Essence of Nursing - Essay Example

Running Head: THE ESSENCE OF NURSING The Essence of Nursing [The Writer’s Name] [The Name of the Institution] The Essence of Nursing Introduction Nursing is a challenging, rewarding and a very exciting career. The nurse's role is not limited to changing bandages, giving needles and offering support, as the past has indicated. In fact, the role of the nurse in the present is now one of advocate, caregiver, teacher, researcher, counselor, and case manager. The role of the nurse is limitless and it is importance to our health care system is vital in providing quality care. Being a caregiver encompasses the physical, developmental, psychosocial, and also the spiritual part of a client. In today's fast growing technology, medical science, and the goal of curing a patient seems to be cold and calculative. This is where the nurse takes on the role of caregiver, by not doing for the client, but the nurse takes into account what this patient is living through, feels what they must be going through, and finds ways for the client to help him or herself. The caregiver helps a patient and their family set goals and plans of action, and meet them in a minimal amount of time. If the nurse was to do her work in a mechanical fashion, the public would obviously feel that the health care system is cold and calculating, since the nursing profession is a big part of the health care system. The trust would be gone, and the public would feel like they were just number. However with a nurse taking the caregiver role, he or she demonstrates to the public that they are not just numbers, but they are individuals with different needs and attitudes. Nursing As a Part of Multidisciplinary Clinical Team In nursing, according to Kozier, Erb, & Blais (2006), "the caregiver role has traditionally included those activities that assist the client physically and psychologically while preserving the client's dignity", (p.129). In order for a nurse to be an effective caregiver, the patient must be treated as whole. The caregiver role is vital in providing direct quality care to a patient and is greatly influenced by the attitude of the nurse. By treating the whole person, the nurse can build trust between the nurse and client, thus promote healing and peace of this individual. Everyone is an individual and a caregiver must consider this in order to deliver quality care and love. A nurse must do this by following the code of ethics. By following the code of ethics, and providing care to the individual, the client feels that he or she is viewed as a whole and complete person, regardless of their illness or disease. With care giving, being a client's advocate is a very important role that a nurse assumes. According to Tyson (1999), "advocacy is the act of informing and supporting individuals so they can make the best decisions possible for themselves", (p.64). Nurses frequently encounter clients that feel powerless, vulnerable to assert their own rights. A nurse, who takes the role of advocate, must promote a climate in which the individuals, groups, families or a population can act in their own interest, and this includes having access to resources and intervenes when they are unable to act in their own interests. The role of client advocate is there to protect the rights of clients. Multi-Dimensional Role of Nursing The nurse in the role of counselor is also very important. Kozier, Erb, & Blais (2006), state "counseling is the process of helping a client recognize and cope with stressful psychological or social problems, to develop improved interpersonal relationships, and to promote personal growth", (p.129). The nurse in this situation counsels a primarily healthy individual in making normal adjustment in the health. This is not to be mistaken with being a psychotherapist, since psychotherapists are there to counsel individuals with identified problems. The nurse in this role is there to help a client to develop and see new feelings, behaviors and attitudes. This role does require great communication skills, as the nurse in this role, may have to lead group counseling sessions, or one to one counseling. The type of one to one can be for losing weight, where a patient may also need to decrease their level of activities, or even cope with impending death. Kozier, Erb, & Blais (2006, p130) mention that the nurse who is in this role, should be willing to model, and teach the desired behaviors, the nurse must be sincere when dealing with clients, and also demonstrate interest and caring in the welfare of others. The nurse must also be very inventive, have a great sense of humor and also have a very flexible attitude. The role of counselor requires that the nurse be very understanding. Without this role, a client may not be willing to help themselves, since they had no one to guide them in bettering themselves. Clients would come back to the health care system, with no improvement of themselves, since no one was there in the first place to guide them properly. Another role and quite important role is the nurse as a teacher. Whether employed at a community clinic, hospital, school, workplace or home care agency, nurses help to educate patients, volunteers, students, employees and other health professionals. There has been in the health care system, so much emphasis on health teaching. The nurse is often seen teaching a patient how to use their medications properly, and how to care for their wounds at home. If the individual, family or group of people being taught has not understood, the nurse in this role will modify her teaching plan; investigate her assessment tools, teaching strategies and all of her teaching materials that she has used. In today's high tech world and costly medical health system, the emphasis on health promotion and maintenance of optimum health has increased, rather than the focus on the treatment itself, and this is where the nurse's role as a teacher is so important. The health care system has placed on patients a shorter stay in hospitals, so the importance of teaching the patients on how to care for themselves at home is very important. It is very clear that practicing nurses will increasingly play an important role in health-care education, given the emphasis governments and health-care policy makers today are placing on health promotion and disease prevention. There are many different settings, where a nurse can research. The nurse may be employed in the hospital setting, in the community, in the academic setting, or even in an independent professional setting. Collaborative Role of the Nurse All nurses are to know what research is and its importance, in order to deliver quality care to patients. According to Kozier, Erb, & Blais (2006), "nurse case managers work with the multidisciplinary health care team to measure the effectiveness of the case management plan and monitor outcomes", (p.131). Depending where this nurse works, the role is specified to the unit or agency that the nurse is employed. In some situations, a case manager may be responsible to oversee the staff nurses on a unit, however in some other agencies; the nurse may have to perform direct care to clients and their families. In the hospital setting, the case manager helps develop plans of care in collaboration with the health care team. Once the plans are place, the plan is then evaluated for its effectiveness. Manley (1996) recognized two schools of thought regarding advanced nursing roles; one relating to the acceptance by nurses of roles previously considered to be those of doctors, and the other, the theory to which she subscribes, associated with the advancement of nursing rather than medical practice. She sees the purpose of such posts being multi-dimensional, promoting and developing clinical nursing to strategic and policy levels whilst creating a culture where nurses strive for more effective patient and healthcare services. Manley, (1997) through the plethora of terms and the diversity of expanded roles in practice, developed a conceptual framework in order to try and operationalize the advanced practitioner/consultant nurse role in the acute setting. Initial and continual audit of the service would be required in order to assess need, recourses and measure its impact on patient outcome. It would involve working across professional and organizational boundaries, an approach fundamental to supporting quality service improvements (Coombes and Dillon, 2002, 387-93). Initially, collaborative relationships between ward and ICU staff would need to be developed. However, if the change was led and managed sensitively it could lead to improved communication and intraprofessional understanding and recognition. Thus, to the breaking down of barriers that exist between ICUs and ward areas, not only in the study by Coombes and Dillon (2002) but also in the clinical area, potentially leading to the transformational culture envisioned by Manley. As the role is only potential it is difficult to accurately assess to what extent it would impact on patient care in the clinical area. It would depend not only on the numerous aspects conceptualized by Manley but also critically on the background, motivation and personality of the individual. However, if the role was realized to its full potential it appears the impact on quality of patient care could be considerable and far-reaching. Quality of care would be effected both directly, through the role's strong emphasis in expert clinical practice, so also providing a role model, and indirectly through development of staff and practice and through the initiation and management of change to direct service provision to meet the needs of patients'. The example of setting up a critical care outreach service and PERT led by the nurse consultant could result in the breaking down of barriers between clinical areas and increased collaboration between staff, as well as directly effecting patient outcome and providing a direct link between practice and management at all levels. The undertaking of, contribution to and support of other staff in research projects would further contribute to nursing practice and staff development and so to quality of patient care. Communication Skill and Nursing Role Like all roles, the nurse needs to have great communications skills, and possess a very good clinical background. The importance of this role in the Health care system is very well stated in Kozier, Erb, & Blais (2006), "regardless of the setting, case managers help ensure that care is orientated to the client, while at the same time controlling costs. With the ongoing need to limit costs and ensure quality, managed care and case management are increasingly important approaches to health care", (p.131). Whether the nurse is in the caregiver, advocate, teacher, researcher, counselor, or case manager role, all these play a big part on the health care system in reducing costs, and also the biggest part in delivering quality care to the public. The main focus on all of these roles, comes down to respecting, guiding, providing information, to clients who in the past had the perception of nurses as simply being individuals who only provided medications, and treatments. The future holds great potential to the nursing field, and attains its respectful place as a profession in the health care system. Health care delivery has in the past and sometimes still, follows an autocratic model. The doctors' order ruled, without question or negotiation. Doctors, in turn, have their own pecking order and sisters ruled over staff nurses. “Nurses could be viewed as prisoners of their own past, steeped in tradition, comfortable in their hierarchical structures and managed in a conventional environment” (Koefman, K. and Woods, M. 1995 ). While fear as a management style can accomplish impressive short-term results, for example in critical situations like accident and emergency, the long term consequences can be demoralizing. Discontented employees may voice their frustrations by being rude to patients, performing poorly or quitting and some leaders may even face lawsuits for acting towards subordinates unfairly. “An autocratic management style encourages high staff turnover and low employee morale. Low morale, in turn, causes a decline in productivity and in the quality of service provided to patients.” (Adam, 2002, 34-36) Community Nursing Role It could therefore be suggested that two key characteristics that the community nurse leader should possess were elevated technical skills and an extensive knowledge of community nursing. The rationale being that nurses need to converse face to face and make decisions based on expert knowledge. The more experienced a community nurse’s leader is the more they tend to use a more democratic style of leadership: delegating responsibility, taking more risks with decision-making, listening to team members, reviewing outcomes. They are apt to be confident in group ownership and decision-making. It is a general consensus amongst district nurses in the UK that they convey the desire to lead the nursing in primary care but to assist this move of more training would be necessary. Today's community nurse leaders face expanding workloads, fewer resources, greater patient expectations, increasing threats (e.g., malpractice lawsuits), and closer scrutiny. The art of caring is being transformed into a business. Like it or not nurse practitioners often find themselves in middle-management roles, with tremendous responsibility and little real power. A mix of leadership styles would consequently seem to work better due to the culture and personalities still evident within the nursing, which can pose great barriers to change. The scope of practice appears to give nurses more freedom in practice. Sundeen, et al (1998; 177-82) described how scope enabled nurses in one trust to move the boundaries of care in almost unlimited ways, for example, the setting up of nurse led clinics. With the removal of need for certification and the placement of onus on individual nurses to decide in what ways to expand their practice, certain legal and professional issues are raised. In accordance with scope, a range of new roles for nurses have since evolved in response to the major changes in UK healthcare and therefore service delivery, national policies and moves to more patient focused care (Spilsbury and Meyer, 2001). Indeed, nurses could be said to have a formal responsibility for exploring way in which quality healthcare can be improved under the auspices of clinical governance (Levenson and Vaughan, 1999, 25). Despite government and professional bodies continued promotion of expansion of nursing roles and support of advanced nursing practice, definition of advanced practice has not been forthcoming. Tume and Bullock (2002) quote the UKCC's failure to define advanced nursing practice as the reason for the diverse interpretation of these roles in practice. Neenan (1997) bemoans the UKCC's refusal to be more explicit in defining the role of the advanced practitioner in the acute setting, though acknowledging their reason being not wishing to stifle potential development. Sutton and Smith (1995) reject the notion of the medical model at the centre of specialist nursing and stress that the truly advanced practitioner focuses their efforts on their clients' and situations which enhance positive outcomes for the client. They are at once intuitive, reflexive and empowering practitioners that use their expanded roles to foster a sense of the individual and focus wholly on achieving excellence in caring. (Stuart and Laraia, 1998, 121-25) Clinical Practice and Nursing Role The emphasis placed on clinical practice made it difficult for advanced practitioners to contribute to other activities such as research, teaching and improving standards of care. They noted that this highlighted the multifaceted nature of the role and raised two possibilities. One being the role is so demanding that the individual cannot fulfill all that is required and the nurse will inevitably concentrate on some aspects rather than others. The alternative is that the disparate elements of the specialist role identified by research may in fact be part of an integrated whole, and although attempting to separate it may be useful in explaining it to others, it may not reflect the ways in which advanced practitioners experience their work (Finlay, 2000, 115-26). Manley (1997) recognizes this, explaining that though her sub roles are presented as separate entities within the conceptual framework, in practice they are overlapping and reciprocal. She argues that it is the multi-dimensional nature of the role that is the key in developing clinical nursing to have greater impact at strategic and policy level. Professional and Legal implications are another area that must be considered with the development of nursing practitioner/consultant nurse roles. The placement of onus came on individual nurses to exercise their own professional judgment on role expansion, whilst continuing to practice within the guidelines set out by the Code of Professional Conduct. “Any expansion of practice will therefore require acknowledgement of accountability by the practitioner and require competency” (Carver, 1998). Whilst scope allowed more flexibility in role development for nurses, its approach could also lead to legal complications (Goldman, 1999). If, for example, in the course of his/her duty an advanced practitioner/consultant nurse undertakes a task normally performed by a doctor, in law his/her level of competence will be measured against the skills and knowledge of a doctor (Diamond, 1995). Interestingly the General Medical Council (GMC) sanctions delegation to nurses if the doctor is sure the nurse is competent (GMC, 1995) and states that the doctor retains ultimate responsibility for the patient's care (GMC, 1992). However, with the nature of advanced nursing roles such a task may potentially be undertaken as a result of an autonomous decision by the nurse, so in such cases rendering this guideline irrelevant. It must also be remembered that accountability is the one element that cannot be delegated (Huber, 1996) and where issues may appear conflicting all professional guidelines ultimately refer back to the Code, which states that 'you are personally accountable for your practice....regardless of advice or directions from another professional' (NMC, 2002). Lunn (1994: 770-72) asserts that legally, nurses are expected to adapt to new methods and techniques in the course of their employment. This is expanded on by Rowe (2000), who states that knowledge and ability to practice must be constantly enhanced in order for nurses to be truly accountable and to deliver optimum nursing care and failure to do this would actually constitute a break of the Code. Accountability for these developments must be accepted by nurses and should be welcomed, as without it nursing could not claim to be a profession and patients' would have no rights. Provided the central principal of protecting patients' is adhered to, the practitioner can enjoy developing his/her own practice (Rowe, 2000). Conclusion Taking in consideration the fact that the unit is small, the fact that there is one modern matron off side, a teaching sister in the unit, the good skill mix of staffing within the unit, the fact that the unit is now changing in to a fast-track unit, and finally that there is a nurse consultant within the trust for ITU who is currently working on policy development, as well as fact that financially it will be a big investment in such a role, by description the enormity of this role may not appear practically achievable; it seems unlikely that one individual could create such an impact on quality of patient care. However, the essence of nursing is often difficult to describe and therefore, the true nature of such a diverse and dynamic role is even more challenging to capture and convey. In practice the sum of the roles' aspects appears to be greater than its parts and so its integrity and true nature appear to be compromised by attempting its analysis. (McQuillan, et al 1998, 1853-58) Parker approaches the issue of nursing role and identity in a way that possibly echoes environmental nursing models through the links that she forges between nursing and ecofeminism. For her, nurses have a unique access to the healing powers of nature that flow most readily through women (Parker 1993:89). She evokes a picture of nursing as a humanizing force in the dehumanizing environment of technicist health care, a force that is fundamentally embodied in an increasingly theorized and abstract realm. Knowledge, tradition, science and emancipation were powerful discourses drawn upon during the planning and introduction of the UK’s reform of nurse education, Project 2000. For the medical model, knowing the disease inevitably determines the treatment strategy. The goals of therapy are seldom client-centered and the individual must assume the client role with the concomitant obligation to co-operate (McKenna, 1993, 121-27). This compliance is an important element in the treatment process. There is also a perception that nurses will comply and co-operate with the physician’s orders. Nurses are discouraged from providing information to the patient about their possible prognosis - this is the doctor’s job and the desire to meet goals within a nursing care plan is not a sufficient reason for a patient to remain in care once the medical treatment is complete. (Heron, 2001, 89-93) Therefore, while the therapeutic plan may present the facade of the egalitarian team approach, the doctor, as the healer, is viewed as superior to all other disciplines (Mitchell, 1986). Quality of care evaluation in contemporary practice is becoming increasingly related to cost-effectiveness. If used appropriately, nursing theories can demonstrate cost-effectiveness through reducing dependency, reducing nursing preoccupation with non-nursing tasks, encouraging client self-care, and the early detection of clients’ problems (Webb, 1986, 208-12). Nursing theories can also assist in bringing about desired patient outcomes (Sorrentino, 1991). In addition, using a theory to underpin practice allows staff a greater articulation of health goals, hence identifying more efficiently the resources and skills needed to achieve them. Modern health care is a multidisciplinary endeavor and a team activity and therefore doctors, physiotherapists, etc. may also have a view on how the patients are being nursed. In such a culture, nurses are being seen increasingly as team players. In the not too distant future we may begin to value, select and use multidisciplinary theories on pain, rehabilitation and pre-operative care. Considering this, Smith (1994) believes that the uniqueness of nursing knowledge is no longer a relevant question for the 1990s. She maintains that human concerns will be investigated through a multidisciplinary lens, blurring, perhaps even dissolving, and the once sacrosanct disciplinary boundaries. By focusing on distinguishing our beliefs, values and theories, nurses may cause false dichotomies that will not merely limit their perspective but will divide them. 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