The Discipline of Nursing: Contemporary Issues and Trends - Literature review Example

Insert Name: Tutor: The Discipline of Nursing: Contemporary Issues and Trends Course: Date: Part One Nursing and person/patient‐centered care Nursing According to Daly, et al (2010) “Nursing is the use of clinical judgment in the provision of care to enable people to improve, maintain or recover health to cope with health problems and to achieve the best quality of life whatever their disease or disability, until death”. Patient-Centered Care Patient-Centered Care (PCC), also known as individualized patient care or negotiated care, focuses on the patient's right to have his/her values and beliefs respected as an individual. This respect is viewed as part of a commitment to build a deep understanding of the patient as a thinking and feeling individual with the ability to change and develop. A person-centered model of care requires a nurse to work with an individual's beliefs, values, wants, needs and desires. This adaptation to a patient's personal needs requires the nurse to be flexible, respectful, and reciprocal when providing patient care. Professional communication Therapeutic communication Direct quote Gaskell (2010) defines therapeutic communication as “The deliberate form of verbal interaction generally intended to settle emotional conflicts involving people with mental issues and psychiatric disorder. It is the process that emphasizes focused, non-judgmental interactions, allowing an individual to feel safe to share his innermost feelings”. Paraphrase According to Gaskell (2010), therapeutic communication is the intentional type of verbal interaction aimed at resolving emotional conflict taking place in people with psychiatric or mental issues. It is a process that highlights non-judgmental and focused interaction, giving a chance to someone to feel comfortable to share anything about his feelings. Active listening Direct quote “Active listening is a non-intrusive way of sharing a patient’s thoughts and feelings. In its most simple form, one hears what the patient is saying, repeat what you heard, and check with the patient to make sure the reflection is correct. In more complicated listening response, you don’t listen to words; you try to reflect the feeling or intent behind the words”, (Klagsbrun, 2003) Paraphrase Active listening is sharing the patients feeling and thoughts without intrusion. One listens to what the patient is communicating, repeats what he hears and confers with the patient if he has got the correct information. In a complex way someone tries to get the meaning inferred by the words (Klagsbrun, 2003). Clarifying Direct quote According to Brooker and Nicol (2003), “Clarifying is the skillful use of paraphrasing, preferably without questions or with open-focused ones, in order to enable other people to have a clearer idea of what their issue or difficulty is”. Paraphrase Clarifying is the act of reframing statement, more often eliminating question or using ones which are open focused, to make it easier for other people to understand the significance of an issue (Brooker& Nicol, 2003). Summarizing Direct quote “Summarizing is the drawing together the salient points of an interview into a short statement. Some uses are to enable reflection during a difficult interaction, to demonstrate empathy and to wind up an interview before leave taking” (Brooker & Nicol, 20030). Paraphrase According to Brooker and Nicol (2003), summarizing is getting important points from a conversation and placing them in a precise manner. One application is to think over a challenging interaction to show feeling for a person and bring to an end and interview before excusing yourself. Forms of communication Verbal communication Verbal communication is defined as the language, spoken or written, which is utilized to pass to others information. The application of language differs depending on the circumstances we a person is in and the party he is communicating with. Sign language utilized by people who are deaf is a form of verbal communication. It has the characteristics of any language that include dialect, social convection and vernacular. The way someone writes or talks to people who are intimate to him in his personal life differs from the way he communicates in formal or professional settings. In the practice of nursing the words which are used are of great concern regardless of them being spoken or written. To make sure the intended meaning is passed across. If one is distressed or anxious he may tend to hear the communicated message in an intimately personal frame and not in the same perspective as the person communicating. Nurses should chose carefully the language they use in order to show more understanding of how other people may not perceive individuals in pain (Levett-Jones, et al, 2009). Non-verbal communication Non-verbal communication is the kind of communication that involves the subconscious mind without it being written or spoken. The Non-verbal communication portray one sense of occasion, emotions, status, sense who he is relating with and sense of whom he is. It describes the proximity of the individual to the one he is communicating to. Other people reactions to the individual’s moves are also portrayed. Every individual has a sense of the space that is around him. The limit of this is cultural determined in relation to social status, age or gender. The space around as can be portrayed as intimate, personal, social, or public. If people enter one’s space without being invited he backs away from them. The significance of non-verbal cues is very evident utilization of metaphor and idiom. If someone says another’s hands were wet as fish and some people jumped for joy, one can visualize the joy and feel the handshake (Sully & Dallas, 2005). How to use Communication to Facilitate Patient Care According to Ellis et al (2003), communication skills can be used to facilitate safe care of the patient. The main purpose of communication skill is to make social contact. The way they are used will be inclined with the kind of relationship that is aimed at being formed with other people. Skills that are used for social contact are those leave-taking and greeting, active listening, referring, reporting, assertiveness, explaining and questioning. The non-verbal messages of facial expression, gesture, self-presentation and touch can all be used to enhance the verbal. The communication skills can be used to initiate therapeutic relationships that go the a process that involve introduction, presenting concerns, reconnaissance, contracting, summarizing and agreeing on goals, agreeing a contract of working and termination. When the patient presents his concerns and worries, as a nurse one should be keen and internalize everything in order to give the appropriate guidance or assistance. In the introduction the nurse has to create a conducive and accommodating atmosphere to win the trust and confidence of the patient. In the reconnaissance stage the nurse has to give the patient elaborate information about the condition that he is experiencing. The nurse is the one who has professional training to be able to explain in simple language to the patient the situation he is experiencing. The nurse is trusted by the patient to give vital information concerning his health (Ellis et al., 2003). According to Hitchcock et al. (2003), the nurse should permit dialogue and discussion to make the patient to give out his innermost feelings. Regardless of the degree of the situation the nurse is mandated to support and encourage the patient so that he feels at ease. In so doing, the nurse is able to accurately assess the magnitude or seriousness of the situation. In applying the communication skills, the nurse has to observe and listen gathering any information that is relevant to prevailing situation. The nurse should not be judgmental in the assessment but ask open-ended question than encourage the patient to pour his heart out and seek emotional support. The nurse should employ silence, touch, problem identification and referral when communicating with the patient. The nurse should be aware of body language and interpret appropriately what is being conveyed by the patient and attach meaning to it. The nurse should engage fully when he is communicating with the patient. Appropriate use of the communication skills can form a comfortable environment for the nurse and the patient to relate well. In using paraphrasing the nurse make it easy for the patient to understand that he has grasped the magnitude of his situation. Identifying with the patient and having empathy for him is the best step to will him over so that the nurse has the patients trust. Silence is used to create respect between the nurse and other people. Effective application of professional supervision in which support and constructive feedback can be sought and given is very important in the nursing profession. The nurse should not appear like he is just himself in the way that he acts. His authority will come out almost naturally and he has the responsibility of maintaining respect with the patient (Levett-Jones et al, 2009). Barriers that may impinge ability to communicate effectively with patients The barriers to effective communication can be categorized into three sources which most of the time overlap are linked very closely to the factors influencing communication. This will include: The barriers emanating from within a person for instance our race, age, gender, culture, disability, feelings, social class, experiences of similar encounters and the physical state. The barriers emanating from within a person makes a person forms a perception about how he views other people. It makes someone to prejudge a situation before getting full information. Secondly there are barriers emanating from other people for instance, other people’s perception of an individual, their races, ages, cultures, disability in hearing, expectations from an individual and the particular situation. These barriers make others form opinions about an individual without having accurate information. There are perceived stereotypes that people have against others that make them also to prejudge (Watson, 2008). Lastly there are barriers that comes from the environment for instance extraneous noise, the circumstance in which the encounter is occurring, if it is public or private place and who does it belong to, and temperature prevailing. The environment may contain noise that may make it difficult for an individual to hear what is being communicated. Part two How the nurse can ensure appropriate professional boundaries are maintained when working with vulnerable individuals Apart from setting limits on behavior, boundaries are meant to contain behavior, as compared to a jar holding honey and preventing it from spilling and being wasted and spoiled. Boundaries in the professions ensures that nurses to focus on the fundamental task of the practice of nursing and keep away distracting influences from the responsibilities role of the nurse. To ensure professional boundaries are maintained when working with vulnerable groups, the nurse should make sure that he sticks within the area of his specialization. The nurse can take up or reject duties and can as well classify his role concerning other practitioners together with their clients. Boundaries demarcate the limit and extent of practice in a profession and consequently the nurse need to be sure of his own individual limits and skills, what need to be taken to others and what he can handle by himself without assistance. In so doing he will not be allowing any room of may be unnecessary confrontation from a vulnerable client or patient. It cannot be dismissed that some of the patients that seek services of the nurses are very knowledgeable themselves and it is very easy for them to detect any shaky behavior in the nurse pointing towards incompetence. Maintaining the limits is also very fundamental in ensuring that another person fault is not made worse and therefore there is enough accountability since one is answerable in his area of specialization. Safe practices ensure that the nurse is not caught in a territory that is not his and therefore he cannot defend himself. Any duties of delegation extended to him should be confined in his area of study or specialization. The nurse should also ensure that he does not engage into unnecessary conversation that may spill over to other things. According to Rose and Best (2005), the nurse should avoid a lot of informal conversation that may be misinterpreted by the patient and making him to engage in necessary bickering that will hinder communication. To deal with vulnerable individuals the nurse need to be polite but firm, and stick to the very basics of his profession without compromising his principles. As stipulated the nurse should avoid using the doctor’s first name in front of the patient. The implicit boundaries involves where a nurse in a team observes but has never been discussed by the team. The nurse should observe these implicit boundaries without being pressurized. Explicit boundaries are very conspicuous and laid down in the regulations of the behavior in the ward and outside the ward. Whether boundaries are explicit or implicit, the nurse should strictly adhere to them. The nurse should be aware of the existence of these professional boundaries so that he is not caught overstepping his mandate. Hierarchy and uniform also provide boundaries in a manner that they give people identification in relation to others. The nurse should respect the status of the doctor to make the patients also follow suit. The nurse and the doctor are easily identifiable with the kind of uniform that they put on and they have different portions of their own respect accorded to them. When dealing with vulnerable individuals the nurse need to use an easy to understand language and avoid unnecessary jargon. If a lot of the jargons is included in the conversation it will definitely irritate a vulnerable individual leading to confrontations that can be easily be avoided. Luhanga (2007), argues that the patient or individual should be informed politely who will be caring for him and the responsibilities that are expected from him. Although this appears to be an informal contract it results into it results into the anxieties of the patient being contained. The nurse should not be intimidated by the individual and should not also in any ware intimidate the individual. In case the nurse does not understand any of the communication relationship with any of the clients, he should be able to consult expedient other co-workers. The nurse should offer any clarification sought by the individual. The nurse should be patient and should lose his cool easily even if provoked. The nurse should able to negotiate working contracts that are explicit and encompasses limits to relationships that include personal responsibility, possible place of work and time. As the nurse tries to explain himself he should ensure that he is assertive in the mode of communication. The nurse has to be very observant and not any unfamiliarity inn his place of work. While the nurse provides supportive help he should ensure that he is not lost the situation in that he fails to observe the explicit and implicit boundaries. The nurse should be very decisive and make decisions promptly to ensue that no misunderstanding situations crops up between him and the patient. In as much as possible the nurse should withdrew from an environment that is threatening to spillover (Alexander. et al., 2000). Strategies that should be utilized to manage challenges which are likely to be experienced during clinical placement The most import issue for the student nurse during clinical placement is to gain workplace experience. The strategies that a student nurse has to employ are intended to enable him to cope with the challenges that come with clinical placement. Firstly the student needs to put away the feeling of being inadequately prepared so that he has the confidence of dealing with the task that will be assigned to him on the ground. Watson (2008) notes that the student nurse should be respectful of the learning process and on his own prepare adequately for the occasion without only waiting for direction from the instructors. The student needs to have a interrogative conversation with someone who has been on clinical placement so that he knows what to expect on the ground (Meleis, 2007). More importantly, the student nurse should enquire about the challenges encountered by others who have gone through the process and know what to anticipate. The student should pay more attention if any clinical laboratory simulation is conducted. The student should always refer to the clinical supervisor in case he encounters any difficult in the field. Alexander et al. (2000), notes that it is fundamental that the student nurse appreciate his colleagues and he is willing to learn from them if they know anything extra. The student will gain a lot from attending extra-coaching and any additional session. During the clinical placement the student should be keen to follow any instruction given to him and besides he can get a colleague who they can discuss day to day experiences and learn from each other. Bibliography Daly, J., 2010, Contexts of Nursing, Edition 3, Elsevier Australia, Melbourne. Karen Jean Gaskell. 2010, Definition of Therapeutic Communication. Retrieved March 29, 2010 from < http://www.livestrong.com/article/87211-definition-therapeutic-communication/ > Klagsbrun, J, 2003, Listening and Focusing: Holistic Health Care Tools for Nurses, Retrieved March 28 from Brooker, C. & Nicol M., 2003, Nursing adults: the practice of caring, Elsevier Health Sciences, Melbourne. Alexander M. F. et al., 2000, Nursing practice: hospital and home: The adult, Edition2, Melbourne Elsevier Health Sciences. Hitchcock, J. E., et al., 2003, Community health nursing: caring in action, Volume 1Edition 2, Cengage Learning, NY. Levett-Jones, T. et al, 2009, The Clinical Placement: A Nursing Survival Guide, Edition2, Elsevier Health Sciences, Melbourne. Rose M. & Best D., 2005, Transforming practice through clinical education, professional supervision, and mentoring Elsevier Health Sciences, Melbourne. Luhanga, F. L., 2007, The challenges for preceptors in dealing with nursing students engaging in unsafe practices, ProQuest. Meleis, A. I., 2007, Theoretical nursing: development and progress, Lippincott Williams & Wilkins, 2007 Watson J., 2008, Nursing: the philosophy and science of caring, University Press of Colorado, Colorado. Sully P. & Dallas J., 2005, Essential communication skills for nursing, Elsevier Health Sciences, Melbourne. Ellis R. B.et al., 2003, Interpersonal communication in nursing: theory and practice, Edition2, Elsevier Health Sciences, New York. Read More