Providing Health Care within Therapeutic Nurse-Patient Relations - Coursework Example

PROFESSIONAL DEVELOPMENT ESSAY by PROFESSIONAL DEVELOPMENT ESSAY Ethical issue considerations are essential elements of providing health care within therapeutic nurse-patient relations. Nurses face ethical dilemmas and distress in their practice. Constant changes in health care systems such as technological advances and value systems contribute to ethical conflicts and dilemmas. Understanding and communicating beliefs and ethical values to nurses helps them to prevent or avoid unethical practices. Additionally, they will be prepared to deal with them when they occur. Consequently, nurses must use their professional skills in their therapeutic relationship with patients. Therapeutic relationships are often established, maintained and determined by the health professional via the use of professional nursing knowledge, skills, caring attitude and behaviour that provides the best health care to the patient (Beauchamp & Childress, 2009). A nurse has moral, professional and legal obligations to act in the best interests of the patient, and especially in medical care decisions. However, the client has a choice over the type of medication to receive and nurses should respect a patient’s freedom of choice, unless it endangers his life During care provision, nurses consider the setting in which health care is provided. Providing a quality and improved care setting has great impact on providing ethical care. Quality care setting creates and maintains characteristics that support professional nursing practices such as sufficient professional preparation, suitable environment/conditions for nursing practice, respect for nurses as responsible health care decision making and recognition of their professional expertise the ethical values that are most important in nursing include fairness, truthfulness, client well-being, client choice, respect for life, maintain commitments, privacy and confidentiality (Bishop & Scudder, 2005). Nurses face ethical conflicts especially when they act in a manner that disregards their profession. These conflicts can be solved by following the nursing code of ethics and professional guidelines on moral behaviour. In extreme cases of gross misconduct involving loss of life, legal actions is taken against the nurses. An example of unethical behaviour was a problem based learning scenario where a nurse refused to treat a patient with HIV. In this scenario, the patient was moved from a medical ward to a rehabilitation gymnasium in a local National Health Service (NHS) Trust Hospital. The attending physiotherapist discovered from the referral notes that the patient was HIV positive. He then talked to the head of rehabilitation and stated that he would not treat that patient. The therapist called the ward manager and informed him that they were not happy to treat this patient. The patient who was in the earshot and heard all the conversation. I requested the therapist if we could speak in private and raise my concern over the unethical practice nut he refused to apologise (Fry 2004). He didn’t see anything wrong with this misconduct. In this scenario, a complaint can be lodged with the hospital management, nursing professional bodies and the police for discrimination against the patient. The therapists broke the nursing codes of fairness, professionalism, and respect for life. Action against them include, heavy fines, suspension from the practice, legal suit against discrimination and withdrawal of licence. Group dynamics refers to a system of behavioural traits and psychological processes that occur in a social group (intergroup dynamics) or between social groups i.e. intergroup dynamics. Studying group dynamics is important in understanding decision-making processes, track spread of diseases within the community and create effective therapeutic methods. The studies are applied in epidemiology, education, social work and community studies (Holmes & Purdy 2002) Theories of group majorly focus on group dynamics that depend on group cohesion. Group formation begins with a psychological bond among people who have a common interest. Thus, group cohesion tends to refer to the process that keeps members of the group connected. For example, attraction, solidarity and morale are qualities that bring group cohesion. Cohesion unites the group with a common purpose and creates coordination of efforts within the group. In nursing, group dynamics is a very important concept because nurses need to work together to provide quality health care to patients. Nurses need to work in groups to provide health care solutions and discover new ways of offering care especially in practicing evidence based nursing care. Group work is inevitable in nursing practice especially due to numerous medical emergency cases that require nurses in different specializations to work together and save lives (Jameton, 2003). While forming the groups, nurses rely on safe patterned behaviour and identify a leader to give group direction. Nurses in a group need to feel accepted and safe for them to be productive. They gather impressions and data about the similarities and differences within the group. Group diversity allows the nurses to be effective in providing an all-inclusive quality care to patients. The nursing groups develop rules of behaviour that help keep work simple and avoid conflicts that affect work. Group theories help nurses handle competition and conflicts of personal and work relations that may affect quality of health care. As nurses attempt to organize for tasks, conflicts inevitably results from their personal relations. Individuals have to bend their feelings, attitudes and ideas to suit the group’s main focus. Just like other professionals, nurses fear of failure or exposure of incompetent areas, which increase their commitment to group goals as their desire to excel increases. A relevant problem based learning scenario involved a group task to establish how evidenced based health care was applied for patients with skin cancer. The group comprised health providers in different medical specialization. From this experience, I learnt that understanding group dynamics facilitates a nurse to manage learning and participate actively in care delivery in a through working multi-professional care setting. Learning is facilitated through working with others and conforming to the established rules. Within a group, a nurse can learn new skills from others through observation and active participation in health care processes (Lynch & Hanson 2005). Working in a nursing group health task allows a nurse to exchange ideas and gain new skills from other nurses. I learnt how to handle different pressurizing situations and contribute maximally towards group efforts to solve a health problem. In a group task each nurse learns how to work with others and consequently, he gains new nursing skills, experiences and ability to handle different types of patients. Theory of change (TOC) is a tool that is used to develop solutions to complex social issues and problems. The theory explains how long-term results are obtained from early and intermediate accomplishments. A complete theory of change states the assumption about the early and intermediate goals and how they contribute to long term success of an initiative. TOC creates great value to the community. Community initiatives at times are planned without an explicit understanding of the initial and intermediate steps that are required for long term evaluation effectiveness of plans. A TOC gives a clear and honest picture of the steps needed to fulfil each goal. It gives stakeholders a chance to assess the factors they can influence, the impact of these factors, and whether it is realistic to reach all the goals within the stipulated time, using the allocated resources (Bacote 2002) The process of creating a TOC is simple and elaborate. The initial step involves the stakeholders identifying clear goals they want to achieve through their initiative. Elaborate goal setting is important because different group members often hold different ideas about what an initiative’s goals should be. The next step involves stakeholders identifying all the preconditions/building blocks requirements that must be present to achieve the long-term goals. They then consider which of these preconditions are critical and how to manage them so as to reach the initiative’s long term objective (Keyserlingk 2009). Some preconditions are beyond the influence of individual initiatives e.g. requirement of a stable economy for an initiative to thrive. Other preconditions could be beyond the influence of a single program but stakeholders can identify areas for strategic collaboration or partnerships. For example, a precondition for school admission could be that all children must be properly immunized and healthy before they can join schools. A small initiative may not influence this precondition. However, the initiative may collaborate with other programs in the community who can directly influence the precondition’s success. TOC can be used to bring service improvements in nursing practice by forming health initiatives in partnership with community members. Nurses can identify long-term goals such as prevention of diseases within the local community through active participation in health initiatives and regular medical check-ups. The early and intermediate goals could involve sensitizing members about diseases and healthy living to prevent them. The long-term goals will be achieved by forming preconditions such as regular medical examinations for all community members, medical camps and campaigns to educate about disease preventive measures and active participation by all community members (Luft 2008). Continuous efforts by nurses to educate and regularly examine members for symptoms of infections will result in a society or community that is often sensitive for their health. Consequently, members will be proactive in avoiding unhealthy habits and work with nurses to improve health care delivery in the entire community. Service improvement for nurses will be achieved because community members will be able to identify symptom of diseases and seek treatment before prevalence of diseases. Nurses will work with informed patients who are willing to cooperate to prevent diseases and treat them before they advance (Tervalon 2008). Cultural diversity is the ability to maintain effective interactions with people of different cultures and social economic orientation. Cultural competence is influence by the following components. First, awareness of a person’s culture. Understanding one’s culture will help them appreciate why people hold onto cultural beliefs, because they define who they are, why they do things and behave in a certain way. Second, one’s attitude toward cultural differences will determine how competent they are in relation to intercultural interactions. Maintaining a positive attitude and tolerance of other cultures facilitates interaction with people of different culture (Sue 2001). Third, knowledge of different cultural practices and worldwide view is another factor of cultural competence. To gain this knowledge, a person must have the ability to think positively, eliminate cultural bias and treat everyone as an equal. Gaining knowledge about cultural practices help a person understand why cultural diversity is a good thing worth celebrating because it makes people unique. Cross cultural skills are another factor that show cultural competence. These skills allow a person to maintain interactions and participate in diverse cultural practice. Moreover, the skills allow a person to collaborate with people of different cultures in bringing community change. Providing culturally tailored health services can reduce disparities among minority groups such as the Latinos in America. Disparities such as language barriers can be reduced if nurses provide customized health care that suits this minority group. The learning needs that a nurse requires to achieve equality of health care for the Latinos include awareness, attitude, knowledge and skills (Johnson 2002). To cultivate awareness, nurses must ‘conscious about their reactions to the Latinos who are different from them. The nurses must remain conscious of the special care needs of this group and barriers that must be broken to facilitate efficient health care provision. Change of attitude is another element that all nurses must acquire. Nurses must adopt a positive attitude and drop any predetermined negative notions towards this minority group. Change of attitude will allow nurses to remain emphatic to the needs of the minority group and tailor medical care to these special cases. Acquiring knowledge concerning the cultural practices of the minority group is critical. Nurses must learn cultural beliefs that may prevent the group from accessing medical care and discriminate some members such as women from participating in community medical initiatives. Acquiring skills that will increase cultural competence for nurses is a critical factor in facilitating equality of health care to the Latinos. The skills focus on perfecting cultural competence. For example, nurses must understand communication skills of the Latinos (Keyserlingk 2009). Understanding verbal and non-verbal communication will break linguistic barriers and improve health care provision for the minority group. Nurses dealing with minority groups require patient-related continuing courses on medical education. These courses training on cultural and linguistic competence that allow nurses to tailor medical care services to the needs of the minority groups. These efforts will help in reducing health disparities among minority groups. References Beauchamp, T. & Childress, J. 2009. Principlesof biomedical ethics. (3rd ed). New York: Oxford Betancourt, J. R., Green, A. R., Carrillo, J. E., & Park, E. R. 2005. 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Ethics in nursing:An anthology. New York: National League for Registered Nurses Association of British Columbia. 2008. Standards for nursing practice in British Roy, D., Williams, J. & Dickens, B. 2004. Bioethics in Canada. Scarborough, ON: Prentice Shapiro, I. 2005. Theories of change. Guy Burgess and Heidi. Sue, D. W. 2001. Multidimensional facets of cultural competence. The counseling psychologist, 29(6), 790-821. Sue, S. 2006. In search of cultural competence in psychotherapy and counseling. American Psychologist, 53(4), 440. Tervalon, M., & Murray-Garcia, J. 2008. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. Journal of health care for the poor and underserved, 9(2), 117-125. Read More