The Discipline of Nursing: Contemporary Issues and Trends Essay Example

THE DISCIPLINE OF NURSING: CONTEMPORARY ISSUES AND TRENDS 13

The Discipline of Nursing: Contemporary Issues and Trends

The Discipline of Nursing: Contemporary Issues and Trends

Nursing and person/patient-centered care

Definition of nursing:

According to Daly, Speedy, & Debra, the international council of nurses (ICN) captured the complexities of definition of nursing as follows:

Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, preservation of illness, and care of ill, disabled and dying people. Advocacy, promotion of safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles (Daly, Speedy, & Debra, 2009, p.5).

Definition of person centered care:

Nursing is also defined as person centered care as “a value base that asserts the absolute value of all human regardless of age or cognitive ability; an individualized approach, recognizing uniqueness; understanding the world from the perspective of the service user and providing a social environment that supports psychological needs”(Brooker, 2007, p.12).

Other definitions:

“Therapeutic communication is a specialized form of communication used in health settings to support, educate and empower people’s to meet health related goals” (Hally, 2008, p.144 ). This creates rapport between the communicator and the client encouraging the client to reveals his own experiences more accurately and hence served in a better way. In a therapeutic relationship, self awareness, trust, co-existence and empathy exists; which makes the client feel comfortable enough to be open and honest (VanBurskirk, 2005).

“Active listening is a dynamic interactive process in which a nurse hears a client’s message, decodes its meaning, and provides feedback to the client regarding the nurse’s understanding of the message” (Clement, 2007, p.134). It is different from simply hearing the message as the listener is supposed to participate in constructing the meaning of the words and sounds so that he can decide what action to take. It is also different from passive listening in that the listener requires a lot of energy and concentration in absorbing and understanding what is being said. Active listening is very important since it makes the patient to feel a sense of worth and as a result feels comforted and valued (Enferm, 2008).

Clarificationis defined as “making something clearer by explaining it in more details” (Clement, 2007, p. 34). It is a very important concept in professional communication especially because nurses are often required to encourage client to clarify their experiences so that they can be understood better. It is also important that the nurse clarifies any issue he deems of importance to the patient. Clarification of issues is very important as it prevents cases of misunderstanding between the nurse and the patient.

“Summarizing brings all the facets of the conversation together. It is a natural way of bringing a session to a close” (Nicklin and Kenworthy, 2000, p.176). It is used to encourage the client to conclude the important issues that have been discussed in a particular session. During the summary, the client reveals their problems and focus on finding the solution. Summarizing helps both the nurse and the client to reflect and review their discussion while making sure that all the important details have been raised. By summarizing an issue, it marks the end of a particular session and opens a new session. A summary helps the parties to clarify on the issues discussed and reach on some agreement. All the important issues that have been discussed should feature in the summary and should be communicated more clearly for both parties to understand.

Communication is the process of exchanging understanding and information, using non-verbal and verbal methods of communication. If the nurse cares for a patient who cannot understand his language, an interpreter comes in handy. Besides words, sounds convey valuable information and if well interpreted by nurses, sounds can significantly improve health care provision.

Sounds made by the voice are used to deliver important feelings. “Sound can convey pain, distress, sadness, boredom, despair and excitement” (Funnel, Koutoukidis and Lawrence, 2008, p. 450). When the client makes some sound, the nurse might ask questions such as, “that sounds like you have pain, Mrs. Jacobs, do you have pain?” (Funnel, Koutoukidis and Lawrence, 2008, p. 450).

Similarly, the tone and pitch made during the voice could possess some deep meaning. Tone and pitch can display apathy, anger, enthusiasm among other emotions. Tones and pitch talks volumes of the meaning of the message even more than the actual words. For example aggression can be expressed by rapid, loud and forceful words. The nurse ought to discern the client’s emotional feelings and energy levels from the way they talk, and should respond accordingly (The Journal of nursing education, 2009)

Non verbal communications are the messages communicated without words. They include; facial expressions, body movements, eye behavior, touch and personal appearance among others. During the interaction with the patients, it is very important that the nurse look out for non verbal expressions besides the words. Missing out on such expressions means that much of what could be discerned is missed out.

Communication skills can be used to facilitate safe patient care. As such, when a nurse meets a patient for the first time, the way the communication is opened up makes important impression that influences the relationship with the patient in future. Even the way they greats the patient is an important part of this process. “As a nurse, the people we come into contact with may be anxious, frightened or angry, and making appropriate adjustments to our communication may help to address the person’s concerns and facilitate an effective therapeutic relationship”( Association of Operating Room Nurses, 2010, P.54). Building a rapport immediately the nurse meets a client encourages them to adopt a friendly relationship thereafter, which makes service delivery very effective.

When meeting a client for the first time, it is very important that you start by introducing yourselves and then seek to know the identity of anyone else who accompanies the client. The style of communication should be adjusted depending on the audience. For example when addressing a person with hearing problems, nurses should maintain a close contact and talk loud enough and use gestures where applicable (Sully and Dallas, 2005).

People from different cultural background have different attitudes toward communication and as such, nurses should be aware of the cultural background of their clients, and should know how to address them without creating offence. “Forms of address vary across cultures, with some cultures placing higher regard on the use of titles than others. Individuals may feel offended if their full title is not used” (Sully and Dallas, 2005, p. 30). Although it might appear unrealistic to learn all the cultures in a certain cultural set up, a lot can be learnt from observing what the patient appears comfortable with. For example the way a patient responds to the greetings can talk volumes of what they understand s and what they don’t understand. This can be observed from the level of confidence exhibited, eye contact and so on.

A skilled nurse facilitates information flow from the doctor to the patient. The flow of information is not supposed to get interrupted by anybody. To monitor the information flow, a nurse must be skilled enough to observe the patient’s physical and mental condition” (Association of Operating Room Nurses, 2010, P.54). The nurse clarifies any point that the patient fails to understand well. The nurse also helps the patient to get the best benefit of the medication by making sure that the client understands and follows the dosing instructions received from the doctor. To achieve such objectives, nurses need to possess very strong communication skills (Magee, 2008).

Active listening is very important when dealing with patients. Body language can be used to show the patient that you are listening and taking concern over their story. If they feel something, encourage them to show it off. If listened carefully with attentive ears, patients are understood better. Making the patient fell comforted and worth encourages them to reveal more of their experiences and as a result, the nurse can be able to give more decent diagnoses.

My ability to communicate can be obstructed by several factors. For example,lack of experience or knowledge can prevent the nurse from applying appropriate therapeutic techniques. The nurse can fail to effectively assess the patients’ needs or meaning from the way they behave hence impending effective communication. Breakage of communication-feedback loops also impairs the passage of information. This happens when the message delivered is not clear or when the message gets incorrect interpretation (Delucia, 2009). The communication can also be interfered with where the useful feedback is not made.

When the nurse or the patient is anxious when communicating, perception and the ability to communicate is significantly altered (Delucia, 2009). In such cases, the nurse is supposed to identify the source of the anxiety and seek interventions. When a nurse approaches a patient with a discriminating attitude, the communication and perceptions are totally distorted. Resistance as a result of anxiety can also impede effective communication (Association of Operating Room Nurses, 2010, P.34). The gap between nurse and the patient can block communication. Failure to meet a need out rightly leads to communication breakdown. This problem arises from; assessment that is not adequate; nurses failure to separate her needs from the needs of the patient and lack of definition between helping relationship and friendship (Delucia, 2009).

How nurses can ensure appropriate professional boundaries are maintained when working with vulnerable individuals

It is recommended that all communications between the client and the nurse must take place within the professional boundaries. “the nurse must abstain from obtaining personal gain at the expense of the client and refrain from inappropriate involvement in the client’s personal relationships” (White, 2005, p.119).Innocent sexual advances: Sometimes the patients make sexual advances to nurses. Sexual advances my result from intellectual impairment, disorientation, confusion or they could be intentional. When the advance is out of confusion, the nurse should respond appropriately without upsetting the client. “the first step in situation of any sexual advance, verbal or physical, is for the nurse to assess the mental competence of the client in relation to understanding and accountability” (Funnel, Koutoukidis and Lawrence, 2008, p.146). Sometimes the client may undergo involuntary election while being attended by the nurse. In that case, the nurse should tactfully ignore it, use some humor to reduce the embarrassment or professionally disclose to the client that it is normal and it should not be of much concern.

Intentional sexual advances: In some cases, the client may make intentional; sexual advances from the nurse. If the client is in a position to understand the behavior and the consequences, the nurse should seek to address the real problem and not to criticize the client for the actions.” The nurse could tell the client “I feel uncomfortable about you touching me like that and it is not appropriate-please do not do it again” (Funnel, Koutoukidis and Lawrence, 2008, p.146). If the inappropriate sexual behavior is repeated, it can be reported to the nurse in charge for documentation and redress. If the situation is very serious and cannot easily be addressed, then the help of a professional counselor should be sought.

It is considered as professional misconduct for a nurse to engage into a sexual relationship with the client. Nurses usually fall into temptations of overstepping the sexual boundary when they feel psychologically unfulfilled. Any act can violates nurse-client relationship can be interpreted as violating of the professional responsibility and it is inadmissible. Nurses should absolutely keep away from such affairs (Radcliffe, 2000).

Nurses have the responsibility to use information gathered from the client in the best of his interest. Sharing of such information in the public domain is however strictly prohibited as it amounts to violation of professional boundary. It is important that a nurse establishes clear agreements with the client regarding the role as a service provider, the nurses’ availability, best ways of communication and what they should do if they meet in the public. Such agreements should be as early as possible to avoid cases of the relationship overstepping the professional boundary (Pan-Canadian Planning Committee on Unregulated Health Workers, 2009).

Immediately signs of boundary violations appear, it is important for the nurse to seek remedy in haste before the matter gets out of hands. However, the nurse should be very sensitive to the clients’ feelings; should avoid confrontations but instead strive to solve the real problems. The nurse must emphasize the importance of maintaining professional boundaries and explain to the client how its violation can be inappropriate and uncalled for.

Self- disclosure

The nurse should avoid disclosing personal information to the client, and if such information must be disclosed, it should be very limited. This is because disclosure of too much personal information may confuse the client and shift the focus on the roles and the expectations of the relationship. The client might think their relationship is too close and impose obstacles on the professional boundary of the nurse. Continuous Clarification of role and boundaries is a good remedy towards boundary violations (Delucia, Ott, & Palmieri, 2009).

A nurse prior personal relationship can sometimes tempt the nurse to overstep the professional boundary. However to avoid this, “the nurse should determine whether the personal; relationship could interfere with the provision of care” (Funnel, Koutoukidis and Lawrence, 2008, p.149). It there is any threat as a result, an alternative care should be sought. It is also important to note that former clients continued relationships must be justified. “However, if a former relationship was a psychotherapy one, the nurse must not engage in romantic relationships at any future point unless an impartial professional judges that the relationship would not have a negative impact on the client’s well-being” (Funnel, Koutoukidis and Lawrence, 2008, p.149).

The nurse should avoid giving of too much special attention to a particular client. Spending more time or offering care in a more favorable manner than usual to a particular client can lead to violation of professional boundary. Similarly, a client could be offering some special treatment of favors to the nurse which is again inadmissible. To avoid such temptations, the nurse to avoid treating a client in a special war, or even being treated in a similar manner by a certain client (Tau and International Honor Society of Nursing, 2001).

Strategies to manage challenges during clinical placements

Create a rapport. I will always strive to create a report with my clients to enhance better relationship and to be able to serve them better. In the hospital, there are so many professionals such as doctors, pharmacists and many others. Relating with such professionals may be quite challenging in especially considering the fact that many look down upon nurses. To address such issues, I will always ensure that I build a strong rapport with them, and maintain friendly relationship.

I will always avoid too disclosing personal information to my clients as doing so can draw my client too much closer and hence compromising my professional boundary. Similarly, I will avoid close relationships with my clients so that I can maintain my professional credibility. Having little experience, I am expecting to undergo a lot of challenges before I get used to the job. But to gain experience as quick as possible, I intend to collaborate with my colleagues who are more experiment; so that I can acquire important skills from them.

To better serve my clients, I intend to utilize communication skills effectively so that I can better understand my clients. For example I will not only listen actively to what the clients tells me, but also pay attention to body language and gestures to decipher the meaning better. Having good communication skills I expect most of the things to flow easily without many obstacles. I will avoid any sexual relationship with my client, and in case any clients’ approaches me for sexual relationship, I will not relent from explaining my lack of interest with such affair as it can impair my professional boundaries.

Bibliography

American Medical Association, 2010. Effective nursing communication. Journal of the American Medical Association (online) 296, 4-52. Available from http://us.mc1146.mail.yahoo.com/mc/welcome?&.rand=706519020#_pg=welcome&&.rand=1017605803&.jsrand=6085772 (Accessed on 1/04/2011)

Association of Operating Room, 2010. Nursing publication. .AORN journal (online) 55, 23-26. Available from
http://books.google.co.ke/books?id=x6sTAQAAMAAJ&q=How+communication+skills+can+be+used+to+facilitate+safe+patient+care (Accessed on 1/04/2011)

Brooker, D., 2007. Person-centred dementia care: making services better. Philadelphia: Jessica Kingsley publishers.

Availablefromhttp://books.google.co.ke/books?id=TCwVAQAAMAAJ&q=How+communication+skills+can+be+used+to+facilitate+safe+patient+care (accessed on 1/4/2011)

Clement, J., 2007. Basic concepts on nursing procedures. New Delhi: Jaypee Brothers Publishers.

Daly, J., Speedy, S., & Jackson, D., 2009. Context of Nursing: an introduction. Melbourne: Elsevire Chatswood.

Delucia, R., Ott, E., Palmieri, A., 2009. Performance in Nursing. Reviews of Human Factors and Ergonomics (online)5, 1–40. Available from http://www.ingentaconnect.com/content/hfes/rhfe/2009/00000005/00000001/art00002?token=00571bb82e8d9c715ba383a4b3b2570497b5f5f6c382d384b67282a726e2d58464340592f3f3b57df63bdd3(accessed 24/03/2011)

Enferm, G., 2008. Publications on pain and nursing diagnosis in a Brazilian database. NCBI (accessed 24/03/2011)http://www.ncbi.nlm.nih.gov/pubmed/19068584 (online) 29(3), 461-67. Available from

Funnel, R.,Koutoukidis, G., Lawrence, K., 2008.
Tabbner’s Nursing Care: Theory and Practice. Melbourne: Elsevier Australia

Hally, B., 2008. A Guide for International Nursing Students in Australia and New Zealand. Melbourne: Elsevier Australia.

Magee, D.J., 2008. Orthopedic physical assessment. Amsterdam: Elsevier Health Services.

Nicklin, P.J., Kenworthy, N., 2000. Teaching and assessing in nursing practice: an experiential approach. Amsterdam: Elsevier Health Services.

Pan-Canadian Planning Committee on Unregulated Health Workers, 2009. Maximizing Health Human Resources: Valuing Unregulated Health Workers. Cnanurses (Accessed 24/03/2011)http://www.cnanurses.ca/CNA/documents/pdf/publications/UHW_Final_Report_e.pdf(online). Available from

Pennsylvania State University, 2010. Essentials of nursing. The Journal of nursing education (online) 3, 1-25.Available from http://books.google.co.ke/books?id=4yoNAQAAMAAJ&q=journal+of+nursing+communication+-journals&dq=journal+of+nursing+communication+- (Accessed 2/04/2011)

Radcliffe, M., 2000. . Doctors and nurses: new game, same resultBritish Medical Journal(online)320 (1085), 1085. Available from
(accessed 24/03/2011)http://www.bmj.com/content/320/7241/1085.1

Sally, P., Dallas, J., 2005. Essential communication skills for nursing. Amsterdam: Elsevier Health Services

Tau, S., International Honor Society of Nursing, 2001. Facts about the Nursing Shortage. Nursesfor Health Tomorrow (online).http://www.nursesource.org/facts_shortage.html Available from
(accessed 24/03/2011)

VanBurskirk, S., 2005. The American Nurses Association designates Nephrology Nursing as a recognized nursing specialty.
Nephrology Nursing Journal(online). Available from http://findarticles.com/p/articles/mi_m0ICF/is_6_32/ai_n17211712/?tag=content;col1#comments(Accessed 30/03/2011)

White, L., 2005. Foundations of Nursing. Stamford: Cengage.