Nursing: Contemporary Issues and Trends - Coursework Example

Running Header: The discipline of nursing: Contemporary issues and trends Student’s Name: Instructor’s Name: Course Name & Code: Date of Submission: The discipline of nursing: Contemporary issues and trends Introduction Nursing is defined as a caring profession that is based in its practice to provide care to patients. Despite the recent increase in scientific activities as a result of complex technical development in medicine and machinery used at the bedside of every patient, nurses are the first care givers that patients come in contact with incase of emergency or once they need some help. (Coltrane and Pugh 1998, pp. 34-36) describes that care is therefore one essential emotion that every health profession must possess before carrying out any responsibility. Nursing can be defined as a health care profession whose duty is to provide care to individuals and to various communities. Nurses maintain, attain and recover patients’ health as well as improving their quality of life. Nurses work in various fields of specialty where they mostly work under a team or may work independently as part of the team. The role of a contemporary nurse is to implement care to their patient. It is therefore necessary for government authorities in various countries to ensure that proper care is offered and at the same time maintaining credentials standards and competencies (Davies 2002). Therapeutic communication This includes techniques that are used by nurses in order to bring about a positive attitude by the use of open communication. Nurses and patients engage in a conversation that is meant to give a healing change to suffering patients. Nancy (2009) describes that this communication guides patients by showing them there issues and how to overcome them. There are various types of communication techniques used which include psychotherapy. Therapists should be well armed with tools that enable patients to deal with their personal issues and personalities. One important tool is that these therapists should be sincere and be interested in listening to their patients. Active listening This is a communication technique that involves a listener and an interpreter. The listener in this case the nurse or a therapist should be capable of understanding, interpreting and evaluating information given by the patients. This is important as it improves relationships between the two parties therefore avoiding secrets, mistrust due to strengthened cooperation. Davies (2002) shows that listening skills are essential and have a major impact on the effectiveness of a job. Nurses ought to listen actively to the problems affecting their patients as this will enable then come up with an effective therapy. This is practiced by question an answer method and writing down for future use or to critically analyse the problem. Clarifying This involves the process of coming clean about a problem that one has been suffering from. After the communication process nurses should be capable of coming up with one single problem and informing their patients about their condition. Milgrom (2002) argues that though nurses have been accepted as members who contribute to better health care now for more than 30 years, their health care delivery systems is not clear. Nurse practitioners critically define their roles under the nursing and medicine duties and should therefore work towards providing clear information to achieve effectiveness. Summarising This gives the general picture of the collected information. It categorises various details in order o come up with significant and clear information that can be used to solve a disturbing issue. Nurses should also be capable of reviewing their records in order to sum up the number of patients viewed and how many have the same condition. This is important as the health givers may discuss on the best way possible of eliminating the condition of the problem affecting most patients. This would include setting up strategies that will cater for every individual’s need. Forms of communications used by nurses Nurses receive orders from the physicians and the transfer of these orders requires effective communication to avoid errors. Communication is therefore the most useful tool to health care providers. There are various forms of communication used by nurses and these include verbal and non- verbal. Non- verbal signs indicate nurses true feelings for example once a nurse crosses her arms or avoids eye contact she simply means that she is avoiding interruption. The attitude projected by an individual can be a barrier to a conversation for example if one starts smiling while being told negative news or while a patient is in pain then this might affect the other persons attitude and will avoid sharing such conversations. According to Davies (2002) verbal communication on the other hand should be clear and articulated. This is because there might be some challenges such as language barriers or cultural differences. Nurses need to understand and examine the message and how it is delivered. Action needs to betaken by the people involved in the conversation in case a problem occurs. Nurses have to ensure that the environment is conducive, and that some clarification is available for complex words. The nature of communication should also be considered which includes being assertive and avoiding being insensitive. Nurses should provide a setting that is comfortable to their patients. They should also sit down to listen and maintain eye contact. The patient should do more of the talking and if any questions they should be simple and clear and to encourage the patient to talk, the questions should not have a simple answer. In case of carrying out an interview, one should sound sincere in order for the patients to open up their problems. To encourage nurse-patient relationship, a practical nurse should be capable of communicating effectively and expressing care to the patient. Communication skills that facilitate safe patient care Providing safe care to patients has been a challenging subject in today’s health care environment. Milgrom (2002) shows that despite the increase in technology which has developed effective communication, there still remain some duties of providing care that is needed by individual patient. Ineffective communication has been one major factor leading to setbacks of effective health care. This is because it causes medical errors, delays, injuries as well as surgery at wrong places. Five factors have been identified that may hinder effective communication in health care centres. One includes interruptions which tend to disrupt effective work flow therefore leading to pending tasks. The other factor includes differences in education skills for example between nurses and physicians. The two professions may make assumptions about the other therefore leading to errors. Effective communication may be hindered by authorities for example in places where decisions are made by top management only and the other members of the organisation are not informed. The health environment is complex and therefore responsibilities are not equally divided therefore causing disruptions and delays. Transfers, change of shifts and discharges are also major causes of ineffective communication since some critical information is lost in the process therefore causing delay and errors. According to Tomey and Alligood (2006) to facilitate safe patient care, various communication skills should be initiated by care givers. These include having effective teamwork that provides competent skills, respect to patients and good interpersonal skills. Most health care providers fail have problems as a result of misunderstandings among colleagues. A recent study showed that about 53 percent of nurses have major concerns about their colleague’s competence and they find it difficult to discuss their concerns. It has also been shown that out of ten nurses, three of them have issues of poor teamwork and disrespect among themselves which include abuse or bullying. This disrespectful communication expressed by nurses and physicians is ironical considering that their profession is about providing care to patients. To improve communication skills, a culture has been introduced that involves setting up strategies that promote open and effective communication among nurses and other health care providers. According to the American Association of Critical- Care Nurses (AACN) some standards have been established for sustaining a healthy environment. These standards involve nurses and shows that they should be proficient in all their skills which included communication skills and clinical skills. The other standard introduced involves establishment of a collaborative relationship based on mutual respect among every health provider. In order to improve communication skills, education should also be considered. This reduces the professional differences between nurses and physicians and it also prepares future nurses for effective communication. Organisations also need to promote a culture that facilitates effective communication among team members. For example nurses should be involved in the decision making process in order for them to speak up their problems which might place a patient at a risk. Various models have been introduced for example the Situation, Background, Assessment and Recommendation (SBAR) which provides nurses with a better understanding of how to improve communication within the work environment. St. Joseph Medical Centre in India has implemented the model and has seen much improvement in transfer process, decrease in wrong surgeries and loss of information during handoffs (Milgrom 2002). Three barriers that may interrupt effective communication According to Davidhizar (2004) communication takes place if the message being communicated is effectively received and a feedback is provided. The two forms of communications may be used while a nurse wants to get important information from her patients though some challenges may occur in the process. Some of the barriers of communication include language barriers, failure to understand body language or attitude towards a patient. Language barrier may hinder effective communication where a nurse may be speaking to a different language speaker. In this case the nurse should get some one who can interpret the message to avoid misunderstandings. Nurses who use body language should ensure that the patient can effectively understand the message being conveyed in order to receive an expected response. Some of the methods used in nonverbal communication include rapport and showing empathy. Rapport involves holding someone in respect, understanding and acceptance. The attitude that patients express towards nurses may hinder effective communication since most of the patients avoid questions. Listening barriers can be overcome by involving active listening which promotes interpersonal communication. How the nurse can ensure appropriate professional boundaries are maintained Proper guidance Professional boundary issues arise which are outside therapeutic relationships with vulnerable patients. Nurses Association of New Brunswick (2000) suggests that registered nurses may be involved in various relationships in their professional fields. Some of these non therapeutic relationships require trust. Nurses should therefore ensure that their professional boundaries are respected according to their role. Nurses should also be provided with guidance, which includes code of conduct and personnel policies as agreed by labour law, and managers of the health service provider. AARN provides support and safe, competent and ethical practice of nursing care. It therefore has set guidelines which show the boundaries appropriate for nurse-patient relationships. Reviewing their code of ethics Nurses and other professionals should recognise that violation of these boundaries may harm the patient, the profession and others involved in non-professional relationships. According to AARN there have been low reports about violation of rules. Most nurses working in health providers may get over involved or under-involved in a nurse-patient relationship. This relationship is not a helpful one and it is therefore important to have healthy boundaries. These promote respect between the two parties and it facilitates safe provision of health care. The patients also maintain their human dignity, autonomy and privacy. The nurses on the other hand are recognised as strict to their profession and are said to know their rights and obligations. In order to resolve boundary issues, nurses should ensure they set limits which protects themselves and their patients. This is by taking a patient as an individual who needs special health care and taking a registered nurse as an individual who is there to provide this professional care. Knowing how to maintain professional boundaries is categorised as a competency in nursing courses. It is therefore important for managers in health care providers to recruit nurses who are well qualified in that field. Nurses should be capable of understanding that therapeutic relationships are different from other social relationships such as dating (Tomey and Alligood 2006). It is therefore important for registered nurses to understand and apply the set standards according to (Canadian Nurses Association) CAN Code of Ethics which protects all nurses from losing their professional respect. Canadian Nurses Association (2002) state that nurses should also interpret legal requirements as per their license, legislation and the scope of conduct. These should be frequently reviewed as it helps to maintain professional boundaries. Nurses should be in apposition of avoiding bias while conducting their day to day duties such as while collecting, interpreting and communicating information to their patients. These duties should instead be conducted with professional understanding and confidence which will enable the vulnerable patient to focus on the necessary information being communicated. According to Mary Ann et al. (2007) clients should also be encouraged to contribute to improving their own health. This is by identifying their strengths and weaknesses. The process can be achieved through self- evaluation and ensuring that nurses maintain their self- respect. Nurses should also ensure that they demonstrate their ethical skills by practicing and complying with the code of ethics set by the organisation. Professional boundaries are normally flexible in relation to the law and professional judgement. This is because it is risky getting help from a health giver and it is also risky to give this help. Develop self-control The nurses should therefore keep their boundaries wide and avoid crossing unless under certain circumstances. For example a nurse who know their client responds to a simple hug may provide a comforting hug showing compassion and support though this should not be frequently repeated since it might stop being helpful to the patient. Tomey and Alligood (2006) shows that sharing emotional stories that may be of help to the patient is also allowed since it offers therapeutically care for example client who have issues with their marriage or childhood moments might need some one to listen to them and offer some counseling services. Nurses gain experience of how to carry out their duties once the crossings of boundaries are discussed and examined by a trusted person. Every profession has its challenges which need one to revisit the deeds and safely talk about them in order to allow room for correction and improvement. Healthy boundaries are therefore maintained through proper education, reflection of past mistakes and creating awareness of the need to help others. Sound understanding According to College of Registered Nurses of Nova Scotia (2002) registered nurses should be capable of understanding how complex professional boundaries are in maintaining their job. In order to understand this, good communication skills are essential as this makes nurses to be more sensitive to the private questions asked about the patients’ health. Some of the questions and activities carried out by nurses are therapeutically acceptable only if these activities are necessary to provide the therapeutic needs of the client without crossing the boundaries. An action is said to be unacceptable if the results benefits one party only causing an expense to the other one. Principles protecting nurse-client relationship Most people seeking health services tend to be vulnerable and therefore nurses should be aware of this in that when a client express discomfort with a particular registered nurse then this should be addressed by the managers to avoid more damage from occurring. The other principle is that it is nurses’ duty to maintain a healthy relationship with their clients and that social relationship are not acceptable according to the nurses’ code of ethics. Davidhizar (2004) describes that nurses should therefore be responsible in ensuring that professional care is provided and should understand that social relationships do not provide a healing benefit. The third principle guiding nurses show that prior relationship with a client should not violate nurse’s profession of providing therapeutic care. This should not interfere with provision of treatment and if it does then an alternative care giver should be provided. Social intimate relationships are not allowed at the time of providing care. Nurses should consider checking patient’s wellbeing, mental and emotional status to prevent confusion between health care and personal care. In case one crosses the boundaries, the problem should be discussed by the parties according to the agency policy and consultation from AARN should be provided (Canadian Nurses Association 2002). Strategies of managing nursing challenges As a nursing student, in order to manage my challenges I would set up various strategies while carrying out my responsibilities. Some of these clinical challenges include crossing the boundaries of nurse-patient relationship, communication challenges, disrespectful colleagues and vulnerable patients. One of the strategies would be to ensure that I concentrate on my duties and put more focus on providing the best care to my patients. This is by providing care that promotes patient’s autonomy and their best interest. In case of a vulnerable patient, it is my responsibility to make them understand that they are there to be provided health care and not social care. Once a client sees a boundary then they will be able to respect me as their health care giver (Davidhizar 2004). In case of a professional challenge such as being invulnerable to crossing the boundary, I would discuss the problem with one of my colleague whom I trust and who have more experience in the profession. This colleague should be in a position of helping me make ethical decisions. In case of team disrespecting me or bullying, I would first try to discuss the problem with the guilty partner and if this persists then, as a student I would approach the supervisor for him to come up with helpful measures of curbing this disrespect among team members. I would then encourage interpersonal relationships among team members by forming groups through the help of the supervisor which can enable people to share their concerns and issues rather than keeping to themselves which ruins effective communication. Conclusion To promote effective communication with patients without crossing the relationship boundaries, nurses should avoid divided attention and listening. Active listening is encouraged as one seems to be emotionally involved and can provide empathy and give encouraging words to the patient. It is also important to maintain eye contact and body language as this makes the patient feel important by having a good listener who is ready to understand his problems. The other technique necessary is to have reflective thoughts. A registered nurse should be capable of reflecting patients’ words in another perspective to understand them properly. Nurses should be involved in encouraging their clients for them to share their problems. This encourages a good relationship that develops connection and the patients feel free to share their personal experiences more openly. References Canadian Nurses Association 2002, Code of ethics for registered nurses, Springer, Ottawa. College of Registered Nurses of Nova Scotia 2002, Guidelines for nurse-client relationships, Macmillan, Dartmouth. Coltrane, F & Pugh, C 1998, Danger signals in staff/patient relationships in the therapeutic milieu, Journal of Psychiatric Nursing and Mental Health Services, vol.16, no.6, pp. 34-36. Davidhizar, R 2004, Listening, A nursing strategy to transcend culture, vol. 54, no. 2, pp. 4-22. Davies, A 2002, Nursing, Oxford University Press, Hong Kong. Mary Ann, F Ronda, G & Marcia, Z 2007, Communication, Patient safety and the nursing work environment, Spring, Tennessee. Milgrom, J 2002, Boundaries in professional relationships, A training manual, Walk-In Counseling Centre, Minneapolis, Minnesota. Nancy, K 2009, Therapeutic Communication in the nursing profession, Wyden books, New York. Nurses Association of New Brunswick 2000, Standards for the therapeutic nurse-client relationship, Fredericton, New York. Tomey, A & Alligood, M 2006, Nursing theorists and their work, 6th ed., Mosby: St. Louis. Read More