The Care Rendered by Nurses in the Clinical Setting - Essay Example

Introduction Nurses play a very important aspect to humanity’s quality health care. They offer very important contribution to all medical-related situations. Nurses do have clearly defined and explained responsibilities attached to nursing as a profession. Because of this, it is then believed that nurses need continuous mentoring especially when it comes to their leadership, management, teamwork and interdisciplinary collaboration to the nursing profession skills. The Care Rendered by Nurses in the Clinical Setting Nurses comprise the largest single component of hospital staff, they are the primary providers of hospital patient care, and they deliver most of the nation's long-term care. Most health care services involve some form of care by nurses. Although 60 percent of all employed Registered Nurses (RNs) work in hospitals, many are employed in a wide range of other settings, including private practices, public health agencies, primary care clinics, home health care, outpatient surgicenters, health maintenance organizations, nursing-school-operated nursing centers, insurance and managed care companies, nursing homes, schools, mental health agencies, hospices, the military, and industry. Other nurses work in careers as college and university educators preparing future nurses or as scientists developing advances in many areas of health care and health promotion (http://nursing.about.com/gi/dynamic/offsite.htm?site=http://www.aacn.nche.edu/education/Career.htm, 2004). As stated above, nurses of different category offers various forms of care and health services to patients. Generally, nurses make contributions to the care and support to all people. Nurses working within well-women and family planning services contribute to the health of people by providing sexual health, health promotion, counseling, family planning and contraception advice. Some nurses work as part of highly specialized teams in genetic departments where the focus is on detection and counseling (http://www.scotland.gov.uk/library5/health/phsi-06.asp, 2004). Though often working collaboratively, nursing does not "assist" medicine or other fields. Nursing operates independent of, not auxiliary to, medicine and other disciplines. Nurses' roles range from direct patient care to case management, establishing nursing practice standards, developing quality assurance procedures, and directing complex nursing care systems. With more than four times as many RNs in the United States as physicians, nursing delivers an extended array of health care services, including primary and preventive care by advanced, independent nurse practitioners in such clinical areas as pediatrics, family health, women's health, and gerontological care. Nursing care's scope also includes care by certified nurse-midwives and nurse anesthetists, as well as care in cardiac, oncology, neonatal, neurological, and obstetric/gynecological nursing and other advanced clinical specialties (http://nursing.about.com/gi/dynamic/offsite.htm?site=http://www.aacn.nche.edu/education/Career.htm, 2004). Advantages of Additional Skills: Leadership, Management, Teamwork and Interdisciplinary Collaboration to the Nursing Profession With these very special functions of nurses, it is then became imperative for them to acquire additional skills and knowledge that would help them in the successful attainment of all the nurse’s common goal – the quality health care. Hence, leadership skills, management, interdisciplinary teamwork and collaboration became a part of every day’s routinary attributes of nurses. With regards to leadership skills, one important and practical theory that can be best practiced by nurses is transformational leadership and the dynamic leader-follower relationship model (Valentine, 2002). Transformational leadership merges ideals of leaders and followers. Its focus is to unite both manager and employee to pursue a greater good and "encourages others to exercise leadership" (Sullivan & Decker, 2001). Transformational leadership promotes change and suites the extremely dynamic health care system. Its focus on change can be directly applicable to nursing (Sofarelli & Brown, 1998). Nurses are in a unique position of evaluating end results of both new and old policies and procedures. Using transformational leadership, managers can motivate nurses, especially the new ones, to submit feedback on how well unit specific procedures are carried out and implemented. The key is to actively listen and institute pertinent suggestions that not only promote client outcomes, but also again help to build a base of leadership with the nurses. Not everyone can take direct action on issues directing affecting patient care by sitting in on an advisory meeting or voting on proposed legislation. Transformational leadership provides new nurses with a method of taking an active and participatory role in policy within a new nurse’s jurisdiction and power (Valentine, 2002). Central to the theme of new nurses as leaders is the fact that effective leaders are also proficient clinically. New nurses can incorporate leadership fundamentals while developing competency in their profession. Nurses provide the majority of care and spend the majority of time with a patient, they are clearly not at the same power-level/structure as physicians or administrators. Few new nurses have input on major decisions affecting an organization. What new nurses can do is propose improvements to the existing status quo. They can submit new scheduling options, take the lead in presenting in service training or consult on retention and recruitment issues (Valentine, 2002). Meanwhile, the value of working in interdisciplinary teams is not a new concept in long-term care. Its value is a key to the success of this alternative long-term care model. Team members include an executive team made up of a medical director, attending physician, home health aides, nurses, nurse practitioners, nutritionists, pharmacists, physical and occupational therapists, recreation therapists and aides, social workers, van drivers as well as students from professional schools and residents (Dixon, 2000). Quality patient care depends on professionals who are experts in their field to contribute to the care plan. But when the focus is on each function and/or specialty, care is diminished because it is fragmented. The interdisciplinary team approach promotes integrated and coordinated care for the resident in which all participants in the care-delivery process are focused on the patient rather than their specialty. Expertise is shared synergistically from a holistic viewpoint (Dixon, 2000). The interdisciplinary team is particularly important in any health care – may it be a short or on a long term basis, because patients lose function gradually and require multiple interventions from a variety of caregivers over time. Hence, it makes sense that the various disciplines collaborate to provide the most appropriate care for the long duration. An example is completing the Minimum Data Set (MDS), which provides a baseline opportunity for interdisciplinary teamwork. However, effective teamwork needs to be much more than completing the form. The form is the end product. What is equally important is the dialogue, inquiry, and collaboration that should occur in care-plan development that results in completion of the MDS. All disciplines have tremendous opportunities to work across traditional boundaries. A coordinated and integrated approach is more likely to lead to quality care (Dixon, 2000). The high commitment of the team was another success factor. Team members were driven by the desire to be mission-focused and solve facility problems that affected quality of care. Having a common goal and approach to reducing the number of falls helped the team attain intended outcomes. In addition, team members were mutually accountable for achieving performance results. Finally, the underlying respect that team members had for each other helped them to resolve conflicts productively. The sum of all of these factors contributed to an effective interdisciplinary team (Dixon, 2000). Furthermore, team members had to learn to trust each other, and in so doing, overcome typical hierarchical issues such as charge nurses taking direction from housekeepers. In the team process, essentially, the person's idea is what counts, not his or her title. In addition, the team found that celebrating small victories reinforces success and learning (Dixon, 2000). In addition, healthy interdisciplinary teams develop behavioral norms that help them to manage group dynamics effectively. They manage functional and organizational boundaries particularly keeping in mind the more subtle psychological boundaries related to identity, politics, task, and authority. Diversity is valued and differences that naturally arise because of education, personality, gender, ethnicity, etc., are respected. Small and large wins are recognized, celebrated, and rewarded. Finally, successful interdisciplinary teams are continuously learning (Dixon, 2000). Reflection on Training and Mentoring in the Clinical Area To start, the mentor or trainer in the clinical area must learn the basics of the training as a whole. He/she must know how to initiate a training plan, how to facilitate and manage it and at the same time, he/she must know how to end it and do the evaluation. Training Approach To establish a good training, there must be a complete training cycle to follow. A training cycle is composed of planning, execution, and follow-up or revision or the post – evaluation phase. Tom Goad, training specialist, describes these phases as an inter-related system or continuous cycle, (Goad, 1982). To illustrate it: Figure 1. A training / Learning Cycle In the analysis phase, there are two primary purposes – to make sure that the training is very much needed and to ascertain that the training would be based on credible and reliable training materials. In this phase, the trainer should identify what the issue is that has posed training as a solution (this is often called "needs assessment"), inquire about the tasks and skills needed to accomplish a function or job, and identify who the possible learners are (Goad, 1982). During the designing phase, the trainer/designer determines the strategy to be used in accomplishing the training. Furthermore, the trainer, on this stage, gathers data on which to base his/her learning objectives, the driving force behind the design. He / she should have also decided on what training approach he/she is to follow, through looking at the learning objectives, the training methods, tools, and timing appropriate for the skills to be learned and the learners participating. And lastly, this would also be the phase during which the need for pre-testing might be determined (Goad, 1982). Meanwhile, on the development phase, the trainer develops training methods, which may include experiences, tools, and methods of delivery. In this phase much attention is paid to the look and feel of the final training event, including supportive materials, packets, overheads, technological requirements, etc. The final flow, or blocked out design results from work done in this phase (Goad, 1982). The next phase would be the conduction phase. This will be the time when the trainer conducts the actual training. In addition, the trainer monitors progress and response of learners, attempting to evaluate the effectiveness of the design and delivery as the training unfolds, and adjusting during the session as needed. Notes taken during this phase will be valuable in the evaluation phase (Goad, 1982). And last, but definitely not the least, would be the evaluation phase. The training program is evaluated and feedback gathered for updating or revising the training design. What is so surprising is that this phase is typically the most neglected phase of the training cycle as the trainers and learners all breathe a sigh of relief. However, if attended to correctly, this phase can create better training programs later, can serve to guide revision of the program, can give the trainer important feedback on his/her performance. This phase leads directly back into the Analysis phase during which data gathered in evaluation is used to determine further training needs (Goad, 1982). Conclusion Becoming a nurse, offering numerous medical care services, specifically in the clinical area, is truly not a joke. The baccalaureate degree alone, requires hard work and too much discipline on the part of the nursing student. And by attaining the degree does not mean that it will end there. Once you practice your nursing profession, you have to obtain more skills and knowledge, which more often than not, do not came from the four corners of the classroom, but through your own experiences. And these skills such as the ability to effectively and efficiently take the lead, proper management of teams and interdisciplinary and teamwork collaboration are enough practices and attributes which enhances the harmonious relationship within all the medical and/or health providers, especially the nurses. All these are aiming directly at one ultimate goal – to provide good quality healthcare. References: Clark, Donald. Introduction to Instructional Design System. July 1995. Updated November 6, 2000. Dixon, Diane. 2000. New Perspectives on Interdisciplinary Teams in LTC. http://www.amda.com/caring/march2003/leadership.htm Goad, Tom W. Delivering Effective Training. San Diego, CA: University Associates, 1982. 1996. Association of Research Libraries, Washington, DC. Sofarelli M.. & Brown, R. 1998. The need for nursing leadership in uncertain times. Journal of Nursing Management 6(4), 201-207. Spitzer, Dean. Five Keys to Successful Training. June 1986. 1996. Association of Research Libraries, Washington, DC. Sullivan, E.J. & Decker, P.J. 2001. Effective Leadership and Management in Nursing (5th ed.). Upper Saddle River, NJ: Prentice Hall. Valentine, Susan O. 2002. Nursing Leadership and the New Nurse. http://juns.nursing.arizona.edu/articles/Fall%202002/Valentine.htm College of Nursing. 2004. The current contribution of nurses and midwives. 2004. Your Nursing Career: A Look at the Facts. 2004. Read More