Professional Experience of Nurses - Essay Example

?Introduction Nursing has continued to be an evolving practice that is hard to define. However, many definitions of nursing have been suggested by many authors. Florence Nightingale defines nursing as the process of utilising the patients' environment to assist in their recovery (Kozier et al 2008). Virginia Henderson views nursing as an act of assisting individual, well or sick, in the performance of those activities that contributes to health, it's recovery, and promoting quality of life or to a peaceful death (Crisp &Taylor 2005; Funnell et al 2009). In nursing, a combination of clinical experience, technical skill and theoretical knowledge is required in providing high standard care (Funnell et al 2009). Hence, an Act of Parliament in 2002 created the Nursing and Midwifery Council (NMC) to regulate nurses, and protect the public by ensuring that nurses provide high standard of care to the patients (Kozier et al 2008). NMC code of conduct stipulates that nurses are obligated to act ethically and are accountable for their own actions (NMC 2010). This essay will reflect on the roles and responsibilities of a registered nurse in relation to consent to treatment. For this reflection, I will apply Driscoll’s (2007) reflection model that asks three main questions: What? So what? and Now, what? (Bulman & Schultz 2008). To protect the anonymity of patients and staff, real names shall not be used (NMC 2008). Nurse role in relation to consent What? Luke is an 18 year old male with a diagnosis of major depressive with psychotic symptoms. He was admitted informally to acute mental health inpatient following an impulsive overdose few months after the death of his father. On a morning shift during my placement, Luke was elated in mood, very anxious and was observed to be experiencing auditory hallucination saying that “he wants to go and rest with his deceased father". Hence, Nurse A decided to urgently administer his medication after consulting with the duty doctor who prescribed Risperidone 2mg. Luke refused to take the medication stating that his mum has not been informed. However, Nurse A had an informal discussion with Luke where she informed Luke that he would not be allowed to the servery if he does not take his medication. Hence, Luke reluctantly took the medication without formally consenting to it. Hence, Nurse A breached the informed consent requisite to care when she failed to adequately provide information to Luke and his mother and enable them to make an informed decision. So What? Luke was admitted informally and had previously made an advanced directive to have his mother make the medical decisions for him. Elkin et al (2007) noted that in advance directives, patients communicate their wishes or values about future medical care to help guide decisions that include overwhelming illness, sedating drugs or unconsciousness, when the patient can no longer participate. It is a means of empowering a person with mental illness by increasing autonomy and decreasing coercion in the treatment they receive (Kozeir et al 2008). According to the Department of Health (DoH 2008), patients may want to nominate a person to be notified of, or involved in, decisions related to their treatment and care. The involvement of his mum can have a major benefit for the treatment and care of Luke. DoH (2008) asserts that such involvement can provide reassurance to Luke, who may feel distrustful of practitioners who are relatively unfamiliar and unknown to him, or able to impose compulsory measures on him. However, Nurse A administered the medication without adequately informing the patient and his mother. Thus, nurse A’s actions violate Luke’s right to informed consent. The role of nurses is to gain informed consent based on the provisions on standards of conduct indicated by the Nursing and Midwifery Council (2008). Even if Luke handed the reins of the decision-making authority to his mother, Mental Capacity Act (MCA 2007) stipulates that patients must be informed in which circumstances they can be treated without consent, and circumstances in which they have the right to refuse treatment. Informed consent is a procedure that allows a patient to voluntarily agree to proposed treatment after a discussion of risks, advantages, disadvantages, and alternatives (Watterson 2012). The inclusion of patients, who are seriously ill, and therefore potentially vulnerable, requires careful exploration of ethical and legal principles that underpin informed consent (Agar et al 2013). In health care, the purpose of informed consent is to make sure that patient's autonomy is respected in decisions about their health care (Silveira et al 2010). Since effective informed consent depends on patients being able to make decisions about treatment free of pressure and based on logical reasoning, patients should receive adequate information about the nature and benefits of the proposed treatment (Susilo et al 2013). Based on ethical principles, Nurse A should honour Luke and his mother’s right to be informed about the procedure and make a decision based on the information given to them (Silveira et al 2010). Nurses must share with people, in a way they can understand, the information they want or need to know about their health (NMC 2008). This would enable them understand in broad terms the nature, likely side effects and outcomes of treatment, which include likelihood of it success (DoH 2008). According to Goldfarb et al (2012), obtaining informed consent in the clinical setting is an important yet challenging aspect of providing safe and collaborative care to patients. Collaborative care involves enhancing the patient’s skills and knowledge through maximizing their independence, giving information, giving patients choice, and understanding patients’ individual needs (Wocial et al 2010). It is clear from these indicators of partnership that nurses must work collaboratively with patients, with nurses sharing their knowledge and decision-making power (NMC 2010). Thus, Nurse A did not demonstrate collaborative care when she compromised Luke’s visit to the servery and failed to contact Luke's mother prior to the treatment. This highlighted the power imbalance between nurses and patients which is a potential inhibitor of partnership in care (Henderson 2003). Kallert (2008) noted that when adolescents are hospitalised because of their unstable mood and/or self-destructive behaviour, without exception they are almost deprived of their right to self-determination. Hence, nurses and other healthcare practitioners have undeniable authority over them and often make decisions against their will (Biering 2002). In order for mental health nurses to become more effective, Warne & McAndrew (2007) argue that nurses need to learn how to relinquish some of their power, even where this gives rise to uncomfortable tensions for them. Regrettably, patients tend to be marginalized within illness discourse and possess little power to make their own decisions about their care (Henderson 2003). Nurse A may argue that it was in Luke’s best interests to take the Risperidone in order to prevent serious deterioration mental state. However, this argument would not hold in the face of the fact that the patient agreed to have his mother be authorised to make the decision on his behalf. Nurses are duty bound to give their patients the necessary information they need about any medical procedure and allow them to make the autonomous choice on the procedure (Silveira et al 2010). Hence, the MCA stipulates that individuals have the right to make what might be seen as unwise or eccentric decisions (DoH 2005). However, as an alternative and best practice in averting possible risks factors of non-concordant to prescribed medication, Nurse A should have considered calling for a mental capacity assessment (DoH 2005). This would help to ascertain whether Luke lack capacity to make an informed decision, if otherwise, Luke would then be sectioned under the mental health act 2007 which will impose section 3 (compulsory admission for treatment) and section 62 (urgent treatment) subject to second opinion (Jones 2011). Therefore nurses must be fully aware of the legislation regarding mental capacity, making sure that people who lack capacity stay at the centre of decision making and are fully safeguarded (NMC 2008). Now what? I have learnt that patients deserve as much respect from healthcare practitioners as other members of the public. The legal and ethical requisites relating to health care delivery must be applied to all patients, regardless of their mental state (NMC 2008). Nurses have the responsibility to inform their clients about the options relating to their care and avoid using coercive means to administer any treatment or intervention (Hannum 2011). Informed consent implies that the patient knows what treatment would be applied, including its risks and side effects and is willing to take the possible risks relating to such treatment (Cheatle & Savage, 2012). I have also found out that Nurse A is accountable for her failure to gain the patient’s informed consent. Nurses are therefore required to practice much caution in their decisions, and are accountable for their actions and decisions (NMC 2008). Respecting the patient’s right to informed consent is a legal and ethical requisite and part of the nurses’ public responsibility (NMC 2010). Possible exceptions which would justify the lack of informed consent are not present in this case especially as Luke’s mother is authorised as his medical representative (Heinrich et al 2011). OUTCOME 2: SWOT Analysis Introduction In this session, I will critically analyse my strength and weakness in relation to my ability to undertake the role of a registered nurse. In other to achieve this, my Strength, Weakness, Opportunities and Threats (SWOT) analysis will be developed in order to assist me in identify my developmental needs from the present time to 6 months post qualification. Strength I believe that my strength lies in my ability to read through non-verbal cues. I am a very intuitive and observant individual. I can easily read people and how they are feeling even if what they are saying is different from what they are actually feeling. Caring for a patient is a complex process and part of this process is non-verbal communication, which is a vital aspect for nurses to take into consideration during care delivery (Royal College of Nursing 2004). Certainly, non-verbal communication is a major influence that can control the entire interaction process between nurse and patient, and hence impact on the quality of care (Chan 2013). Thus, all nurses must build partnerships and therapeutic relationships through safe, effective and non-discriminatory communication, which must take account of individual differences, capabilities and needs (NMC 2010). My mentors have mentioned that they observed how well I can observe my patient’s non-verbal cues and to make the necessary adjustments to their care based on these cues. Moran et al (2011) found that direct involvement with clients and communication skills are the two most strongly supported core roles for student nurses. Hence, given that student nurses in mental health settings often experience less time pressure, clients have more access to them and value their input highly (Warne et al 2000). Therefore, if properly mastered, non-verbal communication can significantly help in providing quality and effective care from nurse to patient (Cleary et al 2006). Weakness Since I started my nursing training, I have recognized the fact that there are some aspects of my nursing practice which I need to improve on. I recognized that I need to improve my verbal communication skills, mostly those which relate to establishing rapport and informal conversations with patients. I have found that I sometimes do not know the words to use in order to develop rapport with patients. My mentor also remarked that I tend to use practiced and rehearsed words which do not help patients relax. As a result, it sometimes takes a long while before my patients are comfortable with me. They often remain tense and do not become comfortable with me during the initial minutes I am meeting or caring for them. In reviewing literature on communication skills, I have learnt that establishing rapport with patients is an important aspect of nursing care because it sets the tone for the rest of the health care administration process (Hulme 2013). According to Porr et al (2012), it can dictate the tone and direction of the nurse-patient relationship and is crucial in ensuring safe, timely, coordinated, collaborative, and effective patient care. hence, nurse need to communicate efficiently with everyone in the healthcare environment and therapeutically with patients (Funnell et al 2009). Nurses’ ability to communicate therapeutically is a crucial factor in the way patients experience illness (Jasmine 2009). Hence, mental health nurses must use skills of relationship-building and communication to engage with and support people distressed by hearing voices, experiencing distressing thoughts or experiencing other perceptual problems (NMC 2010). The Skills Framework and NHS knowledge sets communication as its number one core dimension (DoH 2004). Its purpose is to describe and define the vital components of communication NHS staff should apply in order to deliver quality care (Hogston & Marjoram 2011). The dimension emphasises that staff should maintain and develop communication with people on complex maters, ideas and issues and or in difficult situations (DoH 2004). Hence, Heidental (2003) states that clear and open communication is essential in managing disagreements and conflict amongst people. Callaghan et al (2009) concur to that by stating that effective communication helps in preventing and managing aggression amongst patients. Nurse should have sufficient skills in what they do for patients but at the same time they need to be communicating with them in a ways that are helpful, supportive and in ways which promote feelings of trust (Glen 2009). In hindsight, I am now aware of the fact that I need to develop verbal communication skills in the area of building rapport to be able to relate effectively with patients and other healthcare practitioners. Moran et al (2011) establish communication to be one of the four core support competencies, and concluded that the workers personal attributes are essentially linked to the success of communication between qualified nurses and their patients. Thus, it is important that newly qualified nurses are provided with an understanding of effective communication principles by senior nursing staff and given the opportunity to practise these in a supportive environment (Cleary et al 2012). Opportunity In order to improve my weakness, I have to participate in a preceptorship (NMC 2006). The preceptors are Registered Nurses (RN) who supervise, role model and support their designated students, working in partnership with them to identify and meet the learning needs of individual students (Newton et al 2012). The preceptor can help me build relationships with patients and other healthcare professionals, ensuring my place as a member of the healthcare team (Whitehead et al 2013). The preceptor’s role is to ensure that I would be able to undertake the role of a registered nurse by using real experiences with their support and guidance (NMC 2010). Through the preceptorship programme, I would be working with a senior qualified nurse (preceptor) (Whitehead et al 2013) who can assist me in improving and developing my communication skills in rapport building and to also improve and strengthen other areas of my practice. The duration of the preceptorship would have to be based on the skills I need to build and how well I can follow through the preceptorship programme. Hence, in order to enhance continuity and clinical learning within the 6 months of my preceptorship, I would be rostered on to the same shifts as my preceptor (DoH 2010). During the preceptorship training, I would gradually adapt from the transition of being a student nurse to a registered nursing staff by developing my areas of weakness and strength with the support and assistance of my preceptor. Newly qualified nurses should endavour to improve their strengths and weaknesses, and learn ways by which such gaps can be managed (Duchscher 2008). However, in order to improve my skills in building rapport, I will participate in a Professional Development Program, choosing the program which builds on communication skills and rapport building (Haddad et al 2010). Threat I see some threats to my practice with the main threat being the inadequate time which I can allocate for my patient and with my preceptor. Inadequate time has always been a problem in the nursing and medical practice, and this problem relates to the inadequate staff members employed by hospitals and the healthcare community in general (Garrosa et al 2010). Shortage of staff is credited to the limited number of nurses actually seeking and maintaining a career in nursing (Harrison-White & Simons 2013). This shortage is also attributed to the economic limitations on budget allocations for healthcare and decreasing hiring of nursing staff (Cleary et al 2011). The shortage of staff impacts on the remaining staff members who are stretched too thin among patients (Omansky 2010). Hence, the time allocated to patients is shortened and can impact on the quality of care which can be rendered (Funnell et al 2009). This shortage also impacts on the relationship of the transitioning nurse and the preceptor especially as the time they can spend together is affected (Teng et al 2010). Thus, preceptor cannot spend as much time as possible for the transitioning nurse and cannot properly inform and improve the skills of such nurse (Happell 2009). This is unfortunate considering the fact that these transitioning nurses can learn a lot from their preceptor and the preceptorship may be the only time for the transitioning nurse to improve their skills before they can actually be introduced as registered nurses into the nursing practice (Applin et al 2011). My threat relates to the fact that I may not have enough time with my preceptor and in the end, I may not be able to improve on my skills or manage my weaknesses. Conclusion The SWOT analysis has helped me to explore and identify my own developmental needs in relation to my ability to undertake the role of a registered nurse. This weakness has been singled out because I want to improve on it and because most of my mentors also noted that I need to improve it in order for me to relate better with my patients. NMC (2010) states nurses must use the full range of communication methods, including verbal, non-verbal and written, to acquire, interpret and understanding of people’s needs. Therefore, I will channel all my energy in improving my communication skills in order to communicate effectively with patients and other healthcare practitioners. Read More