10 Seiten, Note: 70
The purpose of this essay is to identify the elements of ‘good nursing practice’ and to discuss how this contributes to ‘quality care’. It will begin by talking about the main interpersonal skills and qualities expected of a nurse and then discuss some of the governing bodies of nursing practice. It will look at the nursing Process, the necessity for it and the roper Logan Tierney model as a framework for nursing. The Department of Health (DOH) benchmarks for nursing and institutions set up in order to assess quality will also be briefly discussed.
Nursing is defined as “The use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death.” (RCN, 2003) This definition is said to be a generalised one but nonetheless important as it addresses elements common to the different facets of nursing. (RCN, 2003)
Stevenson et al (2004), state that good interpersonal skills and the ability to build relationships are the foundation for achieving quality care. They also go on to say that every nurse that starts in the profession has previously obtained social skills and behaviours from other aspects of life which are a benefit in their role. The need for flexibility with these skills is also highlighted as nurses work with and care for individuals from various backgrounds, cultures and religions (Stevenson et al, 2004). Listening is described as an art whereby the nurse should understand when not to interrupt a patient. Interrupting the patient even when they may have paused for a while may lead to the patient not divulging information that could be crucial to their care. A good nurse will be able to listen effectively by being receptive and giving the patient their full attention while making other observations about the patient at the same time. Effective listening shows the patient that the nurse is taking an active interest in what they are saying. (Stevenson et al, 2004)
Information collection is essential in nursing and allows a nurse to gain vital knowledge about a patient, which could directly impact their care. A skilled nurse would need to possess the ability to gain information in a variety of ways. The nurse could gain information in a variety of ways such as, asking closed or open questions or gentle encouragement. Closed questions would simply demand a Yes or No answer whereas Open –ended questions would demand a more detailed answer (Stevenson et al, 2004)
Empathy is a skill needed In order for a nurse to demonstrate understanding of a patient’s experience. A skilful nurse will be a able to build a rapport with the patient thus making them more comfortable with divulging possibly essential information vital to their care. It is a skill of encouragement which the nurse can employ by making the patient feel that he or she can relate to what they are saying. (Stevenson et al, 2004)
Opinions on good nursing practice vary, depending on which individuals or theories are consulted. Tingle and Cribb (2007) state that nursing education and development involve nurturing certain characteristics deemed as acceptable and also continuously improving on clinical skills. More importantly they stressed that, at the foundation of these characteristics is the natural ability and skill to care, react to a patients’ needs and pay attention. It is their belief that without these characteristics an individual cannot be a good nurse. (Tingle & Cribb, 2007)
Furthermore, Tingle and Cribb (2007) go on to say that every individual has some idea of what it is to be a ‘good nurse’ and could also do so by following in the steps of role models. In this respect they would be setting personal standards for themselves. However they also stress the importance of recognising the difference between setting personal standards and adhering to standards set by governing bodies of nursing and evidence based practice.
The body that governs nursing is the Nursing and Midwifery Council (NMC). The NMC code is “the foundation of good nursing and midwifery practice, and a key tool in safeguarding the health and wellbeing of the public.” (NMC, 2008) This would imply that in order to achieve good nursing practice, a nurse would have to adhere to the NMC code. According to Tingle and Cribb (2007) a ‘good nurse’ is one that is happy to work within the standards set by the governing bodies, However they also state that some nurses will aim higher and even challenge policy, thus bringing about necessary change. The next part of the essay will identify the components of good nursing practice as outlined by the NMC.
The NMC advises that nurses make the care of their patients their first priority and in doing so should also appreciate the fact that every patient is an individual. Burnard and Chapman (2005) believe that every individual is aware of what is right or good depending on the choices they make and their conscience. They also discuss the utilitarian view that ‘good’ actions cause more happiness than pain and vice versa. An example is used here of a child being refused a demand which makes the child unhappy. This does not necessarily mean that because the child is unhappy the action was a ‘bad’ one. The idea that Burnard and Chapman are trying to convey is that it is difficult and impossible to forge one rule which applies to any given situation, especially in nursing. They also stress that each patient must be treated as an individual. This applies also to patients of different cultures and backgrounds. (Burnard and Chapman, 2005) A study by Gerrish (1997) was aimed at investigating whether nurses were armed with the necessary skills and knowledge to work in a multicultural environment. She concluded that even though acknowledgement and acceptance of different cultures is necessary for promoting relevant care, there was insufficient coverage of this in nursing syllabi. Additionally, by focusing on studying specific communities’ beliefs and customs, there arises the danger of creating cultural stereotypes, which do not reflect the existence of cultural differences within ethnic communities. A Subsequent study by Narayanasamy (2003) also revealed that although a large majority of nurses maintained that they addressed the cultural needs of their patients effectively, considerable improvement was needed.
It is imperative for a nurse to gain permission or consent to carry out any treatment and also make sure that the patient is aware of reasons for their treatment and what it entails (NMC, 2008). A study by Rush & Cook (2006) concluded that the most frequent expectations of patients were: the ability to communicate well, respect, knowledge of the patient’s symptoms, conditions and medication and hygiene. Similarly Burnard & Chapman (2005) expressed the right of the patient to knowledge and awareness of their treatment with this responsibility falling on the nurse. Nurses should go about care with the realisation that patients are individuals just like them with rights to reject or accept treatments or care regardless of the outcome. (Burnard & Chapman, 2005)
The NMC code asks that all nurses treat their patients with respect, regardless of differences in age, sexuality, class, culture or religion. (NMC, 2008). Difficulties are present however due to the fact that some nurses may not be able to understand an individual’s cultural behaviour and may interpret it differently. They may find the behaviour strange and this could lead to communication problems between patient and nurse (Burnard and Chapman, 2005). Nurses are encouraged to reflect on their own behaviour and how they act in given situations in order to understand themselves. (NMC, 2008) It is thought that if a person can understand why they carry out certain actions or behave a certain way, then it will be easier to understand another individual’s behaviour and customs. (Burnard and Chapman, 2005).
It is also important for nurses to collaborate and work with other professionals or agencies in the care of their patients. One patient, depending on his or her illness or ailment could have physiotherapists, social workers or care assistants assigned to them. Goodman and Clemow (2008) stress this importance due to the fact that it is impossible to organize or coordinate a patient’s care without understanding what the other professionals involved in their care do (Goodman and Clemow, 2008). Burnard and Chapman (2008) also stress that it is important for professionals from different disciplines to not compete with each other as this would be detrimental to the patients care. They should instead work in a professional manner and respect what each person is bringing to the team. If a nurse in a team feels that the actions of another nurse or professional could bring harm to a patient or negatively impact their treatment, they are expected to report this to a higher authority. This policy is problematic due to the fact that the reporting nurse could face being isolated by other colleagues or even management. Nurses are also expected to maintain their knowledge and skills and learn new ones, and as such are expected to show that they have taken part in at least five days or thirty five hours of learning activity in order to continue practising. Lacking skills and knowledge would make a nurse lack competence which in turn could put a patient at risk. Knowledge can be gained by conducting research or actively taking part in research. (Tingle and Cribb, 2007)
Although authors like Tingle and Cribb (2007) stress the importance of care as a foundation to nursing, it is difficult to define exactly what constitutes care and how to measure it. Watson (2002) describes caring as an ambiguous phenomenon which cannot be measured in its entirety.
The nursing process “provides the framework in which nurses use their knowledge and skills to express human caring.” (Wilkinson, 2007). (Hogston et al, 2007) describe the process as a problem solving process whereby a deterioration of quality of care occurs if the nursing process is not used or adhered to.
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