Nursing in the British Community - Essay Example

Name : xxxxxxxxxxx Institution : xxxxxxxxxxx Course : xxxxxxxxxxx Title : Nursing in the community Tutor : xxxxxxxxxxx @2010 Nursing in the community Introduction Community nurses have a significant role in improving health status within communities. This is why defining community nurses’ role is vital since it has enhanced service delivery through providing them with mandate to make contributions in the reforms. Community nurses have numerous challenges like inadequate training and work force and such challenges need to be addressed. Generally, policy making in health sector should always include the community nurses and the community at large (Queen’s Nursing Institute 2005). Contemporary ideas and approaches underpinning the organization and management of care One of the issues underpinning the organization and management care include that the nurses do not have suitable training. Home care issue should be well planned so that the nurses are adequately trained to offer required care and treatment to individuals. Therefore, education quality, training and availability of equipments should not be ignored and should be done just like with hospital professionals. Another issue is the drug prescription. Doctors think that if the community nurses are given proper training regarding drug prescription, it is a threat and thus they do not offer proper support to the nurses in this matter (Handy 1993). It is evident that community nurses who have extended their prescribed responsibility and have accessed training which as a result has enabled them to prescribe independently and supplementary prescribers has risen. About 20% of 14,000 NIP/NSP have community responsibilities. Even if there have been claims that limitations on Community practitioners Formulary make it unattainable for them to prescribe treatments that they view as necessary in their nursing practice. The benefits that have been observed in the community nurses being able to prescribe include, saving time and being convenient since it seems patients get better information from the community nurses regarding the prescriptions in addition to sense of satisfaction, status and independency (Dimond 2008). In cases where community nurses prescribed, such benefits have been observed. Patients report simpler and quicker access to medications and raised choice while accessing the medications. Moreover, there is evidence suggesting that traditional nursing expertise, for instance emotional support and listening skills when joined with independent and complementary prescription results into increased learning, efficient prescribing decisions and the patients’ confidence in their medications increases. Still, enhanced loyalty to treatment management and decreased wastage of drugs has been observed (Armstrong 2007). The biggest imperfection in evidence base is that it lacks research on co-morbidity. Evidence-based medicine exempts individuals having co-existing medical conditions since it makes it difficult to understand the attributability of the result. The nurses will thus need complex and comprehensive expertise which is difficult to achieve (Dimond 2008). The specialization model in nursing will join the hospital the community and hospital nursing and therefore will join them as specialization in a condition in addition to specialization in a symptom/care management. Consequently, there would be for instance, diabetic nurses, cancer nurses, ulcer nurses and many more (Hurst 2005). In long-term conditions, the ordinary medical practitioners are sending community nurses to tackle complex diseases like cardiac arrest, diabetes, high blood pressure, cancer and many other disease conditions. Such occurrences are motivating the nurses to obtain specialized trainings to enable them focus on areas of specialization and overlook the common nursing services they are supposed to offer (Ritchie 2003). This has thus compromised the quality of service deliverance. When it comes to administration, domination and power, community nurses are perceived as inferior to other specialists possibly because of their lesser training. The present systems also restrict activities of such professional nursing (Department of Health 2007). Evolving role of the nurse in contemporary health and social care Basically, district nurses have traditionally been associated with GP practices but are currently working in amalgamated care teams and are also working as specialist district nurse consultants as well as consultants in primary care. For instance, contemporary matrons are being employed by North Devon Primary Care Trust to be the clinical leaders of community nursing and community hospital homes to enhance the quality of the patient experience (Department of Health 2006). Currently, district nurses are in apposition to offer same services being offered in hospitals due to increased training and the nurses being given the suitable education. As a result, the district nurses have a role of tackling broad range of conditions, from ear, nose and throat to rehabilitation to end-of-life care (Pollard 2005). The main chief priority of NHS is to improve the care of individuals suffering from long-term conditions. NHS spends most on the health care in UK in chronic illnesses. NHS illustrates increased productivity for the nurses through speeding the amount of care moved from hospital to community, smaller district hospitals will join together with community services and general practice (Nursing and Midwifery Council 2008). For the long-term conditions, care and treatment needed has moved to treating and managing long-term conditions, like diabetes and cardiac arrests. This implies that there is increase in specialization in community nurses and this has diminished the high-quality general nursing care. More nurses are also caring for individuals with co-morbidities (Swage 2003). This has resulted into community nurses of various types working for a range of varying organizational types. New forms of care have thus emerged and this does not indicate professional identities, like homecare (Department of Health 2006). The community nurses have a likelihood of being having employers without skills on how to work within community and home settings (Abbas 2004). Community matron can be referred to as a nurse who offers advanced clinical nursing as well as case management. Matron’s role is has been perceived to have a huge effect on the management and expenses linked with the management of long-term conditions. With the rising number of people with long-term conditions, community matron is one of the ways that are improving the management of the people living with log-term conditions. This consists of anticipating, coordination and combining of care of specific high intensity patients with complex long-term conditions, at the same time as supporting new approaches of working to lessen unplanned hospital admissions and reduce the costs (Watson 2005). Community matrons should establish connections with hospitals to make sure that patients identified that they require case management are referred to community matron. However, community matrons have the challenge of often shifting between a reactive service and a proactive service and dynamically balancing their time between patients to avoid preventable hospital readmission (Northouse 2009). Community matrons work with patients suffering from complex interrelated physical, emotional and social needs. Consequently, to be successful, the matrons should address matters like depressions, learned helplessness as well as anxiety. Community matrons should also have both palliative care support and high degree of interpersonal skills. Community matron role has presented great opportunity for the development of community nurses. Community matron presence has offered a resource person for guidance, information and support, improved communication and information sharing, has raised the profile of long-term condition patients and nursing and has also created awareness on the valuable role of nurses in ling-term condition care (Queen’s Nursing Institute 2002). Community matrons have led to enhanced care standards and innovative practice which had facilitated continuity of specialized care which provides a holistic approach to people. However, community nurses are facing challenges like misunderstandings regarding their responsibilities, not being supported by GPs, career rivalry and lack of support from secondary care services (Agnew 2005). Legal and professional responsibilities of the registered nurse The nurses are responsible for ensuring that they are personally responsible for their conducts and should also take the responsibility of making sure that what they practice fulfill the legislative standards as well as the professional requirements ((Jasper & Jumaa 2005). When the nurses are working, they are supposed to strictly follow the professional legislation in addition to the professional policies. Furthermore, the nurses have the responsibility of making sure that they offer quality services and they ought to make sure they are at all times supporting others in maintenance of efficiency when delivering the service (Department of Health 2002). The nurses also should evaluate the services they offer and take inventiveness to improve their efficiency and ensure that they are in shape to offer their services. Moreover, they should always make every effort expand their knowledge to be able to tackle the developing challenges and should always try to further their knowledge with additional trainings to make sure they are adequately efficient and be in a position to provide evidence based practice (Department of Health 2006). The nurses hold a duty of establishing preventing measure within community, supervising the patients with long term diseases and making diagnosis of simple illnesses. In short, they nurses are supposed to conduct the first evaluation of the patients, prescribe medicine if possible and if they are not in a position to prescribe medication, they should make referrals and also the nurses are supposed to offer management and continued care, more so in instances of chronic illnesses and rehabilitation. They nurses also have the responsibility of conducting health promotion and developing public health promotion programs that assist in reducing the gap among community members (Department of Health 2005). Again, the nurses are responsible for offering services to the public and they are supposed to work together with the clients as well as other community members while working in actions that entail planning, implementation and evaluation. When working, they should communicate and increase their proficiency by using team work that develop and improve how they care for their clients (Dowding & Barr 2002). For instance, in Scotland, public health for the nurses and midwives was prioritized during the development of a concept of nurse within family health which joined the nursing care within clinics and developmental plans in public health, the key focus being the people, community and families. Community nurses work in home set up and hence they deal with various presentations in addition to rehabilitation which include caring for their clients until they dies. Therefore, if the community nurses without collaborating with hospitals, it would be very risky to the patients and also to the nurses (Department of Health 2002). Still, the nurses have a duty of monitoring other health service team members and guiding their clients as well as other community members regarding nursing care. The nurses should collaborate with district doctors or their clients’ personal doctors who assist a lot in promoting health, preventing disease and also enlightens the nurses on how to handle and manage emergency case within public health. During health promotion, the nurses should advocate for and follow the public health policies and offer guidance and care to people and families on how to improve their lives (Department of Health 2002). Finally, the nurses have the responsibility preventing both injuries and disease which involves screening the patients for chronic and acute diseases in addition to offering counseling. The nurses should manage chronic illnesses through prevention, diagnosis and treatment of such diseases. This is so since most chronic patients move from hospitals to their homes. The nurses should also frequently carry our health surveillance where they should report and manage infectious illnesses that are risky to general population in communities. Consequently, nurses play a role in reducing severity of disease outbreaks by making use of instant response mechanisms that prevent such diseases from spreading (Queen’s Nursing Institute 2009. Ethical principles influencing current nursing practice and care delivery One of the ethical principles is accountability. This means that the nurses should always be responsible and answerable for whatever they do. Advance directive means that the nurses can help in making decisions on whether a certain treatment should be continued with or should be pulled out. Assent is another ethical principle which means that in case a certain research is being carried out, the participants should first agree to participate in the study and this is by being provided with the exact information about the medical study and after that the participants should agree to participate if they wish through signing a consent form (Armstrong 2007). Autonomy is another ethical principle which means that the nurses should be make independent decisions and choices regarding the action to take. Confidentiality is a very important ethical principle since it requires all the nurses to have high level of privacy for all the people and patients they deal with. Consent also guides the nurses whereby there should be an agreement illustrating that someone freely chose to be involved in the medical study. This should be founded on respect for independence (Armstrong 2007). . The nurses should always exhibit justice, which means when delivering their services and treatments; they should not be biased to certain people or groups. They should also allot resources fairly. Social justice is also an important ethical principle which means that the nurses should offer equal treatment to the most susceptible community members when compared to the other community members. For instance, the nurses should treat the disabled, sickly and the less learned community members the same as the other community members (Tingle & Cribb2007). If a nurse neglects the supposed nursing responsibilities deliberately, this is termed as ethical violation while a nurse can be in an ethical dilemma when he/she has a patient who does not want medications. Here, nurse gets mixed up on what to do (Beachamp & Childress 2008). Organization and management of care from the perspective of service users and carers If I have a high regard for the home-based care, I will take up the treatment positively. For instance, if I belief the nurses have appropriate skills I will willingly take up the treatment and prescriptions they offer. Contrary, if I believe that nurses are not competent like other medical professionals, I will ignore their advices, treatments and more so their prescriptions. The nurse may suggest some treatment I do not value and hence I will ignore it which can demoralize the nurse and may even make both of us to discontinue with the treatment (Department of Health 2007). In my view, the nurses should only offer the treatments they are sure of and in case they are not sure of what to do in a certain circumstance, they should consult with other medical professionals. The patient is the determinant of the ultimate treatment to be offered to him/her since his/her needs dictate the appropriate treatment. Again, it is not ethically correct for a nurse to force on medication to a patient does not want such treatment. For instance, the nurse may make a diagnosis and offer treatment to a patient. On the other hand, might claim that the diagnosis is wrong basing on his/her health history. In such circumstance, the nurse has no moral obligation to force the patient the treatment he/she thinks is correct (Otway 2002). Conclusion Currently community nursing is a very sensitive matter since people are more knowledgeable and empowered in regard to proper health and good quality of life thus extending life-expectancy and consequently expanding the requirements for enhanced home based care. Nurses are supposed to be appropriately trained and should be allowed to prescribe drugs for minor ailments not requiring specialized treatment. Community nurses should participate in policy making since they are advocates in the communities they offer their services.. Hospitals are being moved to communities and the small district hospitals are being incorporated in the community (Baggott, Allsop, & Jones 2005). Bibliography Abbas, L., 2004, Basic Community Nursing, Elsevier Inc, New York. Armstrong. A. E., 2007, Nursing Ethics: A Virtue-based Approach, Palgrave Macmillan, , Basingstoke. Baggott, R., Allsop, J. and Jones, K., 2005, Speaking for Patients and Carers: Health consumer groups and the Policy process, Palgrave Macmillan, Basingstoke. Beachamp, T. L. & Childress, J. F., 2008, Principles of Biomedical Ethics 6th Ed, Oxford University Press, Oxford. Department of Health, 2007, A Recipe for Care – Not a Single Ingredient, Department of Health, London. Department of Health, 2006, Modernising Nursing Careers – Setting the Direction, Department of Health, London. 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