Adult medical/surgical nursing - Essay Example

Part I Adult medical/surgical nursing has been regarded as the basic roots of nursing from which various sub-specialty and super-specialty arenas like oncology, cardiology and neurology have branched out. Due to this traditional approach, this field in itself could not achieve the status of being a separate specialty; although on recent years Academy of Medical-Surgical Nurses (AMSN) has provided the field it's long overdue status (Gatson, 2004). "Medical-surgical or adult health nursing is a complex specialty that requires a wide-ranging literature to inform its research and practice" (Taylor, 2005). Medical-surgical nurses, also known as adult health nurses, specialize in the care of adults with a "known or predicted physiological alteration" (ANA, 1974). The vast scope of adult medical/surgical nursing extends to healthcare settings, including acute and sub acute medical-surgical units, collaborative practices with physicians, home health care agencies, clinical education, and care management that aim to deliver quality, evidence-based care in order to maximize patient care outcomes. Most adult patients present with the most complex health needs there it is required for a learner to develop critical thinking skills while assessing, planning, implementing and evaluating care of the adult client at an accomplished level (PCT, Catalog). Furthermore, the majority of health care consumers in the country comprise of adult clients. The specialized and advanced knowledge and skills of adult medical /surgical nurses are needed to deal with acute illness complicated by co morbidities like diabetes, hypertension, and cardiovascular disease all of which are specific to the adult population. Comprehensive, total patient care, rather than a focus on a particular organ system or problem, is an important aspect of this specialty (Harkness, 1999). The scope of adult nursing is not restricted to a particular disease or a body system and holistic wellbeing which demand an extensive knowledge base about all aspects of adult health. "The care provided is holistic and is rooted in health promotion, disease prevention, and health maintenance and may be carried out in community and institutional settings" (Grindel, 2005). The field of nursing involves simultaneous application of art and a scientific knowledge to understand oneself and one's relationship with individuals, groups, and communities. "Nursing is a therapeutic helping relationship devoted to promoting, restoring, and maintaining the health of individuals, families, groups and communities" (Aurora, Catalog). Learners ought to undergo a rigorously planned professional curriculum for human services that is applicable to the society and reflects the diverse needs of the community with the primary areas of focus being caring, health, learning and commitment to human dignity. Certification for Adult Medical-Surgical Nursing should be delivered solely on basis of individual performance regarding professional practice of medical-surgical nursing (Aurora, Catalog). The certificate program may contain printed hand-outs, videotapes, computerized simulations and lessons, case studies and practical assignments based on advanced reading and research. Knowledge and skill development can be further enhanced by active interactions like educational forums, conferencing, learning labs and faculty consultation. Hands-on clinical training can be conducted under the guidance of preceptors and faculty in medical-surgical areas at authorized medical institutes. Clarity of theoretical concepts is assessed by examinations and written or oral assignments. Practical and clinical skills are assessed in simulated lab situations prior to the actual internship. Learners with prior knowledge, skills, and/or experience fundamental to medical-surgical nursing practice may qualify prior to internship. Learners have to develop a constant need to broaden their knowledge base by through research and evidence-based practice projects. Medical-surgical or adult health nurses may pursue advanced degrees and practice as clinical nurse specialists, nurse practitioners, and researchers. They also may pursue certification at the basic and advanced levels. Part II The primary objects of a learning contract would include issues that affect the quality of patient care, the safety of patient care and conditions in the workplace that affect the delivery of care, legislation that impacts the delivery of health care services (Grindel, 2005). As an outcome of the contract, learners should be able to execute their clinical knowledge and skills, their ability to synthesize patient information and implement individualized patient care interventions, and their capability to efficiently organize care for multiple acutely ill adults in an exceptionally professional manner. Learners will also be taught how to evaluate quantitative and qualitative data within a relevant theoretical framework to promote, maintain and restore health (Grindel, 2005). An extensive clinical coursework coupled with practical exercises will enable trained nurses to provide appropriate and safe medical care in critical situations. Lessons in community health train nurses to support health promotion and recovery among acute and terminally ill patients suffering from diseases like diabetes or arthritis and also those who need to undergo surgery. It should be noted that no matter how large the interdisciplinary team is, the nurse is the only individual who maintains maximum contact with the patient (CAPC Manual); therefore, it is important to cultivate a humane and sensitive approach while dealing with individual patients and articulate a "personal philosophy of professional nursing practice grounded in ethical values and respect for the uniqueness of the individual" (Aurora Univ. Catalog). Programs like psychology, public relations and medical ethics help learners to master the art of human communication. Nurses need to establish a good relationship with the patients and their care-takers by gaining their confidence and co-operation in order to facilitate a positive treatment outcome (Hicks, Rush Uni.). As we have been discussing, adult nursing practice primarily deals with maintaining and promoting health, caring and nurturing, and helping patients achieve independence, well-being and fulfilment, or a good death (Aurora Univ. Catalog). To realize this goal, adult nurses need to carefully analyze and understand patients' needs , work in sync with other members of the interdisciplinary team. This programme will give learners an opportunity to develop skills in caring for adults with long- and short-term health problems. "The Clinical Nurse Specialist in Adult Health is provides care for individuals with a known or predicted physiological alteration. The Adult Health CNS demonstrates an in-depth understanding of complex medical, surgical and adult health problems, as well as interventions to manage and improve patient care. Guided by theory and research, the CNS practice considers all influences on health status and the related social and behavioral problems arising because of the patient's physiological condition. The CNS is engaged in education, case management, expert clinical practice, consultation, research, administration, and practice in settings where primary, acute, or long-term nursing care is delivered" (Curtin.edu). Specially designed field-specific modules instill knowledge, confidence and skills required to nurse adults and the multiprofessional modules give students a broad spectrum of health care knowledge and understanding on other related health courses. In order to attain the honours degree, students are required to complete a double dissertation module that involves in-depth exploration of any aspect of interest chosen by the learner (Oxford Brooks University). Learners will be exposed to both day and night shifts which will help them explore the work environment and routine at all hours of the day and all days of the week in order to increase their flexibility.This is in accordance with Nursing and Midwifery Council (2004) standards of proficiency for pre-registration nursing education (Oxford Brooks University). Clinical experience in a hospital setting is supplemented with lectures, seminars, workshops and laboratory work including discussions and forums, group and tutorial sessions that provide a broad repertoire of academic skills and the level of understanding necessary for competence as first-level practitioners upon graduation(Oxford Brooks University). Case studies provide application based understanding as to how to deal in varied clinical situations. Learners are prepared for practice in a variety of care settings, participation in a wide range of health promotion and teaching activities, and advancement to graduate study in nursing. "Practical knowledge is assessed through clinical competency achievement, and is an integral part of the practice-based modules. Written assessments include essays, examinations, learning contracts and projects"(Oxford Brooks University). A flexible grading system and assessment protocol ensures fair and unbiased evaluation. Evaluation of clinical competency is done by using Clinical Performance Appraisal Form (based on Australian Nursing Council) competencies are further subdivided into four domains: professional/ethical practice; reflective practice; enabling and problem framing and solving.Qualifying these competencies separately ensures safe competent nursing practice (Adult Nursing Practice, Curtin.edu). Both mentor and learner can make use of the form in order to realize course objectives. By the end of the clinical semester the student should have essentially cleared all the aspects. A student constantly receives direct feedback regarding his/her performance and progress and the same are documented on the form by means of performance indicators and remarks entered by the instructor. A written Summative Evaluation will be given at the end of continuous practice. The Clinical Appraisal Form will be the basis for a PASS/FAIL grade in the clinical area (Adult Nursing Practice, Curtin.edu).The evaluation of client care will be based on the concepts of microbiology, biomechanical, comfort, safety, privacy and communication.Students will not be assigned a PASS/FAIL grade based on one-time performance but on the basis of a series of evaluative tests and assignments throughout the semester to avoid any bias or unfair judgement. In the first year, all learners are provided with clinical guides and mentors who teach, train and assess them. The relationship between a mentor and a learner should be essentially positive and productive. This is snsured by round the clock availability and support of the mentor and many interactive sessions wherein students can put forward doubts, questions and ask for guidance. An academic advisor or mentor assesses individual interests, skills and goals by maintaining a close and personal relationship with the learner in order to identify aptitudes and areas of deficit. A mentor helps to overcome weaknesses by devoting extra time and attention to the aspect that is lacking. "A learning contract will be implemented where the clinical supervisor assesses the student's clinical performance to be at a 'fail' standard. This contract will be formulated between the clinical supervisor, student and the unit controller. This contract will clearly identify the deficient competency area, what the student has to do to address this problem and by what date this competency is to be achieved" (Adult Nursing Practice, Curtin.edu) During clinical tenure, learners can explore opportunities and develop their skills in many areas like intensive care units, accident and emergency departments, operating theatres, treatment wards , district nursing and practice nursing. This is facilitated by systematic monthly rotation in each department. Learners posted for the first time in a particular department undergo a week-long observership and orientation program wherein they observe their seniors performing nursing routines and get acquanted with the clinical setting and the instruments. They learn clinical procedures and get habituated to dealing with patients. It is advisable for learners to make use of this opportunities to ask questions and clear doubts. After they have seen adequate number of medical cases and clinical situations, they move on to delivering health care based on their own analytical thinking but under the supervision of a senior. Hands -on training and subsequent reading help in polishing decision making skills. At the end of each month, the student is required to submit an assignment based on the month's learning and skills acquired. This may be a case presentation, an essay, a set of multiple choice questions or even a application based clinical situation. Further, Adult Medical/Surgical Nursing offers a wide range of super-specialties that involve a myriad of challenges for learners in fields of clinical research, general medicine, which provides care to patients with complex medical needs, medical/surgical short stay and transplant, for patients undergoing kidney, pancreas, and liver transplantation. Adult Cardiovascular Nursing Services emphasizes continuity of care for patients with heart disease and involves cardiac step-down, cardiothoracic surgeries, cardiovascular intensive care , heart failure/transplant and vascular surgery (Strong Health , Univ. of Rochester Medical Center) . Adult Neuromusculoskeletal Nursing involves Neurology, Neurosurgery, Orthopedics, and Rehabilitation Units. Nurses here learn to deal with acute orthopedic injuries/surgery, brain tumor resections, epilepsy, interventional neurovascular procedures, spinal cord injury, stroke and traumatic brain injury(Strong Health , Univ. of Rochester Medical Center) . .Ambulatory Nursing deals with provision of outpatient care delivery to infants through adults. A variety of specialty clinics and outpatient procedures are performed in this area, with nurses working as members of an interdisciplinary care delivery team(Strong Health , Univ. of Rochester Medical Center) . Critical Care Nursing deals with taking care of critically ill adults. The specialty areas are Burn/Trauma Intensive Care Unit (ICU) and Burn/Trauma Step-down Unit; cardiovascular ICU, medical ICU, pulmonary Step-down Unit and surgical ICU (Strong Health, Univ. of Rochester Medical Center). . Emergency Department (ED) Nursing is a specialized practice that manages complex and clinically challenging patients in a fast-paced atmosphere (Strong Health, Univ. of Rochester Medical Center). Obstetric & Gynecologic (OB/GYN) nurses provide direct care to antepartum, intrapartum, and postpartum women and deal with patients with complex pregnancies and complex births (Strong Health, Univ. of Rochester Medical Center). Surgical Support Nurses assist patients and families throughout the operative experience. Nurses care for patients of all ages in the operating rooms, post anesthesia care unit, pre-operative area and strong surgical center (Strong Health, Univ. of Rochester Medical Center). By the end of the academic year students gain considerable knowledge and understanding of adult nursing in the broad context of health, illness and health care environments and are competant enough to plan, provide and document sensitive nursing care based on individual patient needs and critically analyse and evaluate the plan of action. Learners demonstrate the ability to effectively use self-management, leadership and teamwork qualities. They also acquire a "broad range of academic skills such as critical appraisal of research papers, logical reasoning, decision making in evidence-based practice, and management" (Oxford Brook University). The practical learning approach on actual patients has been percieved as a challenge and it is argued that there is no evidence that students achieve more knowledge from the former that by using simulators and artificial anatomical models. Presence of a learner in a clinical setting is sometimes considered a waste of time and resources for the patient as well as the practitioner. In counter-arguement it can be pointed out that practicing on simulators and dummies may provide the technical know-how ; but the actual confidence is achieved only by dealing with live patients which develops a sense of empathy and critical thinking - both of which are important aspects in the field of adult nursing. "Modern technology has provided educators with an array of simulations and anatomical and software models to facilitate learning. Nonetheless, we continue to perceive the presence of students in patient settings, with patients, families, and our nursing colleagues, to be the epitome of nursing education. The reality is that little to no evidence exists that documents what, or if, students learn in the clinical setting"( Zungolo, 2003) There is still a constant struggle to achieve high quality, cost-effective, graduate level nursing education. However, a group of inter-institutional partners are working together to identify common teaching and learning challenges in distance health care education. An important goal of the project is to create learning objects, also called Sharable Content Objects or SCOs, and interactive case studies that are applicable across courses, contexts, and educational levels and are designed to meet the usability standards of the Sharable Content Object Reference Model (SCORM) (NEAT Project). The partners will pilot the learning objects and case studies in their own programs and facilitate the dissemination and adoption by others. In order to achieve cost effectively and convenience, four types of teams will collaborate on meeting the following objectives: "Objective 1: Collaboratively identify teaching and learning challenges common in multiple nursing education contexts, and design, develop, and pilot both learning objects and case studies to address these challenges. Objective 2: Design, develop, and pilot a virtual guide on designing online higher education courses with learning objects to facilitate the subsequent use of the sharable content objects and case studies by other faculty and programs. Objective 3: Identify, design, and implement innovative strategies for dissemination and enhanced use of learning objects and case studies. Objective 4: Document and assess collaborative strategies to develop and disseminate learning objects and case studies for the purpose of addressing common teaching and learning challenges in distance health care education"( NEAT Project). "As Drucker notes in The Atlantic Monthly (1994:53), the 21st century will be one of transformations and challenges. Nurse educators will need to think through the purposes, values, and content of educational programs and lifelong learning opportunities. Nurse educators as knowledge workers must prepare to meet challenges by developing nursing learning centers for future needs. Whereas a bold vision of the future, concrete plans that a customer driven, and monitoring for improvement are important, the nurse educator as manager/dean/director for the learning center and faculty teaching here will be key to facilitating nursing transformation into the information age".(Billings, 1996) Most learning objects, and other learning tools, are conceived and designed by a single content expert or group of experts for public use with a common educational purpose. The NEAT project's partners from public and private institutions across the country are coming together to identify, design, and develop learning objects and case studies to address common educational challenges, thereby ensuring the production of useful teaching and learning tools that apply across courses, contexts, and educational levels. Their contributions and strategies might help in overcoming the currently faced challenges faced in teaching and training of adult nurses. References: http://www.pct.edu/catalog/courses/nur226.shtml Taylor, Mary K- Mapping the literature of medical-surgical nursing: J Med Libr Assoc. 2006 April; 94(2 Suppl): E65-E73. Pitman, NJ -Academy of Medical-Surgical Nursing. Scope and Standards of Medical-Surgical Nursing Practice; 1995. American Nurses Association. Standards Clinical of Nursing Practice. 2nd ed. Washington, DC: American Nurses Association; 1998. Grindel Cecelia Gatson, Nursing Spectrum: September 15, 2004 nursingandmidwifery.curtin.edu.au/current/outlines/undergrad/Sem22006/Adult%20Nsg%20Practice%20224.doc http://www.stronghealth.com/healthcareers/opportunities/nursing_specialties.cfm American Nurses Association. Standards, medical-surgical nursing practice. Kansas City, MO: The Association, 1974:2. Grindel C. Medical-surgical nursing: a specialty or not Medsurg Nurs. 2005Feb;14(1):5. Harkness GA, Dincher JR. Medical-surgical nursing: total patient care. St. Louis, MO: Mosby, 1999. Oxford Brooks University, Catalog: www.brookes.ac.uk/undergraduate/courses/2006/adult_dip Rush University, Catalog Aurora University Catalog: http://www.aurora.edu/catalog/ug04-06/programs/nursing.htm http://www.neatproject.org/ Billings DM. Designing nursing learning centers of the future; Comput Nurs. 1996 Mar-Apr; 14(2):80-1, 87. Zungolo Eileen, Challenges in nursing education research: examining clinical learning experiences. (President's Message): Nursing Education Perspectives, July, 2003 http://64.85.16.230/educate/content/elements/nursecompetencies.html Read More