Patient Centered Care - Term Paper Example

? Patient Centered Care Patient Centered Care Introduction A definition by the American Nurses Association , s that “Nursing is the optimization, protection, and promotion of health, as well as, the ability to prevent illness and injury; alleviation of suffering through treatment of human body response; and advocating on how to take care of communities, individuals, population, and families.” According to Bell (2012), the scope of professional nursing defines the boundaries that are held by a nurse including the procedures, actions, and processes within the roles that the nurse has received education, training, licensure, and certification needed to practice his or her occupation. However, these boundaries are subject to change in terms of flexibility, exchange and expansion with respect to the evolving needs of patients, organizations, and the society at large. On the other hand, the standards of the nursing profession are authoritative statements that describe the level of care and performance that are common to the profession of nursing according to which the quality of nursing can be judged (Bell, 2012). These standards reflect the professional activities and behavior that are expected within the scope of the nursing profession. However, professionally trained nurses should understand and integrate the acquired knowledge, training and education with the application in practice so as to improve health outcomes. In real life clinical experience, nursing is a day to day practice that involves the use of critical thinking, decision making and diagnostic skills. Nurses are also involved in other processes which include advanced assessment, differential diagnosis, outcome identification, plan of care development, implementation of treatment, evaluation of outcome, as well as, human relations. Each of these steps depends on the accuracy of the preceding step. A nurse has the responsibility of assessing patients and their families, their response to interventions according to the plan of care, critically review of outcome information as well as re-formulating the diagnosis. A nurse should possess Human Relation skills such as communication, teamwork with fellow nurses, doctors, patients, and families. These skills are very important in the achievement of the desires outcome (Bell, 2012). In performance of their roles, nurses deal with variety of patients from those with mild infections to those who are critically ill. Some of the critically ill patients in the Intensive Care Unit require intubation. This is one of the major role that can be delegated to the nurses. According to Adam and Osborne (2005), the nurse carries out the safety priorities such as: checking that the ventilation bag and suction equipment are functioning, attaching the ventilator to the gas source and ensuring that it is functioning, ensuring that emergency drugs are close such that the patient has access to them, and going through the checklist and ensuring that everything is safe and in place. Such critical conditions require specific nursing care since they can be risky. These risks could include: inability to intubate, aspiration of gastric contents, bleeding from trauma to the airway, endobronchial intubation especially in the right main bronchus, oesophageal intubation, vocal cord damage, perforation in rare cases, hypotension, arrhythmias and even dislodged teeth (Adam & Osborne, 2005). Statistics show that between 1 to 19 per cent of patients in ICU undergo unplanned extubation. Often, this has been associated with restlessness and agitation, confusion, previous accidental extubation episode, current history of smoking, medical “Intensive Care Unit”, use of physical restraint, decreased level of consciousness and oral endotracheal tube (Adam & Osborne, 2005). However, intubation also has advantages to the patient. First, it minimizes complications such as nasal trauma and nose bleeding that are attributed to the nasal route. In addition to that, for patients with major facial, head, or spinal trauma, intubation is done to minimize complications, and similarly gastric decompression should not be performed for patients with intact gag reflex (Beebe & Deborah, 2001). However, there is a possibility of legal issues that may even lead to a law suit especially if the patient’s bill of rights is not met. The patient’s bill of right states that a patient has the: right to considerate and respectful care, right to receive understandable information concerning their diagnosis, treatment and prognosis, right to make decisions about their plan of care, right to have an advance directive regarding their treatment or designating a surrogate decision maker with the expectation that the hospital will honor the intent of the given directive, right to privacy, right to confidentiality regarding his or her medical history, right to review their own medical records among other rights (Beebe & Deborah, 2001). According to Beebe & Deborah (2001), a patient has the right to refuse medical care, refuse medical advice as well as the right to give advance directives by himself or other physicians that should be respected by the hospital. Such directives my include DNR patients who should not be resuscitated. Before intubation is done, a nurse should explain to the patient the benefits of intubation as well as the possible risks involved. After this, a patient can either consent or refuse to consent to the intubation. However, if the patient is not in a position to make such decisions, their next of kin or a designated decision maker should be make the decision for them. The current scope and standards of the nursing profession are dynamic and continuously changing in order to satisfy the ever changing expectations of the society. According to Bell (2010), there has been an emergence of advanced roles in the nursing profession that have been accepted widely. This emergence has been brought about by the growing number of old patients, the growing complexity and severity of illness, the awareness campaign for all citizens to seek health care, and the decreasing number of nurses in the nation. As the roles in the nursing profession advance, its scale of practice widens and the standards go higher. In clinical practice, a professional nurse is expected to possess the quality of advanced assessment. Due to the growing number of people with complex diseases some of which have no cure, nurses have to pay attention to detail and assess syndromes and constellation of symptoms that could be common in other health issues. At this point the main roles of a nurse include generation, collection and integration of data from various sources (Bell, 2010). The data collected is important in making clinical decisions and judgments about treatment procedures and order of treatment. Another role is assessment of physiological and psychological risks that could affect the family and community environments as well as the health care systems. Another standard is differential diagnosis that involves independent analysis and synthesis data so as to determine a differential diagnosis for patients with critical and chronic diseases. With the sole aim of meeting the goals of patients, a nurse has a duty of diagnosing and identifying the possible problems and using that as a basis for creating an intervention that will be applied in the restoration of good health (Bell, 2010). The expected result is a clear formulation of the working diagnosis after analyzing data. This diagnosis should therefore be used in sustaining the patient’s physiological function and safety. It should be based on concrete findings such as x-rays interpretation, intubation, respiratory support and wound debridement. A nurse should be able to independently develop an individualized plan of care that addresses the needs of a patient depending on their age, gender, disability and other complementary health alternatives (Bell, 2010). In addition to that, a nurse should consult with the patient, their family, as well as fellow practitioners before developing the plan of care. However, the plan of action should be revised continuously with respect to their health improvement or deterioration, treatment goals and their response to treatment. A successful plan of care should facilitate a patient’s safe transition across all levels of care from admission, transfer, discharge, outpatient or even homecare (Bell, 2010). However, to avoid any legal issues and respect the patient’s bill of rights, a nurse bears the responsibility of informing the patient, other nurses as well as caregivers on the plan of care. In the implementation of treatment, a nurse is required to prescribe a treatment that is in line with the plan of care. This plays a major role in the management of chronic ailments. The main performance expectations from the nurse by this standard is the implementation of the plan of care incorporate the desired restorative, rehabilitative, curative, maintenance goals and outcomes. This done through prescription and monitoring of medication and therapy. After implementation of treatment, the nurse should conduct evaluation of the patient’s progress through the use of quality indicators, laboratory tests, clinical judgment, and conducting risk versus benefit analysis to achieve the goals (Lippincot & Wilkins, 2007). It is important to note that at each standard the plan of care is reviewed and edited to suit the patient’s current condition. Education and training received by nurses about patient care or nursing is a program that combines the collaborative model of care with the coordination of patient management. This kind of education provides nurses that have advanced competencies with respect to treatment of critically ill patients. The most preferred nursing practice for chronically ill patients is focused on pediatric care and adult gerontology studied at graduate and doctoral level of nursing. The qualification required in documents such as ‘The Essentials of Master’s Education in Nursing’ and ‘The Essential Doctoral Education for Advanced Nursing Practice’ include: advanced health or physical assessment, advanced physiology and pathophysiology, advance pharmacology, organizational and system leadership, health policy and advocacy, quality improvement and safety among other areas of study (Bell, 2010). At the end of the education program, a graduate is eligible to take national certification examinations that are in consistence with the duties as well as the license with regard to the focus of the population. According to The American Nurses Association (2010), the Model of Professional Nursing Practice Regulation of 2006 shows how the lowest level represents the responsibility of professional and specialty nursing organizations to their members and the public to define the scope and standards of practice. The next higher level represents regulations of the nursing practice acts and those of licensing jurisdictions. The highest level is of self determination by the nurse after all the other levels are considered. This results in achievement of safe, quality and evidence based practice. The nursing practice has undergone research that has led to its evolution from basic home care to a professional level. Initially nurses were trained in hospital based nursing schools and later employed to take care of patients privately in their homes. Today, as a profession, nursing evaluates and embraces evidence based practice, quality improvement, informatics and education in delivery of healthcare. Nursing found its foundation as a profession in the 19th century under Florence Nightingale due to her quality nursing care provision to soldiers during war (American Nurses Association, 2010). This encouraged nurses to take care of people beyond their homes improving health and safety in communities to prevent death. Research findings provide new knowledge that is applied in healthcare to promote effective and efficient care leading to improved outcomes, decreased practice variation and set the standards for excellence in healthcare policies. In conclusion, nursing is a demanding role that incorporates leadership, communications skills, critical, and integrative thinking since it is an evidence-based practice. The scope of professional nursing practice is based on the education and training, the environment of practice, the dynamics and needs of the changing society. On the other hand, the standards of the nursing profession are outcome oriented; with the main goals being health promotion, disease prevention, health education, curing, rehabilitation and restoration. References Adam S. K. & Osborne S. (2005). Critical Care Nursing: Science and Practice. Oxford University Press. American Nurses Association, 2010. Nursing: Scope and Standards of Practice. Silver Spring: Nursesbooks.org. Beebe, R. W. O. & Deborah L. F. (2001). Fundamentals of Emergency Care. New York: Cengage Learning. Bell, L. (2012). AACN Scope and Standards for Acute Care Nurse Practitioner Practice. Salt lake: American Association of Critical-Care Nurses. Lippincott, W. & Wilkins (2007). Critical Care Nursing. U.S.A.: Lippincott Williams & Wilkins. Read More