Ethical Issue in Advanced Practice Nursing - Essay Example

Nurses’ Failure to Provide Optimal Patient Care and Nurses in this nation play a role that cannot be ignored, and whose importance cannot be understated. They are the ones that hold the healthcare system together, even though they have very little authority. A healthy nation means more development and reduction of crisis, and nurses aptly play this role with diligence. However, there at times that nurses fail in giving optimal care to their patients. Some of the reasons for this failure include ineffective communication, lack of family support, insufficient information and work overload. In advanced practice nursing, there are many models that have been applied in a bid to improve the quality of patient care that nurses offer in their professions. They include the Strong model, Manley’s model and Benner’s model. To solve the problems above, the Strong model is the most effective due to its seven encompassing and interrelated domains. The nurses have a role to play in ensuring that the quality of patient care given to patients is high and satisfying. Why nurses fail to provide optimal patient care Quality healthcare is paramount for the development of the society and the whole nation at large. The importance of having healthy citizens cannot be understated, and this directly points to the vital and crucial roles played by the nurses. Advanced practice nursing is paramount in ensuring that the nurses who help patients and the general society are not only qualified but also provide the best of services for everyone. The healthcare that nurses provide plays a great role in saving lives, minimizing complications, campaigning and promoting the well being of people, prevention and reduction of suffering and also plays a great role in reducing health related expenditures (Patient-Centered Care, 2013). As a career, nursing has advocated for the frail and the vulnerable and has enlightened the community, all in a bid to improve the quality of life. Suzanne Gordon described the important roles that nurses play (Kelly and Tazbiri, 2013). She described how nurses, with their deep and considerable knowledge take care of the patients from the dire consequences of diseases and illnesses, infirmity and physical challenges, and the challenges of undergoing some illnesses. They take care of the patients in hospitals and in care homes, or even by caring for them at their homes when the patients lose their ability to perform much of the daily tasks, even the most basic of them such as turning in bed, going for long or short calls, walking around the house or even feeding (Kelly and Tazbiri, 2013). Diagnosis, prescription and even treatment are other basic tasks that the nurses carry out, and they are responsible for making huge differences in the outcomes of patients’ health. I believe that the importance of the roles that nurses play cannot be understated. Their work should never be undermined as they are responsible stakeholders in the healthcare industry. However, nurses are sometimes unable to provide optimal patient care in their different fields of specialisation. This inability to optimally perform has adverse consequences on the patients’ safety. Since the importance of the roles that nurses play in fostering a healthy nation is almost incalcable, these factors should be addressed so as to improve the nurses efficiency. The advanced nursing practices that have been forwarded by different scholars in different models may help in mitigating the effects of the factors that lead to the underperformance of nurses, only if soundly applied. With the much respect that I have for life, I believe that nurses have a great responsibility to play in enhancing a quality life. The nurses’ level of learning, their research skills and their competencies are definitely important to boost the quality of life among all the citizens of the nation. Most of the factors that influence the level of quality that patients receive must be sorted out if the health related goals and objectives set for the U.S citizens are to be achieved. Advanced practice nursing is a wholesome term that describes the advanced stage of practices in nursing that makes maximum use of the in-depth and deep knowledge and skills that are paramount in meeting the health requirements of the clients (DeNisco and Barker, 2012). In this work, there are three models that shall be used to explain how the factors that affect the efficiency of nurses do so. The three models are the Brown model, Benner’s model and the Strong model. Before embarking on a discussion of the models, the following is a brief discussion of the factors that may make the nurses fail in delivering optimal patient care. The effectiveness of communication Communication is a cornerstone to every successful institution, especially in health institutions. The manner in which a nurse or any healthcare provider, including the senior medical providers communicates any information to their patients is equally important to the message or information itself. A lucid understanding between the healthcare provider and the patient is paramount to the development of a healthy nation. When sound and effective communication is not there, this can palpably be felt and the patients in need of nurses care may increasingly become anxious, vulnerable and weak. Lack of proper communication between a patient and a healthcare provide might be due to incompetence of the nurses, extremism of behaviors among the patients and the nurses among others (Kaplow, 2007). However, this problem can be solved through application of one of the three models. Information access and patient education The veil of secrecy has long been taken off and information is readily accessed through the television, the radios and the magazines. However, this has not been the case in the hospitals as patient information remains heavily guarded and is only passed on to nurse and people when need be. Sometimes, those who hold the information about their patients are not comfortable sharing it with other people, and hence some nurses, due to this deficit in information access might have trouble attending fully to their patients (Patient –Centered Care, 2013; Irurita, 1999). It is therefore important for the larger healthcare organization to realize that sharing of information is a chief factor in a successful nurse-patient relationship (profession wise). Health libraries for the communities, bedside information exchanges and other packets of information are good tools for promoting information sharing. Models that promote this key concept should be adopted. Work overload and inadequate staffing Emotional exhaustion greatly reduces the effectiveness of the nurses and any other health practitioners. Some of the reasons for nurses having a heavy workload include the increased demand of the nurses, the short supply of nurses, reduced employment of nursing (understaffing), and extra long overtime among others (Irurita, 1999). A model that promotes division and specialization of tasks in the healthcare institutions would be helpful in reducing the work overload (RWJF, 2013). This is paramount for increased optimal patient care. Family involvement Any hospital that understands and is dedicated to fulfilling the patients needs of well being definitely know that families of the patients play a great role. They play a role that is invaluable since they (family members) are the ones who, just by their mere presence can make drastic changes to the patients. The patients feel reassured and their anxiety and their vulnerability reduce or disappear completely. Care teams that involve family members definitely play a great role in patient care (Patient- Centered Care, 2013). However, hospitals that do not allow family participation and involvement make the work of nurses harder. Models adopted should widely encourage adoption of family involvement so as to make the work of the nurses simpler. Assumptions, values and beliefs of the of the three models The three models definitely have much in common with regards to patient quality healthcare. A conclusive definition of quality healthcare among the three models is that it is the extent to which health services for a people of a nation increases the chances of expected and desired outcomes of health (and are related consistently with the current knowledge at a given time). Brown’s model is a conceptual framework that promulgates a comprehensive partnership linking nurses reasoning, varied approaches and patient management to patient incomes. Since its inception, the model has been used extensively in many fields and nurses in Advanced Practice Nursing (DeNisco and Barker, 2012). Brown provided four concepts in this model which are environment, role legitimacy, advanced practice nursing and outcomes as represented in the diagram below. Figure 1: Brown’s model. The model expounds on five attributes of advanced practice nursing. The attributes are focus, scope of the practice, competencies, domains of activity and orientation. The assumption made when applying this model is that all stakeholders have a unique role to play, and that advanced practice nursing definitely improves the value and quality of healthcare. The values and beliefs in this model are that it is the responsibility of nurses and other medical practitioners to provide patients with optimal care (Patient- Centered Care, 2013). The outcomes of the model all shape the kind of the society that we finally get. This is very true since the patient, the healthcare organization, the nurses and other individuals have different outcomes expected. A competent nurse will always deliver high quality patient care and thus this model is an appropriate one for any healthy nation. The other model that has been widely applied in advanced practice nursing is the Strong model. Developed in 1994, this model has five important domains. They include direct comprehensive care, support of systems, education, research and publication and professional leadership. The model is represented in the diagram below. Figure 2: The Strong model The fulfillment of any of the above domains is directly dependent on the community being served, the level of advanced practice nursing that one is in, the interests of different individuals, the strengths of the individual, and the expected outcomes among others. The strands tied to the advanced practice nursing and which all play a significant role in fostering advanced and quality patient care include collaboration, scholarship and empowerment. None of these domains is more important than the other as they are all interrelated and intertwined. As seen from the diagram above, they are all aimed at boosting, fostering and enhancing qualitative patient care (Kaplow, 2007). Personally, I believe that direct comprehensive care is paramount to quality patient care, and this importance extends to all the other domains. The strands below the main domains also enhance the responsibilities that nurses have in preservation of life and of promoting good health among all the citizens of the nation. Advanced education increases the knowledge that nurses have, and research further increases the quality of care that nurses give to patients. All these domains and sub domains are paramount in promoting the efficiency of the nurses. The assumption made in this model is that the nurses will get a chance to advance their studies. The other assumption is that there will be people who will provide scholarships for the nurses who desire to undertake advanced practice nursing lessons in the many fields available. The last model that has been applied towards fostering patient care is the Benner model. The “novice-to-expert” model has continuously been used to promote nursing competencies and therefore promoting the quality of care that patients receive. It also defines seven main domains that provide directives for which advanced practice nursing can be based. They are as represented in the diagram below. Figure 3: Benner’s model The seven main domains are paramount in effective patient care that nurses give to patients. These seven domains conform to my personal values of giving the best to the patients irrespective of their age, physical disability and challenges, race, color, class stratification among others. Patients have a right to good health, and all nurses have a responsibility of providing this quality care. The Benner model is a model that has guided advanced practice nursing for some time and it has proven useful to laying foundations for nurses who are new in advanced practice nursing (Kaplow, 2007; DeNisco and Barker, 2012). This model proves useful in enlightening nurses in their roles towards patient, and towards delivering high quality patient care. The assumptions made in this model are that all people in the society are determined to see patient care provided to patients. The other assumption is that the nurses who are in advanced practice nursing will get a chance to be oriented on the seven domains, and that they can specialize on all of them, or at least be taught on most of them. Similarities and differences of the models in client outcomes In Brown’s model, the client outcomes are not only focused on the patient but it is a wider scope on the overall well being of the society, the patient, the society and the nursing organization at large. According to Brown, scope, clinical care and competencies are important fields in advanced practice nursing and are a great determinant of what a healthy community is. They all affect the kind of care that a patient receives. The strong model has all the domains oriented towards improved and high quality patient care. This model has been cited in many researches as the best model in advanced care nursing. The difference between this model and the other two is the fact that it places a huge responsibility on the nurses. They have a duty to learn, carry out research and collaborate with others to promote high patient quality. With its interrelated domains, this model seeks to find a cure for poor patient care and dissatisfaction. Benner’s model is also aimed towards promoting quality healthcare, promoting the idea of subdivision of roles and responsibilities in the workplace. The client focus in this model therefore is to increase the value and quality of the nurses in advanced practice nursing. The major similarity in the three models is the fact that they all aim towards increasing the quality of nurse output and the quality of patient care. In addition, they all campaign for increased education. They agree on the fact that advanced education improves the quality of healthcare that the nurses deliver to their patients (DeNisco and Baker, 2013). They also unite in agreement of the fact that patient care is paramount to the development of a nation, and that there are more than one stakeholder that contribute to the well being and to the providence of quality patient care. Model that bests solves the issue The factors that have been discussed above as contributing to the failure of nurses to deliver optimal healthcare can be accommodated and solved by applying the Strong model. Nurses must always be accountable in all that they do, and they must also perform to the best of their expectations (RWJF, 2013). The seven domains of the model best fit what is expected of nurses. Comprehensive care through data interpretations, information sharing, patient counseling and assessments would definitely solve the problem of family non-involvement and lack of information. On the other hand, proper research ensures that nurses know what to do at different situations since they have enriched knowledge. With advancement in education, nurses can be able to specialize in different fields and hence the work shall be divided and shared, thus mitigating the problem of work overload. The model shall also help solve the problem of communication effectiveness. An enlightened individual is more effective and the quality of patient care delivered by such nurses will be exemplary. My beliefs towards the respect for life can be met through the application of the Strong model. I believe that quality and advanced education, a lot of research and publishing what one finds in the research can be further shared and disseminated, thus enlightening more and more of the population. This way, nurses can also learn from each other, hence increasing the amount and quantity of knowledge that one has. Empowerment and collaboration in advanced practice nursing are definitely strong tools, and this would definitely improve the quality of life care that nurses give to patients. The Strong model therefore fits to be adopted towards improving the quality of care given to patients by nurses. References DeNisco, S., and Barker, A., 2012. Advanced Practice Nursing: Evolving roles for the transformation of the profession. Chicago; Jones & Barlett Publishers. Irurita, V., 1999. Factors affecting the quality of nursing care: The patients’ perspective. International Journal of Nursing Practice, 5(2), 86-94. Kaplow, R., 2007. Critical care nursing: Synergy for optimal outcomes. Chicago: Jones and Barlett Learning. Kelly, P., and Tazbiri, J., 2013. Essentials of nursing leadership and management. Cengage: New York. . Patient –Centered Care., 2012. Practical approaches for building a patient –centered culture. Patient-centredcare.org. [Online]. Available at [Accessed 27th February 2014]. RWJF., 2013. Adequate and stable nurse staffing is key to improving care for heart failure patients. RWJF.ORG. [Online]. Available at [Accessed 27th February 2014]. Read More