During the semester and the coursework, I got the opportunity to come across a huge number of principles and theories not only from science domain. Those theories were also from arts and humanities domain as well. It helped me to gain some of the most important realization after going through the theories. Nursing theories help by providing the novice as well as the expert nurses with the principles that need to underpin their practices and also help them in generating further nursing knowledge (McEwen & Willis, 2017). Nursing theories mainly provide the conceptual bases to the nursing professionals for the nursing practices. Most of the nursing theories are seen to use a logical structure of idea as well as hypothesis and even assumptions that can be applied towards a variety of situations. These theoretical structures are mainly seen to serve as one of the basis for the different nursing practicum, different patient care strategies. They also help in professional development, nursing researches, education as well as administrative decision making. I can use an example to explain my viewpoint. One of the most important theories that I have come across is the clinical reasoning cycle. This cycle acts as the guiding framework to the nurses to collect cues from the patient when they come with their disorders. Accordingly, information is gathered about them, tests are done and different signs and symptoms are identified. Then the theory helps the nurses to relate them with their knowledge of pathophysiology and the different factors that might have made the person vulnerable to the disorder (Alligood, 2017). Then the theory helps the nurses in setting goals and action plans. Thereby, it helps in active decision making by the nurse ensuring safe and quality care. Jean Watson’s caring model helps in emphasizing the different types of humanistic approaches of nursing as well as combination with scientific work. Apart from these, the coursework also helped us to learn many important theories that would help us significantly in out nursing profession.
One of the most interesting parts of the coursework was that it helped us in understanding the gradual shift of focus of the healthcare industry from bio-medical model of care to that of the bio-psycho-social model of care. I have identified the reasons of failure of considering only the biological determinants of the poor health of the patients. It does not provide comprehensive care to the patients making them visit the healthcare centre again and again. Therefore, holistic care that includes considering the biological determinists along with the psychological as well as the social determinants can only provide comprehensive care that satisfies their needs and requirements (Clark, 2015). I have learnt that holistic nursing can be defined as the nursing procedures and practices that has the main goal of the healing the whole person. As a holistic nurse, I would be mainly focusing on the “mind-body-spirit-emotion-environment” approach in comparison to that of the traditional nursing procedures. Moreover, one of the most important parts of holistic treatment is providing person centred care to the patients. By person centred care, I mean that I have to consider each of the patients as individuals with unique needs whose needs and requirements are different. I need to provide care to them in way that meets their personal requirements that satisfies them. I need to encourage them in active decision making in their own care plans and the coursework helped us to know how this procedure helps in empowering the patients and making them feel respected. I have gone through several evidence based papers where I realised that person centred care maintain dignity and autonomy of the patients, irrespective of their caste, creed, religion, races, ethnicity and others. It also reduces the power issues between patients and professionals as patients feel powerless in the healthcare centre environment (Lor et al., 2016). Therefore, I believe that this module would be helpful for me to ensure patient satisfaction and providing quality care to patients.
We got the scope of understanding the procedures of evidence-based practices in the nursing profession and also did some theoretical projects on them. This aspect helped me to become familiar with the procedures of the evidence-based practices. I felt it to be a difficult procedure in the initial days of the coursework. However, with the gradual passing of the days, I was able to set up my skills that helped to conduct this practice with expertise. Evidence-based practice is a clinical decision making framework where the healthcare professionals use varieties of theory derived, research based knowledge for informing their decisions about care delivery (Kalb et al., 2015). One of the most interesting attribute of evidence-based practices, which I believe is important for flourishing of healthcare science, is that it replaces the policies as well as the procedures that remain based on other sources of evidence like authority and traditions. I have realised one important from the lectures that I had attended on this topic. This procedure takes into account three important attributes that nursing students should take into account. These three aspects are the best practice evidence, clinical expertise and patient preferences. I have done much homework to develop the skill of conducting evidence-based practices. I have come across new information through evidence-based practices when I was doing my homework. Aspirin was previously utilised by nursing professionals for managing and controlling fever in the paediatric population. However, this is no longer a standard practice as it increases the risks of Reye’s syndrome. On another instance, I found that turning patients every two hours with pressure ulcers is no longer a standard practice. The timing of the turning of the patients should be entirely dependent on the condition as well as the risk of breakdown of the patient (Dicenso et al., 2014). A patient might require to be turned out in every fifteen minutes while another patient may not require turning over in 1 hour. Therefore, it helps in providing with information from recent researches that make care more scientific as well as up-to-date ensuring best patient care.
In the course study, I came across an important module on ethics and ethical decision making in nursing. We were explained about the importance of maintaining ethical responsibility in the profession. A nurse must respect the dignity as well as the values of the patients and even the colleagues. She needs to treat all the persons regardless of the different personal attributes as well as other medical conditions (Bollig et al., 2016). I have also understood the responsibility of respecting the right of a person in the self-determination in her medical care. This coursework gave us the scope of learning about different bio-ethical principle that I will be applying in my nursing practices. These are beneficence as well as non-maleficence, fidelity and responsibility, integrity and justice, respecting for rights and dignity of the people and many others. As per the experience shared by our mentor, one of the most important barriers that nurses might face is the ethical dilemma. An ethical dilemma can be a complex situation that often involves apparent mental conflicts between different moral imperatives, in which to obey one might result in transgressing others. Often wrong ethical decisions might involve the nurses in legal obligations affecting her career and indulging her in different negative consequences. Therefore, critical reasoning skills and ethical decision making skills are very important at such times (Iphofen, 2016). In this course-work, we got the opportunity of solving many case studies which included different typed of ethical and moral distress situations. Therefore, solving them gave me an idea about the different situations that I might face in my future professional days. Therefore, this course-work helped me develop my ethical decision making skills which would be very helpful for me in my future.
Using patient care technologies, information systems, and communication strategies that support safe, quality nursing practice
A great deal of information was shared in the coursework regarding the different healthcare technologies, information systems as well as communication strategies that help in assuring high quality care to the patients. Some important insights that I have developed through the modules helped me in expanding my idea as well as my knowledge regarding healthcare technologies. In today’s healthcare systems, information technology had helped in healthcare modernisation making the work of nurses much systematised and easier, reducing the scope of human errors and ensuring better quality care (Nelson & Staggers, 2016). One of the most interesting aspects that had evolved out is the role of the nursing informatics. This is a specialty that mainly integrates the nursing science with that of the computer science for the management and communication of the data, information as well as knowledge in the nursing practices. This module had helped in developing an in-depth knowledge about the use of the information technology by the nurses for the purpose of enhancing the patient outcomes as well as the management of healthcare facilities, nursing education and even nursing researches. One of the technologies that our mentor had focused on was the use of the electronic patient record. This helps in effective documentation by the nurses regarding carious information about their care, treatment plans, medications, delegations and many others. It acts as effective means of non-verbal communication, circulating the information among the different members of healthcare teams, keeping records and help in delegation. Other remote services like tele-health, tele-medicine, m-health or mobile health are different types of technologies that help professionals to provide care to patients in their own homes in the remote places or when patients suffer from mobility issues and cannot visit hospitals (Kveder et al., 2014). Different types of equipments like manual handling and many others have modernised the nursing practices making care interventions much easier.
The module has focused on one of the most important foundation of effective care service delivery to the patient which is “quality improvement”. Quality improvement mainly helps in the consisting of the different systematic as well as continuous actions that have the ability to lead to measurable improvement in the care services (Sherwood & Barnsteiner, 2017). I have understood that quality is directly linked with that of the healthcare organizations’ service delivery approaches as well as underlying systems of care. Different types of Quality-improvement programs can adopt different strategies and procedures but four important key principles need to be adhered to. Quality-improvement should work as systems and the processes; it should focus on the patients; focus on being part of the team; focus on the proper use of data. Effective allocation of resources, funding, man-power, leaders and others like development of the organizational climate can ensure Quality-improvement in the organizations (O’brien et al., 2015). I realized that different types of services can be designed according to the needs of the quality improvement plan for meeting the needs and expectations for the patients and the communities. Different attributes that should be developed for Quality-improvement are systems that can affect the access of the patients. Care provision should be made more evidence based and accordingly nurses should be trained, provided enough resources and guided. Other attributes are ensuring patient safety and providing support systems for patient engagement. Effective coordination with the other parts of the larger healthcare center should be ensured. An organization culture needs to be developed for Quality-improvement which should focus on cultural competence of the nurses. This might include proper assessment of health literacy of the patients, patient-centered communication and even linguistically appropriate care. Effective leadership, proper human resource management, finance management, resource management, development of organizational climate, conducting healthcare surveys and researches in the organization and many others can help in ensuring leveraging Quality-improvement in the organizations.
In the healthcare centers, the nursing professionals do not have the responsibility of only caring for the patients. They also have the responsibility of working as team-members by developing bonds with each other and collaborating together to provide best care services for complex people. However, for effective team development and also to guide new nurses and developing effective care strategies for patients, leaders are important. The leaders have the responsibilities of motivating the nurses for working beyond their potential and meet the organizational goals (Bender, 2016). They act as friend, philosopher and guide to the professionals. They represent themselves as role models so that professionals can follow them and also gain trust on the organizational processes and realistic expectations from them. One of the most important attribute that can help the leaders in effective relationship development with the workers and advocate any issues on their behalf is the communication skills. Not only in patient care but also in effective team management, effective two-way communication is necessary. Two-way communications of the leaders with the subordinates ensure that the concerns of the workers are shared, their suggestions and feedbacks are given importance and that they are motivated to work beyond their potentials (Wong, 2015). Better will be the leadership, better will be the team bonding and safe and effective care can therefore be ensured for the patients.
One of the research papers was seen to state that “Nurses must see policy as something they can shape, rather than something that happens to them.” Initially, I was not sure about what this line meant as I used to believe that policies and regulatory processes are only meant to be followed for effective care service delivery. However, through the course modules, I realised that nurses have much bigger roles than just following the policies and regulatory processes blindly. Out mentor explained that as the nurses are the immediate persons beside bedside of the patients they serve, they are able to understand the healthcare needs of the patients and communities. So, they become the natural choices for leading the way when developing health policy priorities. Nursing professionals are therefore responsible for analysing the different health, financial as well as public policies and they upgrade them by incorporating important essentials identified to be significant for effective service delivery (Buchan et al., 2015). The nursing professionals can identify and analyse healthcare laws as well as public policies and then plan and implement new healthcare policies. They need to implement the strategies for advocating different policy changes. I have realised how contributions of the nurses can influence the public policies both locally as well as globally. It helps in coordinating care with systems in healthcare and expanding of the preventive care. It might also help the organisation to adapt to changes in healthcare like adapting to increased needs and care for aging population, improvement of healthcare efficiency as well as patient efficiency. It can also help in developing access to healthcare, developing the quality of care, reduction of medical errors and costs and many others (Frazier et al., 2014)
Advocacy has emerged out as one of the best methods, acts or processes which would help in supporting a cause or proposals. Research articles that I have gone through in the course-work had shown an advocate as the individual who “pleads, defends, or supports a cause or interest of another”. Advocating for the requirements and needs of the patients or of the communities which are not met by the present healthcare system or present governmental systems is one of the most important aspect of advocacy (Cole, Wellard & Mummery, 2014). I have realised that nurses spend most of the time with the patients and therefore, they can experience the healthcare limitation firsthand. Therefore, I believe that it puts the patient in the best position for speaking up about the needs and safety concerns of the patient. Hence, nurses need to be vocal and know the different avenues, both external and internal of the facilities which are available for facilitating and promoting changes for the benefits of both patients and the health care systems. This is crucial for developing nurse-patient relationship and the important attributes are problem solving, effective communication, influence, collaboration and many others (Kalaitzidis & Jewell, 2015). Not only advocating for patients, nurses can also advocate for other nurses as well for developing organisational climate or others.
The development of the professional identity is one of the crucial aspect that every nurses need to thrive for. This module taught me that development of professional identity is a continuous procedure that begins with the students taking admissions in the nursing program and evolving throughout the professional career in the dynamic and fluid process (Hoeve, Jansen & Roodbol, 2014). Interacting relationships with that of the education as well as the practices leading to self-reflection, growth and even human flourishing is an intricate part of professional identity development. Professional identity is seen to include acquiring of the insight to the professional functioning that helps in creation of the professional values and ideals (Marañón & Pera, 2015). It mainly includes the different attitudes, values, knowledge, skills and beliefs that need to be present in a professional.
One of the most important professional values that need to be developed is ensuring ethical and respectful care to the patients. I need to promote effective communication as well as relationships, promote anti-discriminatory practices and maintain confidentiality of information while caring for the patients. Another professional value that I also need to focus on are promoting and supporting individual rights to dignity, empowerment, independence, safety and even choices. I must make sure that I acknowledge personal beliefs of the individuals and identifying and respecting the diversity. I would be also protecting individuals from different abuses and provide individualized care.
References:
Alligood, M. R. (2017). Nursing Theorists and Their Work-E-Book. Elsevier Health Sciences.
Bender, M. (2016). Conceptualizing clinical nurse leader practice: An interpretive synthesis. Journal of Nursing Management, 24(1), E23-E31.
Bollig, G., Gjengedal, E., & Rosland, J. H. (2016). They know!—Do they? A qualitative study of residents and relatives views on advance care planning, end-of-life care, and decision-making in nursing homes. Palliative medicine, 30(5), 456-470.
Buchan, J., Twigg, D., Dussault, G., Duffield, C., & Stone, P. W. (2015). Policies to sustain the nursing workforce: an international perspective. International Nursing Review, 62(2), 162-170.
Clark, P. G. (2015). Emerging themes in using narrative in geriatric care: Implications for patient-centered practice and interprofessional teamwork. Journal of aging studies, 34, 177-182.
Cole, C., Wellard, S., & Mummery, J. (2014). Problematising autonomy and advocacy in nursing. Nursing ethics, 21(5), 576-582.
DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-Based Nursing-E-Book: A Guide to Clinical Practice. Elsevier Health Sciences.
Frazier, B., Culley, J. M., Hein, L. C., Williams, A., & Tavakoli, A. S. (2014). Social networking policies in nursing education. CIN: Computers, Informatics, Nursing, 32(3), 110-117.
Hoeve, Y. T., Jansen, G., & Roodbol, P. (2014). The nursing profession: public image, self?concept and professional identity. A discussion paper. Journal of Advanced Nursing, 70(2), 295-309.
Iphofen, R. (2016). Ethical decision making in social research: A practical guide. Springer.
Kalaitzidis, E., & Jewell, P. (2015). The concept of advocacy in nursing: a critical analysis. The health care manager, 34(4), 308-315.
Kalb, K. A., O’Conner-Von, S. K., Brockway, C., Rierson, C. L., & Sendelbach, S. (2015). Evidence-based teaching practice in nursing education: Faculty perspectives and practices. Nursing Education Perspectives, 36(4), 212-219.
Kvedar, J., Coye, M. J., & Everett, W. (2014). Connected health: a review of technologies and strategies to improve patient care with telemedicine and telehealth. Health Affairs, 33(2), 194-199.
Lor, M., Crooks, N., & Tluczek, A. (2016). A proposed model of person-, family-, and culture-centered nursing care. Nursing outlook, 64(4), 352-366.
Marañón, A. A., & Pera, M. P. I. (2015). Theory and practice in the construction of professional identity in nursing students: a qualitative study. Nurse Education Today, 35(7), 859-863.
McEwen, M., & Wills, E. M. (2017). Theoretical basis for nursing. Lippincott Williams & Wilkins.
Nelson, R., & Staggers, N. (2016). Health Informatics-E-Book: An Interprofessional Approach. Elsevier Health Sciences.
O’brien, A., Weaver, C., Hook, M. L., & Ivory, C. H. (2015). EHR documentation: the hype and the hope for improving nursing satisfaction and quality outcomes. Nursing administration quarterly, 39(4), 333-339.
Sherwood, G., & Barnsteiner, J. (Eds.). (2017). Quality and safety in nursing: A competency approach to improving outcomes. John Wiley & Sons.
Wong, C. A. (2015). Connecting nursing leadership and patient outcomes: state of the science. Journal of Nursing Management, 23(3), 275-278.
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