Professionalism in Nursing - Essay Example

Introduction Nursing has gone a long way since the time of Florence Nightingale who pioneered the art and science of nursing as we know it today. It is now a distinct profession separate from all other health care professions but still forms a vital part of the total health care team. With its rules, polices, practices, and guidelines, nursing today has evolved its own code of ethics by which all nurses must abide by. However, nursing today is faced with many challenges due to advances in medical technology, new developments in medical devices, scientific discoveries in disease treatments and in the world of medicine, a changed environment due to some political considerations such as health care reforms, and a new activism among patients. This paper examines the issues, concepts, challenges, and ethics in nursing today. Discussion In her book, Tilda Shalof detailed all the joys, excitement, challenges, and frustrations that nurses face every day. Nurses are almost always physically exhausted but also emotionally drained after caring for patients with all their skills, modern scientific resources, and a host of other heroic interventions to prolong life but sometimes they question at what cost? The nursing profession is not what most people believe it to be, something that is as sterile as most of the hospital environments are, but Ms. Shalof showed how nurses can be humorous at times, they can get excited over new patients, be committed to their work, rebellious at times to hospital administration authorities, have a strong sense of responsibility, and a shared camaraderie despite a busy workload. In the first chapter of her best-selling book, Shalof recalled how medical residents are too focused on the vital numbers relating to a patient's prevailing physical or medical condition, they easily forget that the patient lying in the hospital bed is another person and not just a group of numbers. In the case of Mr. Edgar DeWitt, it was Tilda who empathized with Mrs. DeWitt; it was she who proposed calling for a family meeting to soften the bad news. In the next chapter, the author detailed her early days as a nurse-trainee in the intensive care unit (ICU) of a big metropolitan hospital. There are many new challenges of a nurse working in an ICU than compared to other hospital wards. The nurses there have to be familiar with all the medical lingo preferred by the doctors, such as arterial blood gases (ABGs), a multi-system organ failure, a hepatic failure, congestive heart failure, and all kinds of shocks, like anaphylactic, hypovolemic, or septic shock, for example (Shalof, 2004, p. 15). The third chapter of her book tells the reader how some patients or their relatives can be quite cruel to the nurses caring for them, not considering or taking into account all their efforts, time, and energies spent on trying to save their patients. Tilda recounted how the son of an old woman patient named Mrs. Templeton wants everything done to save his mother from certain death. Her case shows the importance of having advance directives concerning future care or a choice of dying in a hospice (Goodnough, 2013, para. 3) and decide on it and not her son. Conclusion Nursing today has many viable theories on the proper role of this part-art and part-science profession. Among these theorists are Jean Watson (carative factors and caring moment), Rosemarie Parse (human becoming), Dorothy Johnson (a system model), Lydia Hall (core, cure, and care), Ernestine Weidenbach (as a helping art), Virginia Henderson (assist a patient regain independence), Patricia Benner (from novice to expert), and Martha Rogers (science of unitary human beings). Whatever theory works best, it worth remembering that patients are individuals who appreciate the care, attention, and empathy extended to them by the nursing profession. Final Scholarly Essay (Part 2) The first chapter of the book by Tilda Shalof illustrated the concept of person-centered care in professional nursing. In this chapter, the author showed how most medical residents are more concerned with the vital physical sign numbers than with the humanity of their patients. The whole idea of most hospital care being impersonal is amplified by the title of the chapter which is “Treating the Numbers” which is indicative of the wrong priorities when it comes to patient care nowadays. It can be noted the title is not “Treating the Patient” so how can a doctor or even a nurse render utmost patient care when what is being treated are the numbers of patients which just goes to show a patient is often forgotten as a human being and seen as just a statistic. Ms. Shalof exemplified this person-centered care by extending sympathy and empathy to the widow of Mr. DeWitt; nursing is not only caring for the terminally-ill patients but also the care of their surviving family members, especially immediate relatives such as a spouse or kids. A professional nurse must go beyond the mere administration of medical treatments but render a nursing care that helps people (patients and their families) deal with the pain, trauma, suffering, and loss associated with ailments and eventual death. She tried to explain to Mrs. DeWitt that her husband’s case is already hopeless and it is time to turn off the heart monitor, which is the single piece of equipment which connected the two spouses to each other but it is inevitable it has to be shut down for good and death is imminent no matter what medical science can or cannot do. For me personally, this concept of person-centered care is to see the patient as a real person, who is a human being worthy of respect, privacy, and confidentiality with regards to his or her emotions, feelings, worries, anxieties, superstitious beliefs, and worst fears about death or dying. The second chapter deals with both responsibility and accountability in the nursing profession. Nurses today must exhibit professionalism at all times by continually updating their academic or theoretical knowledge and current best practices in the nursing profession because a good nurse strives to learn all new things and not allow his or her own knowledge to become dull, stale, obsolete or antiquated. This concept of professionalism is best illustrated by the theories of Ms. Patricia Benner, in which a nurse goes through the five stages or levels of nursing experiences, which are as novice, advanced beginner, competent nurse, proficient, and then the last stage, as an expert nurse, which is attained only after long years of relevant nursing experience. A new nurse cannot expect to become an expert right away just after a few years' of service in a hospital; the experience gained over the years must also be relevant to be valuable. The last stage of being an expert nurse is achieved by a good combination of academic or theoretical knowledge based on solid foundation in medical science, professional experience, a careful attention to a patient’s changing condition (especially in acute care such as in the ICU) in which a slight variation can become an emergency situation, and lastly, application of nursing ethics (Benner, Tanner, & Chesla, 2009, p. 171) to avoid conflicts in moral considerations. This was what Tilda Shalof did to become what she is today, an expert nurse who strove hard to attain the highest level of expertise despite all the challenges and difficulties in her young career as a nurse, but she persevered and did not quit despite her being described as “too sensitive.” Shalof did not give up despite the misgivings of her parents on her chosen course while still in college. For her parents, nursing was not a very dignified profession considering their ethnic Jewish roots and also taking into account the low pay and the long hours involved in being a nurse. A truly competent nurse takes it upon himself or herself to acquire advanced knowledge in order to render the best nursing care possible. Competence translates to self-confidence so a good nurse will not hesitate to do what is right under adverse situations or conditions. However, despite all his or her technical knowledge about nursing care, a nurse never forgets nursing is also a healing art, and more importantly, it is the science of human caring (Watson, 2012, p. 20). Indeed, nursing today is a specialized profession with nurses focused on some specialties such as pediatric nursing, geriatrics nursing, acute care, intensive care, surgical care, palliative nursing, end-of-life care, and a host of other specializations pertaining to where nursing care is rendered, such as in elderly nursing homes, active seniors community housing, hospitals and other medical institutions. These challenges and other pressing considerations make the nursing profession quite a hazard to nurses' health because of work pressures, shifting work schedules, increased workloads, and a felt need to continually keep abreast of the latest developments in the fields of medicine, pharmacology, and nursing care by their enrolling in continuing education. The third chapter of the book deals with the concept of respect for privacy, autonomy, and independence of the patient. All professional nurses must observe this rule and do what the patient wants and always decide in the best interest of the patient concerned. This is especially true and applicable in end-of-life palliative care, whether in a hospital or in a hospice, wherein a patient does not want or no longer wants his or her life prolonged by artificial means. Science today has the modern tools to prolong life indefinitely if needed, but people who are old, sickly, or incapacitated (such as those in a comatose condition) may want to die a dignified death. Just as people plan for a vacation, many people plan their own deaths and want these plans followed. What happened to Mrs. Templeton, an 85-year-old woman, is regrettable and unethical. In terms of nursing ethics, what her son wanted for Mrs. Templeton in terms of medical treatment, violated her own wishes to die already, and yet she is prevented from attaining this last wish because doctors and nurses had gone against her own wish and followed the instructions of her son to prolong her life at all costs. A well-trained expert nurse knows how to decide in cases like this, such as when to pull the plug on a patient and let that patient die with dignity intact. People can have a dignified way of dying if they had planned for it well in advance (when they are still healthy and in control of faculties). Nurses can get confused which orders to follow, whether the patient's wish or family's orders to resuscitate or not, which was what happened in cases like Karen Ann Quinlan (her parents decided for her to end life support) or Terri Schiavo (her husband terminated life support as they were not divorced when she went into coma, and therefore, the husband retained all his spousal rights on matters like this). There are many cases where informed consent is virtually impossible to obtain, and yet nurses have to decide on what is the best for a patient, based on who now has the rights to decide on ending life support and administer euthanasia but to do all of these necessary requirements legally. But an ethical dilemma always presents itself to the nursing profession where there are no easy answers or convenient solutions. Nurses must always maintain an arms-length attitude. Having an arms-length attitude may seem contradictory when nurses are supposed to be care givers par excellence but in many situations, nurses who got emotionally involved will soon be affected themselves with all the suffering and pain patients and their families go through. This is when a nurse must exhibit and maintain his or her composure at all times, be a professional. This is the situation which is easy to say but never easy to do, because nurses can somehow get emotionally involved without them consciously knowing about it, and then their lives get affected too. Nurses can get depressed and become grumpy themselves, not knowing at all what is happening to their own lives because they failed to maintain an arms-length distance. Ethical practices in the nursing profession require that all nurses must situate the needs of a patient based on their values, power balance, and inter-personal relationships. The narrative approach to teaching ethics in nursing has gained wider credence and acceptance today because it allows for students to learn more about the person (the patient) at the center of the moral issues they are being taught to tackle and handle. This new approach gives students the chance to be in a closer relationship with patients to gain insights into the moral problems of humanness (Nisker, 2004, p. 286), to help students put things in the proper context and the right perspective. Like the title of the third chapter, “The Vein, the Artery, and Beyond” a professionally good nurse must go beyond the numbers or the physical features of a patient and see in the patient a real person who suffers from pain and worries, has emotions and feelings, decision-making abilities and aspirations, and the will to get well and survive. A really good nurse is able to elicit from a patient vital information during the initial interview and physical assessment by establishing a good, trusting relationship and a rapport with the patient (Potter & Perry, 2013, p. 45) by a well thought-out interviewing strategy and knows when not to press sensitive questions. Some nurses are really good at this aspect of gaining the trust of a patient, especially during the critical period of assessment when a patient has the choice of either telling the truth and divulge all sensitive information or whether to just clam up, not to disclose anything or everything. Nurses must exhibit professionalism at all times despite all the pressures in their work. They must remember that nursing is caring; one has to go beyond the numbers alone and see the patient as real human being who needs the care and emotional, spiritual, and intellectual support during various phases of their treatments, at various stages of their ailments, and even during the very critical transition period between life and death. Nurses play a vital role in easing the time when patients finally decide they are really ready to go on to the next life. This caring attitude is deeply appreciated by most relatives and family members of the patient as well, who sometimes cannot bear the pain and suffering their loved ones go through before finally dying. Nurses must also take their own pulse, to determine whether they have the fortitude and will to engage in a very physically and emotionally demanding profession. Nurses need to take a stock of themselves, to make constant self-assessments to know whether they are fit for nursing. Nurses may be just doctors' assistants (as signified by their white nursing caps) but they are often more discerning than the doctors, which as one nurse had put it, do not know they are not God, while God knows he is not a doctor and is not confused with what is possible or not anymore. There will always be situations where nurses are put in a moral dilemma, in a quandary on what constitutes good nursing practice or not. Examples are a stance on abortion, euthanasia, torture, and comatose patients; it is unavoidable and inevitable nurses will be confronted with situations like these which demand and require from them to make moral judgments themselves on what it takes to be a good nurse, to determine life and death choices. The personal values and religious beliefs of the nurse will help him or her decide on what is the best course of action. Sometimes, it is often better to have a dignified death than going on having a meaningless life. References Benner, P., Tanner, C. & Chesla, C. (2009). Expertise in nursing practice: Caring, clinical judgment, and ethics. (2nd ed.). New York, NY: Springer Publishing Company. Goodnough, A. (2013, January 10). As nurse lay dying, offering herself as instruction in caring. New York Times. Retrieved September 23, 2013 from http://www.nytimes.com/2013/01/11/us/fatally-ill-and-making-herself-the-lesson.html?pagewanted=all&_r=0 Nisker, J. (2004). Narrative ethics in health promotion and care. In J. L. Storch, P. A. Rodney, & R. Starzomski (Eds.), Toward a moral horizon: Nursing ethics in leadership and practice (pp. 285-309). Toronto, Canada: Pearson-Prentice Hall. Potter, P. A. & Perry, A. G. (2013). Clinical companion for fundamentals of nursing: Just the facts. (8th ed.). St. Louis, MO: Mosby - Elsevier Health Sciences. Shalof, T. (2004). A nurse's story: Life, death, and in-between in an intensive care unit. Toronto, ON: McClelland & Stewart, Limited. Watson, J. (2012). A theory of nursing: Human caring science. 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