Clinical Focus and Advocacy in Patient Care in Specialist Nursing Practice - Literature review Example

Clinical Focus and Advocacy in Patient Care in Specialist Nursing Practice Clinical Focus and Advocacy in Patient Care in Specialist Nursing Practice Who is a Clinical Nursing Specialist? Historical Background of Clinical Nursing Specialist Esther Lucile Brown issued a report in 1948 recommending that public health nursing and other related sciences should be incorporated into a Collegiate level undergraduate curriculum. This recommendation was eventually implemented in 1965 a factor which caused public health nursing to be considered as a basic required component of all the subsequent baccalaureate nursing programs (Fulton, Lyon and Goudreau 2010). In the early development of specialist level of public health nursing, the course’s masters programs were initially housed schools offering public health long before 1967. The current trend of offering master’s programs in nursing schools was seen to start begin around the 1970’s with the gradual phasing out of the public health nursing programs in most of the schools offering public health studies. The very first programs to start preparing and offering Clinical Nurse Specialist (CNS) courses started doing so in the 1950’s (Fulton, Lyon and Goudreau 2010). Definition of a Clinical Nurse Specialist A clinical nurse specialist (CNS) can be described basically as an advanced practice and registered nurse who has undergone graduate preparation resulting in their earning a master’s or doctorate from one of the programs that prepares clinical nursing specialists. Clinical nurse specialists are generally experts at the diagnosis and eventual treatment of illness that fall in their area of expertise. The focus of clinical nurse specialist generally falls into three basic areas; these areas are administration, patients and their respective families and nurse management. Although these three spheres are seen to be interrelated and it is quite normal for them to overlap, they are quite different and possess distinctive focus from each other. In all three areas of influence, the primary role of the CNS is to ensure that there is continuous improvement of the nursing care and patient outcome in general (Fulton, Lyon and Goudreau 2010). The rest of a medical facilities nursing staff tend to look to the Clinical Nurse Specialist to help them improve the efficiency in the work place as well as to receive guidance as they perform their everyday nursing duties. Some of the key elements of practicing CNS is to ensure that there is the creation of an environment that can be seen to implement effective system changes and mentoring programs that will help in the empowerment of nurses who are better able to adequately respond to the diverse patient needs, and develop caring best practices that are not only evidence based but are also able to alleviate patient distress as well as facilitated the making of ethical decisions (Fulton, Lyon and Goudreau 2010). A clinical nurse specialist is found to be responsible for ensuring that patients receive the correct diagnosis and medication for the treatment of the illness or condition ailing them. Other responsibilities that are also assigned to clinical nurse specialists include health promotion, disease management, and ensuring that adequate measure have been taken to prevent disease infection and risky behaviour by groups, individuals, communities and families (Fulton, Lyon and Goudreau 2010). In its statement of support for clinical nurse specialists, the American Association of Clinical Nursing (AACN), is keen to point out that these nurses are experts in providing evidence – based nursing care and happen to practice the nursing profession in a relatively wide range of specialty areas ranging from pediatrics, adult health, oncology, geriatrics, community health, acute / critical care and mental / psychiatric health among others. It goes on to further state that there exists a rather strong correlation between interventions made by clinical nurse specialists and cost – effective, safe patient care. The practice of CNS has been linked directly to the overall reduction in lengths of hospital stay, hospital costs, improved practices aimed at pain management, fewer numbers of complications seen in the hospitalized patients, reduced frequencies at which patients required emergency room visits, and increased satisfaction with the nursing care being received by the patients (ACCN 2013). What is the Gibbs Reflective Model? The Gibbs reflective model is a framework that was developed to encourage one to think systematically about all the phases of any activity or experience that they happened to undergo. The cycle helps one to think about both the positive aspects of the experience and the various areas that require improvement (Jasper 2003). Using the Gibbs Reflective Model to Review a Critical Conflict Incident Stage 1: Description of the events: What happened? At the morning handover, we were in the company of the nursing home general manager, the director of care, The Night nurse, seven health care assistants and me the day duty nurse. As the night nurse was busy giving the handover report, focusing on giving details on those residents who were at a greater risk of developing injuries due to fall as well as pressure ulcers due to factors such as their health and general weakness as a result of their advanced ages. In my professional capacity as the wound care link nurse at this nursing home, I deemed it best to make an attempt at trying to better explain to the seven health care assistants the different methods that they can be able to employ so as to aid them in preventing any of these incidents from occurring at the nursing home. As I was busy pointing out the preventive measures to the health care assistants, the night nurse took offense at this and rudely told me to stop interrupting her as I was making it difficult for her to adequately concentrate on giving out the handover report. When she told me this, I proceeded to politely point out to her that a handover is not supposed to be a one way communication but should essentially be a discussion that aims to highlight points that will help in improving resident care at the facility. In a well timed effort to try and diffuse the now heightening tension at the meeting, the nursing home general manager instructed us to allow the night nurse to continue and finish giving out the handover report without any further interruptions. After the handover report, the general manager called us into her office and sought to know from us what the conflict was all about. We proceeded to discuss the issue together at the meeting and the decision was reached that the handover should for all intents and purposes be a communication session between all the nursing home staff members. The handover should provide all the nursing home workers an opportunity of identifying the current challenges that they happened to be facing in the providing care to the current nursing home residents in addition to helping them identify possible solutions to these challenges. After the discussion, the nursing home general manager stated that she would review the overall structure of the nursing home’s handover procedure so as to restructure it in such a manner that it is able to give all the staff members an opportunity to raise any of the issues that they face pertaining to the care of patients. The night nurse was kind enough to apologize for the rude and condescending manner that she had spoken to me in the presence of the other subordinate members of staff. The manner she had spoken to me was downright inappropriate and destructive of all respect (Jasper 2003). Stage 2: Feelings: What was I feeling and thinking about the whole incident? My initial feelings at the time of the incident were hurt and a bit of anger. I was hurt that the night nurse was addressing me in such an inappropriate manner that was quite destructive of all respect. The fact that this was done in the presence of all the other nursing home staff members, served to further increase the hurt and caused me to become acutely defensive as I tried justifying to her why I was not interrupting the handover but was simply just but trying to provide more information to the health care assistants as is supposed to happen during a handover procedure. I was happy when the general manager called her into the office as I saw that it was a prudent move that could help us resolve the conflict and help in stopping it from growing to a point of getting out of control. When the night nurse apologized to me for being rude, I felt glad that she had taken the initiative to do so and forgave her (Jasper 2003). Stage III. What was good and bad about the whole experience? What was good was that I had prepared myself in advance for a proper handover procedure and had notes on patient care and specifically on how to prevent the residents from contracting pressure ulcers and reduce their risks of falling. I hoped to share this information with the rest of the staff members and especially the health care assistants at the nursing home. I had taken the time to wait for what I presumed to be a rather appropriate moment to make an interjection as the night nurse was giving the handover report. What was bad was that the night had taken my interjection in the wrong light and had proceeded to openly criticize and rudely rebuke me in front of all the other members of staff. It was also quite bad for the other members of staff and especially the juniors to see the night nurse openly being rude to me at a meeting. What was also good was that the general manager quickly stepped in to diffuse the tension and thereafter called us into her office so as to give us an opportunity of talking and amicably resolving the matter. The night nurse apologizing to me was also a good thing as it helped in mending things between us and avoid any bad blood in the future between the two of us (Jasper 2003). IV: Analysis – What Sense Can I be Able to make of the Situation? The result of the conflict was that when I was called into the meeting, I was delayed in attending to one of the nursing home residents, and as a result of that, I felt guilty when I had to cancel the patent’s physiotherapy for that day. It was quite evident that the night nurse was under some form of stress or in all honesty did not know how to conduct a proper handover procedure. This could explain her reaction when I interjected the handover procedure to try and provide more health care information to the health care assistants. I later came to realize that it was quite possible for people to react in the manner that the night nurse reacted in the event that they were under work related stress. This caused me to read various books on work related stress so as to learn more about it as well as know how to effectively deal with it in the future in the event that either I or one of my colleagues happened to suffer from it. I also took the initiative of suggesting to the nursing home’s general manager that the nursing home should organize periodic counseling sessions where the staff members can be able to receive help in dealing with the stress that the work they do dictates that they have to come into contact with on a daily basis. The restructuring of the handover procedure so as to make it more informative and inclusive of all the staff members is one of the good things that happened after the conflict incident. This is because various staff related needs that previously did not have any platform for redress now had an avenue via which they could be effectively addressed. This has helped in causing the nursing home’s work environment to become friendlier as well as causing the degree and expertise of patient care by the health care assistants to drastically improve (Jasper 2003). V: Conclusion – What Else could I have done? I realize that potentially, there is a lot that I could have done to effectively diffuse the situation and hence prevent it from getting out of hand the way it did. I wonder if the night nurse’s reaction to my interjection would have been positive if I had interjected differently or what were the other choices that I had in attempting to do what I deemed that I was supposed to do. I could have patiently taken some time to inform her before hand of my intention to interject the handover procedure and present the information to the other nursing assistants. When the night nurse openly spoke rudely to me, I could have decided to be cool, calm and collected and chosen to back down instead of challenging what she said by telling her how I thought a handover procedure should be conducted. I could have apologized and chosen to keep quiet and wait to talk to her after the meeting. I could also have tried to find out before hand how exactly the particular night nurse preferred to conduct the handover procedure so that I could have been more well informed as I went into the meeting (Jasper 2003). Patient Focus Nursing and Possible Ways in which it can Effectively be Improved What is Patient Focused Nursing? The concept of patient focused nursing care also variously referred to as patient – centered care has in recent years been increasing in prominence to emerge as one of the key aims of the United States general health care system. Despite the growing recognition of the importance of patent focused nursing care, as well as the overwhelming evidence showing its overall effectiveness in the contribution of other goals that the health care system plans to achieve such as effectiveness and efficiency, The United States health care system has repeatedly failed to achieve the intended levels of patient focused nursing care. Patient focused nursing is also seen to heavily incorporate family-centered nursing care. It is generally understood to essentially be an approaching to nursing care that requires patients and their respective families to be largely considered as an extremely vital component in the making of health care decisions and the subsequent nursing care delivery process. Patient focused nursing is a dimension of quality nursing care in which the care being delivered is customized and individualized to the specific patients and their families. It is these patients and their families that have most of the control to the health care issues and not the clinicians. When patients enter the nursing care at a nursing home, they are usually in a down state due to the fact they are in need of care. Family members are sometimes seen to offer some assistance in helping deal with the symptoms afflicting the patients and offering basic care, but they frequently do not have the required expertise to offer adequate attention to innate individuality of the patient. It has been seen that different patients have varying degrees of physical strength, tolerance to pain and knowledge (Hart 2010). Patient focused nursing is seen to rely on effective communication with the individual involved and empathy that might inadvertently result to higher expenses in terms of both the cost of the program and the money (Finkelman and Kenner 2010). How Patient Focused Nursing Health Care Skills can be Improved at the Nursing Home Leadership: Leadership is often cited as being the single most important factor that contributes to patient – focused heath care and subsequent improvement in the staff skill levels. Top leadership participation and support is of vital importance if the sustained delivery of adequate patient – centered care is to be achieved. This can variously be achieved by the implementation of policies that are aimed at providing periodic educational session to the staff members so for them to improve their focused nursing health care skills. A sponsorship program can also be formulated that will help by paying part of the tuition fees for staff members wishing to further advance their patient focus skills (Shaller 2007). A Well Formulated Strategic Vision that has been Clearly Communicated: Once the nursing home secures the full support of the key management and leadership team of the institution it is vital for the nursing home to formulate an effective strategic vision. It is necessary for the institution to articulate well formulated mission and vision statements that will have simple and clear elements; these elements will continuously be repeated as well as be embedded into all the routine activities that the hospital’s staff members happen to carry out. The leadership’s strategic goals focusing on the improvement of patient focus skills should be able to be systematically communicated through out all levels within the organization (Shaller 2007). Increased Involvement of both Patients and their Families: In order to improve on patient-centered care, it is of paramount importance that patients and their respective families are closely involved in offering the nursing care. These family members should not be only limited to just family relatives, but the definition should be broadened to encompass and close friends and significant others who can be able to provide sufficient and vital information and support though out the entire duration of the care process (Shaller 2007). The increased patients and family involvement can help in improving the patient care skills because the families and patients can help in the process of contributing the general process of gathering information pertaining to the perceptions of patient care as well as in adequately analyzing and responding to the treatment strategies being implemented. This information gathered can serve a crucial role in improving the patient focus skills of the nurses attending to the nursing home residents by helping them focus the nursing care they offer as well as helping them to better know their patients (Shaller 2007). Creation of a Supportive Work Environment: Providing Care to the Care Givers: If a health care institution wishes to advance its patient-centeredness, it is imperative that it nurtures and creates a work environment in which the institution’s workforce, which happens to, be their most valuable asset is seen to be adequately valued as well as treated with the same level of respect and dignity that the institution expects all its employees to provide to not only is patients but also its families. The importance of hiring, evaluating, training, adequately compensating and offering support to a workforce that is committed to patient focused care cannot be over emphasized. All stakeholders including nurses, medical staff, managers and other frontline staff should be actively engaged in the creation of effective responsive systems of patient focused care (Shaller 2007). Positive behavior that is modeled by an institution’s team leaders is key in the encouragement of similar behavior in all the other team members. This positive behavior will in turn encourage the other team members to behave in a similar manner. By doing this, the entire team’s ability to provide better self oriented, responsive care to patients and their families will be vastly improved (Shaller 2007). Systematic Feedback and Measurement: One of the most frequently used axioms used in general health care improvements states that it is not possible for one to manage what they cannot be able to measure. One of the principal factors that contributes to improved patient focused nursing care skills is the presence of an active an often robust customer – listening capacity. This Customer – listening capacity generally helps organizations in systematically measure as well as monitor their performance. Feedback can be collected from conducting customer experience surveys, patient loyalty assessments and monitoring any complaints expressed by patients. It is also possible for an institution to collect information by using a walk – through. A walk – through is a process in which some of the institution’s staff members actively play the role of patients and attempt to experience a procedure or service in the same manner that patients and families would normally experience it (Cahps 2012). The value of collecting this feedback and tracking such measurements lies in effectively using the data and information received in the implementation of specific processes or interventions that will help improve on the patient experience, among the interventions and processes implemented will be the general improvement of patient focus skills. The success of collecting feedback is heavily reliant on an organization having real – time feedback. Having real – time feedback helps in aiding nursing homes and other health organizations in tracing results back to certain specific processed or actions that can be keenly studied and if necessary be spread throughout the organization in a successful manner. Supportive Technology: Supportive technology, particularly health Information Technology (HIT) that actively directly engages all patients and their respective families by facilitating easier communication with the nursing home’s caregivers as well as providing adequate access to much needed decision support tools and information are of crucial importance in the improvement of patient focus skills (Shaller 2007). In recent years, a myriad of health information technology applications have been seen to emerge ranging from simple e-mail communication applications that facilitate communication between patients and clinicians to the more sophisticated web portals that aid the patients in interacting with their medical physicians’ electronic medical records. These software applications are seen to range widely in their cost and complexity. The key to the successful use of these technological innovations is for the nursing home to ensure that it is relatively easy for both clinicians and patients to easily adopt them. This can be achieved by gradually implementing these applications so as to avoid creating the fear that adopting these applications will somehow undermine and disrupt the quality of the interaction between the caregivers and patients (Shaller 2007). Bibliography: Cahps (2012). The CAHPS Improvement Guide: Practical Strategies for Improving the Patient Care Experience. Accessed on January 25, 2013. From: http://www.facs.org/ahp/cahps/improvement-guide.pdf S. M. Shortell, J. Schmittdiel, M. C. and Wang et al. (2005). “An Empirical Assessment of High- Performing Medical Groups: Results from a National Study,” Medical Care Research and Review. Fulton S. J., Lyon L. B and Goudreau A K. (2010). Foundations of clinical nurse specialist practice. New York : Springer. ACCN. (2013). AACN Statement of Support for Clinical Nurse Specialists. Accessed on January 24th 2013. From http://www.aacn.nche.edu/publications/position/support-for-cns. Jasper, M. (2003). Beginning reflective practice. Cheltenham : Nelson Thornes. Hart, V. (2010). Patient-provider communications : caring to listen. Sudbury, Mass. : Jones and Bartlett. Finkelman W. A., and Kenner C. (2010). Professional nursing concepts : competencies for quality leadership. Sudbury, Mass. : Jones and Bartlett Publishers. Shaller D. (2007). Patient – Centered Care: What Does it Take? The Commonwealth Fund pub. Accessed on January 23rd 2012 from http://www.commonwealthfund.org/usr_doc/Shaller_patient- centeredcarewhatdoesittake_1067.pdf. Read More