drummond, Sculpher, Torrance, O'Brien, & Stoddart, 2008). Advantages of Program Evaluation Evaluation is vital in determining the effectiveness of health care programs and interventions. Program evaluation leads to collection of evidence about the effectiveness of a project, identifies ways to advance practice, validate the use of resources, and identifies unanticipated outcomes. Health care program evaluation is essential as it ensures that the health of the population is protected and enhanced. The benefits of health care program evaluation go beyond the direct target population, as the decrease in infectious diseases or ecological hazards may benefit the entire world (Saunders, Evans & Joshe, 2005). Program evaluation also can be conducted to make decision about weather to continue or discontinue a program. A program can be discontinued if it is not directed toward achieving its objectives. Evaluation leads to identifications of a program strengths and weaknesses, creating an opportunity for addressing those weaknesses and hence improving the implementation of the program. Evaluation can also examine the benefits of introducing a new program idea within the original program. Program evaluation is also used to compare the performance of different version of a program to determine which one is the best. Specific program strategies or procedures can be added or removed based on their effectiveness as determined by an evaluation. A program can be implemented elsewhere if it is found to be successful in a specific area (Crawford Woodby, Russell & Windsor, 2005). Program evaluation is also used when allocating resources among competing programs. Programs that are found to be lagging behind can be allocated more resources and vice versa. Program evaluation also ensures accountability as it makes sure that tax dollars are used on programs that work. Funding agency may be interested in evaluating a program to determine its cost-effectiveness and find whether it has any unintended or dangerous impacts. The organization that implements the program may want to evaluate a program to show interest groups that the program is good, validate past and future expenditures, achieve support of expanding the program or meet the requirements enforced by the funding agency. Program administrators may promote an evaluation of a program that they believe to be successful to earn promotion later. They may also use an evaluation as a mechanism to gain control over the project or gain evidence to validate the expansion of the program or simply to protect the program from attacks by interest groups who want to eradicate it. Program evaluators may be interested in performing an evaluation for personal gains, such as to earn salary or develop their career (O'Connor-Fleming, Parker, Higgins & Gould, 2006). Disadvantages of program evaluation Everything has got its advantages and disadvantages. Decision makers can launch an evaluation to delay a decision about a program or escape the political pressures from opposing interest groups, each wanting a decision about the program favoring its own position. Decision makers can also carry out an evaluation to provide legality to a decision that has already been implemented or encourage political support for a program through evaluating only the essential parts of a program and shun away on covering up evidence of a program failure (Issel, 2008). The role of the evaluator The evaluator has a role to play that can highly affect both the process and the outcomes of the evaluation. However, the role of an evaluator is not fixed and can vary from one health program to another. The evaluator performs the participatory role, which involves working together with decision makers and other groups. The evaluator also plays the role of the objective researcher. The evaluator principles neutrality and knowingly avoids being biased by the views of decision makers and other interest groups (Savaya & Waysman, 2005). The other role of evaluators is advocacy role. In health program evaluation, evaluators either perfectly or plainly play an advocacy role, because most health experts share a value of loyalty to safeguarding public health and therefore promoting access to health care and delivery of cost- effective service (Unrau, Gabor, & Grinnell, 2006). Conclusion Program evaluation is a systematic process for collecting, assessing, and using the data, which is essential for answering essential questions about projects, policies, and programs.  The three kinds of health care program evaluation are; the evaluation of health programs, evaluation of health care system, and the evaluation of health services. The main aim of program evaluation is to determine if the program has achieved its intended objectives and if not, to find the reasons behind its failure to rectify the mistakes done. In short, program evaluation is used to ensure that the program become successful. For successful program evaluation, the evaluators must perform three roles: participatory; researcher and advocacy. References Crawford MA, Woodby LL, Russell TV and Windsor RA. (2005). Using influential evaluation to enhance a smoking cessation strategy for pregnant women. Health communication, 17(3): 265-281. Drummond MF, Sculpher MJ, Torrance GW, O'Brien BJ, Stoddart GL. (2008). Methods for the economic evaluation of health care programmes. United States, Oxford University Press. Encyclopedia of Public Health. (2008). Evaluation of Public Health Programs. New York, Springer. Frechtling JA. (2007). Logic modeling methods in program evaluation. San Francisco: Jossey-Bass. Gray, J. A. M. (2007). Evidence-based Healthcare: How to Make Health Policy and Management Decisions. New York: Churchill Livingstone Issel ML. (2008). Health program planning and evaluation: a practical and systematic approach for community health. United States, Jones & Bartlett Learning. Lewis D. (2006). Economic Evaluation of Health Care Programs. School of Economics and Information Systems University of Wollongong. Melnyk BM and Fineout-Overholt E. (2005). Evidence-based practice in nursing and healthcare: A guide to the best practice. Philadelphia, PA: Lippincoot, Williams and Wilkins. O'Connor-Fleming ML, Parker EA, Higgins HC and Gould T. (2006). A framework for evaluating health promotion programs. Health Promotion Journal Australia, 17(1): 61-6. Royse D, Thyer BA, Padgett DK. (2009). Program Evaluation: An Introduction. New York, Cengage Learning Saunders RP, Evans MH, Joshi P. (2005). Preparing a process-evaluation plan for evaluating health promotion program execution: a how-to manual. Health Promotion Practice Journal, 6(2): 134-47. Savaya R. and Waysman M. (2005). The rational model: A tool for integrating theory in improvement and evaluation of programs. Administration in Social Work, 29(2): 55-103. Smith MJ. (2010). Handbook of Program Evaluation for Social Work and Health Professionals. United States; Oxford University Press. Unrau YA, Gabor PA, Grinnell RM. (2006). Evaluation in health work: the skill and knowledge of practice. United States; Oxford University Press. World Health Organization (2007). Health Programme Evaluation: Guiding Principles. Geneva: Author. Read More