The Ever Changing Role of Nurses in the Healthcare system

Nurses make up the largest health care profession in Australia, unlike other professions the proportion of nurses to population is consistent across Australia. The capacity of practice for nurses tends to vary depending on the location. The first section of the paper will discuss the ever-changing role a Nurse in the health care system, the focus will be put on the role of a Nurse in the hospital and then the community. While discussing the roles of a nurse, this paper will also discuss the importance of teamwork, inter-professional collaboration and professionalism in the nursing practice.

Caregiver

Planning, implementation, evaluation and provision of client-centred care relies on a key component of the nursing practice, which is the assessment. A nursing assessment is the organised collection of both subjective and objective data, this should be done every time a nurse meets a patient. It can be gathered from the patient, family members, and friends, the more comprehensive the health assessment is, the better the health outcome. A comprehensive nursing assessment should be done on admission, it requires a thorough assessment of the patient’s history, general appearance, physical examination and vital signs. Nurses are considered as first-line caregivers, meaning they spend more time with the patient than any other health care professional. This requires that the health care system and patients rely heavily on nurses for their initial and ongoing assessment. For example, the administration of pain medication depends on the pain assessment done by the nurse at the start of every shift (The Royal children’s hospital, 2014).

Diagnosis and inter-professional collaboration

A Nursing diagnosis is based on the knowledge that has been collected about the client during the nursing assessment. The major role of a nursing diagnosis is present a problem at the point of contact with a patient, this is different from a medical diagnosis which pinpoints a disorder based on the available data collected. The assessment phase also helps Nurses come up with actual and potential problems, for example, a patient who is immune compromised or diabetic Is at increased risk of acquiring an infection. Compared with a young twenty-five old males with a dislocated ankle.

In a hospital setting based on data collected a Nurse would then document there finding and state if a patient needs immediate medical attention, increased surveillance or monitor as usual (Gagliardi, Dobrow, & Wright, 2011). A nurse would first cluster the information into categories, clustering the data collected into categories helps paint a better picture of the patient’s illness.  Some hospitals require a three-part nursing diagnostic labels, it requires an identification of a problem, for example, infection on the wound site. Secondly, aetiology or related factors and finally signs and symptoms which list the characteristics and the rationale. For example, generalised infection demonstrated by the rise in patient temperature (Zwarenstein M, 2009 ).

A collaborative problem is an actual or probable physiological complication that nurses monitor to detect the onset of changes in a patient’s status. When collaborative problems develop, nurses intervene in association with personnel from other specialities like physiotherapists, doctors, and dietitians. For example, in postoperative care most patients are at high risk of developing an infection on the surgical site, a doctor may prescribe antibiotics as prophylaxis.

The nurse would administer the medication, observe for signs of infection and perform neurological assessments. In most hospitals, this is done at the state of every shift. A nursing diagnosis such as acute pain or nausea is a clinical judgment about an individual, family or community responses to actual and potential health problems. Having the patient or the family member involved in the diagnostic process is what makes the nursing diagnosis different from the medical (Castner, 2008).

Planning and Management of care

Nurses in health care are tasked to provide a care plan, this should include a specific nursing diagnosis, goals and expected health outcomes. A single patient can have multiple nursing diagnoses, for example, post-operative patients are often at risk of respiratory, cardiovascular depression and thromboembolism from immobilisation. A nurse’s job together with the collaborative problems that were identified needs to prioritize a plan of care in order of emergency.

In this case, the current best practice guidelines state that the nurse needs to make sure that the patient is breathing normally by themselves before other complication can be treated. Priority of treatment is flexible and is based on the condition of a patient at any given time, hence at the start of every shift it is important to reorder the priorities. For example, say a patient is on two hourly pressure area care, upon being repositioned patient’s stats that their pain score is eight out ten. At that point administering analgesics is more important than repositioning the patient (Gregory & Buckner, 2014).

Planning of care needs to be holistic and person-centred, person-centred goals should reflect the highest level of willingness and independence in function. When planning care, it is important for the nurse to ask themselves what they hope to achieve while the patient is in their care. For example, an elderly patient who has just had fall, the main goal would be for the patient to walk without help from careers or mobility Aids.  Another example is, a patient that suffers from acute pain can realistically expect pain relief, whereas a person who is suffering from end-stage bone cancer can only expect acceptable pain levels. It is important for nurses to review the care plan every time the patient condition changes (Wilkinson, 2011)

Implementation of care

A nurse’s role in the health care system is multifaceted, Nurses are tasked to implement the care based on either the medical or nursing diagnosis. Nursing care and interventions are designed to achieve the goals that were set during planning and diagnosis. The clinical intervention and decision should be based on evidence combined with clinical experience. Evidence-based practice provides nurses with the ability to streamline to the individual or community. For example, diabetes and obesity are prevalent in aboriginal communities, we know a lot of complications that arise from these conditions can be prevented through exercise. So, based on this evidence nursing interventions should focus the energy and resources towards programs that reduce the prevalence of diabetes. There are two types of implementation in nursing, the first one is direct care, which are treatment interventions that are given through direct interaction with the patient, the other one is indirect care (Lukes, 2010).

Indirect interventions are performed away from the patient but on behalf of the patient. Indirect care seeks to control the environment around the patient, for example, when treating patients with addictions controlling where the patient lives are as important as the treatment process (de Witt, 2010). Nurses spend a lot of time in indirect care, communicating with physicians, dietitians and social workers. Communication and sharing information among heath care provider is important because it helps to plan for direct care of a patient (Luangasanatip et al., 2015).

Direct care may include help with activities of daily living, for example, older patients with any form of arthritis often need help with showers. Another example is patients who have just surgery on their arms may temporally need help with putting clothes on. Secondly, nurses perform several physical care techniques when caring for a patient, for example, administration of medication and varies comfort measures like pressure area care. Also, life-serving measures when the patient’s condition suddenly deteriorates. For example, giving emergency medication and initiating cardiopulmonary resuscitation. In the community, nurses can be counsellors and patient advocates. For example, in cases of child abuse nurses notify child services, so that the child can be protected. In extreme cases based on the nurses’ recommendation, the child can be taken away, and the necessary measures like counselling or therapy can be put in place to limit the impact of the abuse (Fiset, Luciani, Hurtubise, & Grant, 2017).

Evaluation of Care

Depending on the level of expertise nurses play a very important role in the way hospitals, care homes, and clinics are run. Nurses spend more time with the patient than any other profession, hence day to evaluation of the patient is left up to the nurse. For example, in most nursing homes the physical mobility of Residents is reviewed every six months. But In a case where the patient’s condition suddenly changes, Nurses can review the care plan, referrals can be made for the physiotherapist to review the patient’s mobility (Higuchi, Davies, Edwards, Ploeg, & Virani, 2011).

Throughout the whole nursing process, it is important for the nurse to evaluate the efficacy of care every time contact with the patient is made. Evaluation is based on the goals that were set when care was planned, for example, a measurable goal in a patient who has just had a septoplasty is for them to breathe normally and have uninterrupted sleep. In this case, whenever the Nurse meets the patient, evaluation should be made as to whether the patient is breathing normally. If not, care should be modified based on the patient’s condition at any given time (Yagil, Luria, Admi, Moshe-Eilon, & Linn, 2010).

Broadly, a nurse’s job in evaluation is to be the patient’s advocate, in this role the nurses’ must protect the rights of the patient. Nurses in health care act as a bridge between the physicians and the patients. Knowing the patient wants, needs and dislikes is the first step in being an advocate.  It is important to remember that advocacy for the patient does not just come when there is an infringement of the patient rights and wants. It is a continuous process that is client centred and through collaboration with families and physicians seeks to promote patient health (Hujer, 2012).

Intra – Professional Collaboration

Intra-professional collaboration is the partnership between teams of health providers, it is done through consultation and communication between the health providers and the patient. Inter-professional collaboration important during assessment, diagnosis, planning and implementation of care. Elements of collaborative practices include responsibility, accountability, coordination, communication, corporation mutual trust, and respect. Teamwork ensures that information is shared among colleagues, it promotes accountability and makes staff feel wanted and important. Patient outcome is improved when everyone in the workplace feels they are part of a team. For example, cleaners and hospitality staff play an important role in infection control, through proper handling of food. If hospitals did not have cleaners, work would fall on nurses, this would, in turn, take away from the day to day care of patients (Cartwright, Franklin, Forman, & Freegard, 2015).

Professionalism in nursing

Professionalism according to the nursing board of Australia refers to the way a nurse behaves while giving care. There are ten codes of professional ethics that are listed on the nursing board of Australia, the focus will be on three main principles. The main aim is to set a minimum level of professional standards across Australia. It also helps the public know the standards that are expected from nurses. It provides a templet for various stakeholders like regulatory groups and businesses with a basis for evaluating nursing conduct.

      Firstly, code of ethics number four deals with the dignity of patient and colleagues. Respect, autonomy, empowerment and communication are all attributes of dignity. Nurses are tasked with a lot of information both from the physicians and patients, it is important that the privacy of the patient is kept always. Nurses should also maintain a good attitude, as a bad attitude can affect patient health. Nurses should not use profane, racists, homophobic language and always be mindful of the patient culture and religion (Nursing and Midwifery Board of Australia, 2008). For example, in a case where a patient needs a blood transfusion, but they refuse based on their faith. The nurse should take time to explain other forms of treatment if possible chaplains, phycologists and priests should be involved (Watkins, 2015).

       Secondly, the information given to either the patient or colleagues on nursing care should be reliable, unbiased and accurate. Involving the patient in their care ensures trust between the nurse and patient, it promotes autonomy and maintains dignity. Furthermore, nurses should provide the advantages and disadvantages of the care that is being given so the patient can make an informed decision based on the information that is given. For example, cancer patients should be informed why chemotherapy is being prescribed, what happens if they do not do the therapy and what physicians hope to achieve at the end of the therapy  (Nursing and Midwifery Board of Australia, 2008). The nurse should not misrepresent information with regards to the health care products that is being offered. Misinformed patients make bad decision. For example, telling an HIV patient that they don’t have to keep on taking anti-retro viral drugs and that the effects of HIV can be reduced through diet. This would be misleading and would provide the patient with false hope (Judkins-Cohn, Kielwasser-Withrow, Owen, & Ward, 2014).

     Thirdly, trust and confidence in the community should be maintained and belt through leadership and accountability. Nursing leadership rests on the premise of a shared governance model. Shared governance is an inter-professional decision-making process that is rooted principles of equity, partnership, accountability, and ownership. It ensures that every member of the team feel like they are part of management. This, in the long run, improves patient and community satisfaction shortens hospital stay and improves the safety of the health care system (Shwaihet, 2013).

The model includes a variety of hospital-wide and unites based communities. In this model, nurses have the authority to make decisions that affect the nursing profession and the lives of patients and communities at large. An example of a shared governance is creating committees that are tasked to investigate patient satisfaction, wound care and falls prevention committees. These councils are made up of different professions and members of the public, this ensures accountability and a high level of professional standards in the health care system. If the trust was in the nurses or the health care system at large was to be compromised, it would affect therapeutic relationships, which would then affect nursing and delivery of care (Burkoski & Yoon, 2013).

Furthermore, setting limits that protect the space between professional power and patient vulnerabilities is also very important. The boundaries between therapeutic relationship, professional and non- professional relationships should clearly be articulated. When nurses cross these lines, they are generally being unprofessional and misusing their power.  For example, a nurse dating a patient going through a major mental breakdown, or taking matters personally.

To manage these boundaries, a nurse needs to realise that is the difference in power between the nurse and the person receiving care that lives the patient vulnerable to exploitation.  For, example, people with no family sign over to their power of attorney to the trustee board upon entry.  In this case, people with dementia and other cognitive impairment are especially vulnerable. Because there is no immediate family to call for immediate, management of care is left up to the care home. The relationship between the independent power of attorney and the nursing home is one of mutual trust and relies on communication (The Nursing and Midwifery Board of Australia, 2010).

Key Points 

This paper has covered the role of Nurses in the assessment, diagnosis, planning, implementation and delivery of care both in hospitals and the community. We discussed how a nurses’ role is wide and is ever-changing and is dependent on the location, nurses now are expected to be patient advocates, teachers, counsellors, and caregivers.  Nurses now are taking roles that were previously occupied by physicians, for example, we now have nurse anaesthetist. Lastly, the paper covered the key principles like professionalism, teamwork and inter-professional collaboration has in nursing practice.  Because nursing is a first line profession, shared governance is important in improving patient care, reduction of hospital stays and increases patient satisfaction.

References

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Zwarenstein M, G. J., Reeves S,. (2009 ). Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD000072.pub2.

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