An Aspect of Nursing Practice - Care in the Community - Coursework Example

An Aspect of Nursing Practice: Care in the Community Introduction A nurse has a pivotal role to play in the healthcare sector and it is assuming moreintricacy with the development of technology and community health services, where the target population is increasingly becoming more heterogeneous and cosmopolitan. Gone are the days when a nurse had to shoulder just minor responsibilities like changing dressings and administering medication according to the doctor’s order in a hospital setting. The profession has evolved along the course of history and we find that nurses now have highly specialized roles to play in the hospital as well as the community setting. Fields like adult/neonatal care, mental health, children, learning disability, etc. are increasingly becoming areas of specialization for the nursing profession. A nurse is a person whose profession involves close contact with patients in their gravest hour of need and leaves a lasting impression for life. It calls for qualities of courage, compassion and unflinching commitment while restoring a person to normal health. At moments they are exposed to sights which are both disturbing and sometimes emotionally upsetting for a normal layperson. Hence it calls for special strengths which are necessary for performing the duties in challenging situations. In a community setting the overall health scenario needs to be dealt with both a proactive and emergent approach. In the former, general preventive measures such as vaccination, dealing with nutritional deficiencies as well as diet restrictions, disease control with preventive medication and making the general public aware of proper health and hygiene related matters incorporate the responsibilities of a nurse. In an emergent situation the nurse has to deal with minor infections and emergency accidental situations which keep occurring at a constant pace in any community setting. A career in nursing can begin with a support role from the lowest level to that of registered nurses which essentially requires a diploma or a degree in the profession. A person may choose to enter the profession by directly earning such qualifications from a school or university offering such courses. Once qualified a nurse has a lot of opportunities towards a satisfying and fulfilling career with growth and development as a person. The National Health Services (NHS) in the United Kingdom offers incentives which are directed towards job satisfaction and support (www.nhscareers.nhs.uk). A career in nursing is very demanding, both physically and psychologically and hence calls for qualities of good health in an incumbent (www.ncsi.co.uk). A good academic background, effective communication skills, determination to succeed and keeping abreast of the latest developments in the area of specialization are absolutely essential qualities for a person in this profession. In the nursing profession, qualities of teamwork and cooperation are absolutely essential as it involves being part of a multidisciplinary team where the activities have to be coordinated to perfection in order to achieve the desired targets and goals. Diagnosis is established only with the efforts of physicians, laboratory technicians, radiologists, pathologists and other experts. Coordinated communication amongst such professionals is crucial for the efficient delivery of health services. With the splitting up of Medicare into multiple disciplines and super specialization due to advances in knowledge as well as technology, earmarking of professionals for specific areas has become absolutely essential. The communication with the target population in need of health services is of utmost importance as it needs to be considerate, professional as well as effective in order to achieve the desired results. A multidisciplinary team is comprised of a general medical practitioner, the district nurse, practice nurses, social workers/care managers in a primary medical care organization. The district nurse provides the full range of nursing services at the practice as well as the patients’ homes while the practice nurses are usually attached to the General Practitioner at the hospital premises and have vital role in community vaccination protocols, travel advice, childhood immunization, health screening including basic diagnostic procedures and providing information, advice and support for programmes involving promotion of family health, health education and disease prevention (www.northumbria.nhs.uk). Social workers and care managers are responsible for ensuring compliance and proper application of the required procedures in the community setting. As this hierarchy of health services in the general practice involves many people, conflicts can arise at various levels due to non compliance at the professional as well as patient level, encroachment on the areas of duty and personal ego. All such issues need to be addressed and clear cut roles assigned to the professionals involved under the overall guidance and monitoring of a hospital administrator. Workloads need to be shared in a justifiable and feasible manner so as to facilitate professional delivery of health services. The coordination in multidisciplinary health services acquires even greater significance in areas of specialized nursing services such as adult care, dealing with patients with mental illness, handling severe trauma in surgical practices, working with prisoners, school children and children with attention deficit disorders. Such categories need special talents as well training in advanced operations in order to tackle the intricate issues involved in specific areas. Ability to take quick decisions, being prepared for any emergent situation and professional precision are essential for nurses selected for working in disciplines requiring specialized training. Ability to work as a team is absolutely essential in such areas of work and any flaws and inconsistencies within the team need to be addresses quickly and the lacunas or differences ironed out professionally. Mental health in the community and psychotherapy are the disciplines which have increasingly been identified as treatable with the recent advances in psychopharmacology and development of newer psychological counselling regimens. Rapid advances in the socio economic scenario and multi ethnic character of society has put new pressures on the human psyche which result in psychological afflictions in people from all age groups. Treatment with drugs is possible, but more important is the compliance with therapeutic regimens and the need for emotional support in such patients, where the duties of a specialist nurse are not only required, but is absolutely essential. The focus of treatment of such patients has now shifted from an institutionalized setting to the delivery of mental health services in the community setting itself where patients are taught to overcome and deal with their individual situations in a practical manner within the society itself (Kenworthy N. Et al). There has been a shift towards social care while dealing with mental illnesses in society with the concurrent rise in the importance of the mental health nurse. The identification and classification of psychological disorders into those of organic origin and others which have totally social behavioural patterns necessitates treatment to be administered at the community level which is less dependent on drug therapy and more on social counselling and rehabilitation. The focus of clinical practice in mental disorders has significantly shifted in the recent past towards providing psychosocial mode of care, with the psychologist and nurse playing important roles (Kenworthy N. et al). With the recognition of palliative care as an essential element of medical services and identification of its elements by the WHO (World Health Organization) in 1990 (Chippendale Simon) its role in surpassing traditional medicine and its clinical boundaries has been recognised. Of special interest is the care of old as well as dying patients who need utmost care in desperate situations, where neglect is usually present in most societies. A more humane approach has been suggested for dealing with dying patients in the medical fraternity (Clark David, 2002). The Gold Standards Framework (GFS) of the National Health Services in the UK is aimed at developing a locally based system to improve and optimise the quality of care for the dying patients as well as for those who care for them in the last year of their life (www.goldstandardsframework.nhs.uk). Nurses who work in this specialized area have a significant and responsible role to play as usually the stress is less on medication and more on providing mental succour and facilitation of life support systems to such patients so that the end is in reasonably congenial circumstances. Working in this area is not only professionally rewarding but also provides a sense of benevolence and satisfaction to the administrator of such services. Nurses have an important role to play in the development of society by ensuring the health of children, especially those with learning disabilities and attention deficit orders to overcome their shortcomings and emerge as responsible citizens in society. This area of specialization has received much significance in the last decade due to identification and available of appropriate treatment for such disorders. A learning disability nurse helps a person reach a balance in his mental faculties and reach the achievable goals in life (Kenworthy N. et al). Such nurses work in conjunction with multidisciplinary teams in the hospital setting as well in community learning disability teams and community homes run by local authorities as well as NHS Trusts. This activity requires development of a number of skills which are necessary to exercise the roles of a learning disability nurse. Besides the specialist role, nursing at the community level needs rapport with the people in society at a personal level and assisting them in following healthy practices in life and providing technical support for patients who need daily care like diabetics, asthmatics and those suffering from hypertension to follow their therapeutic regimens effectively. Assisting people in wound dressing and other minor medical and surgical procedures are also covered in such activities. The nurses are also empowered with a limited right to prescription and the Extended Formulary Nurse Prescribers can prescribe any licensed medication for any medical condition within their competence, including some controlled drugs (www.dh.gov.uk). Necessary training and skills are imparted in order to exercise such prescribing rights. The Nursing Midwifery Council (www.nmc-uk.org) lays down some guidelines and codes of practice for the nursing profession. Such codes include diverse topics such as record keeping, following guidelines for complimentary and alternate therapies, promotion of an environment for care, ensuring proper delegation of registered/midwives for individual patients, maintaining a professional and neutral attitude during the administration of services, obtaining consent before the initiation of treatment, maintaining confidentiality and being accountable for their actions. Conclusion Nursing in a community setting comes with a lot of duties and responsibilities which require professional training as well as awareness of rules, guidelines and codes of conduct in order to practice effectively. With the availability of newer diagnostic and therapeutic techniques, the ability to stay abreast of the latest developments and continuing education in a persistent manner is absolutely essential. The profession has diversified into super specialities such as child care, adult care and palliative care which call upon great efforts in terms of emotional support to the patient and professional competency on the part of the nurse. The profession is both challenging as well as rewarding in terms of career growth and professional satisfaction. The present community environment is diverse due to its multicultural ethnic character and poses new challenges which need to be mastered with general awareness, commitment and attainment of high standards of professional skills which are readily available and within reach. The government authorities and regulatory bodies have facilitated the functioning in a better manner by providing infrastructure for the same. References: Chippendale Simon, AHS321: Palliative Care In Practice [Online] last assessed January 20, 2008 at URL http://resources.glos.ac.uk/subjectsandcourses/undergraduatefields/ahs/descriptors/ahs321.cfm Clark David, (2002), Between hope and acceptance: the medicalisation of dying, BMJ 324:905-907 Kenworthy Neil, Gilling Cynthia M. and Snowley Gillian, Common Foundation Studies in Nursing, Third Edition, Churchill Livingstone Multidisciplinary Team based in the Community, [Online] last assessed January 15, 2008 at URL http://www.northumbria.nhs.uk/subpage.asp?id=267706 Nursing, [Online] last accessed January 17, 2008 at URL http://www.nhscareers.nhs.uk/nursing.shtml NURSING CONSULTANCY SERVICES [Online] last accessed January 17, 2008 at URL http://www.ncsi.co.uk/ Nurse independent prescribing. [Online] last assessed January 21, 2008 at URL http://www.dh.gov.uk/en/Healthcare/Medicinespharmacyandindustry/Prescriptions/TheNon-MedicalPrescribingProgramme/Nurseprescribing/index.htm The gold standards framework, A Programme for Community Palliative Care [Online] last assessed January 16, 2008 at URL http://www.goldstandardsframework.nhs.uk/ Read More