Y khoa, y dược - Chapter 1: The role of the nurse

Chapter 1The Role of the NurseAgendaThe NMC and the nursing registerCourse Design and the Branches The NMC and Mentorship The NMC & Public ProtectionPortfolio development and maintaining clinical knowledge and competence Educational TechniquesClinical Decision MakingThe Nursing ProcessGovernment legislation and health polices (a modern approach to healthcare delivery)The Introduction of Research and an evidence base to nursing practice The Importance of ethical decision makingNursing career potential The NMC and the nursing registerAll professions have a regulatory body to protect the public.The Nursing and Midwifery Council (NMC) must protect the public by establishing standards of performance, nursing education and conduct (NMC 2004).During training student nurses have standards of practice that they must abide by NMC (2005a)Although not professionally accountable, students can be called to account by their university or by the law for the consequences of their actions or omissions.The nurses’ part of the register has marks to identify the branch of nursing practice in which the nurse has achieved the standards of proficiency.The NMC and the nursing register cont.The NMC state that pre-registration nursing programmes should:prepare students to apply knowledge, understanding and skills to provide the nursing care that patients require in a safe and effective manner thereby assuming the responsibility and accountability necessary for the protection of the public The basic principles underpinning educational programmes are:That evidence should inform practice through the integration of relevant knowledgeStudents should be actively involved in nursing care delivery under supervisionResearch should underpin practiceThe importance of lifelong learning and professional development is recognised Course Design and the BranchesYear 1: All nursing students study together in a Common Foundation Programme (CFP).At the completion of Yr 1 students must have met pre-designated outcomes or essential skill clusters (ESC) to enable progression into their chosen speciality or branch. The educational programme is 50% theoretical and 50% clinically based. Outcomes are achieved in several ways: constructing a portfolio of professional development and practiceseveral clinical competencies must be achieved whilst on practice placements. These include ESC based on medication deliver, aspects of care and communication. The Four Branches of Nursing Adult Nursing: caring for those 18 and above, this includes various clinical settings and levels of patient dependency. Mental Health Nursing: provision of care for those experiencing mental distress through the application of therapeutic relationships directed at providing support and understanding for those afflicted.Learning Disabilities Nursing: aims to influence behaviours and lifestyles of a vulnerable client group to enable optimum health. Includes positive promotion and active support for the inclusion of those afflicted within society as equal and deserving citizens.Children’s Nursing: the development of family-centred care and the belief that children should be cared for by people they know and whenever possible within their home environment. The empowerment of children and their families is a key element to promoting and providing safe, effective and informed care. The NMC and Mentorship Your course will be composed of 50% theory and 50% clinical practice It is therefore imperative that the clinical provider (Healthcare Trust, privately run concern or a Primary Care Trust) provides you with a ‘coach’ or supervisor.An experienced nurse will be designated your mentorThe mentor/mentee relationship is a professional one dependent on joint, dynamic, sharing characteristics. The choice of mentor should be determined by the mentee as the mentoring philosophy is based on a common groundTherefore the mentee will need to work for a period of time before they can identify their personal mentor. This does not suit students on short placements- instead a supervisor (formerly known as a clinical preceptor) is identified for them. The NMC & Public ProtectionThe NMC has a wide range of powers designed to protect the public, these include the ability to:remove a registrant by the evoking of a ‘striking off order’ impose a ‘suspension order, or a ‘conditions of practice order’Impose a caution of between 1-5 years can be imposed The “NMC advice for delegation to non-regulated healthcare staff” also sets out ten principles for nurses and midwives to follow when delegating to non-regulated healthcare staff. The full set of principles can be viewed on the NMC website.Portfolio Development, Maintaining Clinical Knowledge & Competence Nurses and other healthcare professionals work in an area of constant change (technological & scientific, political & social, etc).It is crucial for nurses to continuously update their knowledge and skills base A portfolio is an essential part of professional development which demonstrates individual professional knowledge and competence to cope with these changing demandsProfessional development is linked to the registration process through Post-Registration Education Practice (PREP) standards.PREP standards identify lifelong learning and professional practice- the basic requirements for entry to the register The PortfolioThe portfolio contains both personal and professional components.The personal portfolio is a private document which contains:individual records of the development of the nurse’s skills, knowledge, attitudes, understanding and achievementsmay also include structured written reflective accounts of individual case studies and critical reviews of practice The professional profile is a public document, which may involve a combination of the above structured to be open to scrutiny. It may include:accounts of professional experiencedirect observations of practice development evaluations of new working practices and critical incident reviewsreflective pieces should focus on various topics and demonstrate positive aspects of practice as well as incidents that could be worth re-evaluation. Educational TechniquesThere have been several different educational approaches employed to educate student nurses. Three types of knowledge were been identified: Propositional: relating to academic and scientific theory- permits students to understand basic concepts, the ‘what is’ and ‘whys’.Practical: relating to the acquisition of practical skills and the application of technology. Permits students to demonstrate ‘how to’.Experiential: relating to the application of propositional and practical knowledge, which through time and experience allows the addition of reasoning and permits flexible application and considered practice Today these three basic principles are employed through the delivery of enquiry based learning (EBL); this approach is motivated by a process of enquiry, where the learner is introduced pragmatically to a potentially complex problem or clinical case scenario. Clinical Decision-Making Nurses make multiple decisions rapidly in highly complex environments to deliver expert individualised care. A patient’s condition can change rapidly and, therefore, demands intelligent and decisive decision-making from nurses in short time frames.Clinical decision-making can be defined as the process nurses use to gather patient information, evaluate that information and make a judgment that results in the provision of patient care This process involves collecting information with the use of both scientific and intuitive assessment skills This information is then interpreted through the use of knowledge and past experiencesThe Nursing ProcessThe nursing process is a tool used to assist with decision-making and to predict and evaluate the results of nursing actions It guides the professional practice of nursing in providing care in a systematic manner. The nursing process has evolved over recent years to incorporate five or six phases or stages:Assessment – collection of subjective and objective clinical data to provide a rationale for careNursing / Working Diagnosis – analysis of physical presentation confirmed by scientific fact (data collection results) Planning / Outcome identification – plan of care and realistic goals discussed with patientImplementation – performing interventions, reassess plan following each intervention to determine initial responseEvaluation – have expected outcomes been achieved? Determine patients level of clinical need and regularity of subsequent assessment Government Legislation & Health PolicesStudent nurses should be aware that government policies play a significant role is healthcare provision and services through legislationIn 2000 the Government published The NHS Plan- a white paper identifying a 10-year plan for healthcare reform and development (DoH 2000). The NHS Plan discussed the development of the nurses’ role in this framework, such as the expansion of the role into supplying medicinesThe NHS Plan is available in a digestible format (executive summary) from the Department of Health’s (DoH) website dh.gov.uk. The central focus of modern healthcare assists individuals in making choices to their lifestyles that have a positive impact on their health.Providing healthcare within the community and assisting individuals in maintaining their independence are also contributable elements.The Introduction of research & an evidence base to nursing practiceFor many years healthcare delivery was dependent on the particular skill base and subject beliefs of individual practitionersThe modern approach centres on the practitioner working with the patient to deliver a plan of care with the patient as the central focus, referring to an evidence base, and taking into account cost effectiveness. “Evidence-based” refers to objective treatment based on observable data, in contrast to subjective preferencesChanging practice is a monumental task and to this end clinical governance was established. The clinical governance initiative is conveyed into clinical practice by the National Institute of Health and Clinical Excellence (NICE). NICE have released numerous national guidelines on specific patient presentations or illnesses These are supplemented by the DoH's National Service Frameworks (NSF) on specific disorders and ‘best-practice’ developed by specialist organisations (e.g. British Thoracic Society)The important of ethics in clinical decision makingThere are basic ethical beliefs that underpin nursing. These 5 principles are defined below:Non-Maleficence: - this principle dictates that practitioners allow no harm to come to their patients. This is directly linked to the nurse's duty to protect the patient's safety and is born out of the Hippocratic oath.Beneficence: is at the heart of everyday nursing practice. Beneficence means taking action by helping, preventing or removing harm, and promoting good. A crucial component centres on paternalism, which can be categorised as "weak" or "strong." Weak paternalism infers protecting the patient when the patient is vulnerable and unable to make decisions. Strong paternalism involves interactions to benefit a person despite the fact that the person's risky choices and actions are informed, voluntary, and autonomous. The important of ethics in clinical decision making cont.Autonomy: means that an individual has a right to self-determination- to make decisions and choices about their health or life without interference from others.Justice: giving each person, or group, what they are due. Justice is measured in terms of fairness and equality. In nursing, justice frequently focuses on impartial access to care and on the concerns around fair distribution of scarce resources. Privacy and Confidentiality: Privacy is a fundamental right of each individual and, as such, it cannot be taken away from that person unless they chose to share it. Confidentiality, on the other hand, means that information shared with other persons regarding the patient will be used only for the purposes intended. A patient's sharing of private information imposes a duty of confidentiality on health care providers. That duty means providers will share information only on a need-to-know basis (NMC, 2004).Nursing Career PotentialsNursing in the 21st century offers the student a diverse and rewarding career, second to none.Once qualified, and after a period of practice to consolidate their learning, the nurse is ready to begin planning their future.Teaching and educating others plays a major component of the nursing role, therefore, many nurses undertake a coaching or mentoring course early in their career. There are clear pathways for nursing development from newly qualified staff nurse through to Matron and Consultant nurse.