Nursing practice is directed and guided by an understanding of the definition of health and the factors that impact a client’s health framework. In the relationship between the nurse and the client, nurses respect the client’s unique psychosocial, spiritual, and cultural needs and advocate for their health choices and decisions. Nurses support client participation in the process of actualizing a defined image of health and do not negate the ability of clients to form their own image of health.
The history of nursing is inextricably linked with caring activities--indeed, much of the early literature on nursing uses these terms interchangeably. Over the past 150 years, this relationship has been both exploited and actively rejected by nurses (, 2003).
While caring activities have been an integral part of any society over the ages, and have often been credited as the foundation of nursing, the nineteenth century witnessed a unique integration of nursing within Australia. It is not unreasonable to conclude that the nineteenth century was certainly an age of transition with regards to health provision as nurses increasingly distinguished themselves from other health care professionals (2003).
Over the years nurses have responded to the frustrations of hospital work with a variety of revised and expanded forms of nursing practice. The development of a theory and practice of primary care has emphasized the need for continuity, and one nurse may now coordinate with all aspects of care for an individual patient.
Nursing has responded to and always will continue to respond to the needs of the clients. In times of war, nursing has responded by meeting the needs of those who are wounded in the combat zones and in military hospitals in some countries abroad. When communities face health care crises, such as those that occur from infectious diseases or a lack of health care resources, nursing is there to establish community-based immunization and screening programs, treatment clinics, and health promotion activities (2004).
In today's health care work environments, nursing roles are shifting dramatically in response to profound changes at system, organization, and individual levels. These changes may be influential to nurses' quality of work life and intent to remain with their employers and in nursing. Professional autonomy is a highly desirable nursing role characteristic (2003).
In this transformational time in health care here at the outset of the 21st century, the primary role of the nurse is to live fully aware of the unfolding potential of this journey. It is the skill sets of awareness, availability, and anticipation which now most defines the character of clinical leadership and calls the nurses’ understanding of the application of the role into a new arena for it (2003).
The changing patterns of health care delivery have increased complexity in all practice environments. Evidenced-based practice models have intensified rather than simplified nursing care delivery because they have been inserted into traditional practice patterns. Nursing lacks systems to plot its patterns of care delivery. Consequently, except in limited circumstances, nurses are unable to predict what activities make a difference in the outcomes and satisfaction levels of their patients. The inability to identify and control the processes, protocols, patterns, rituals, and tasks related to safe, compassionate care delivery and better health outcomes does not assure professional practice (2005).
In response to change in health care delivery, how nurses perform their roles is open for interpretation. Although nurses' roles still involve traditional bedside responsibilities for patient care, increasing numbers of RNs are enacting new roles that emphasize collaboration. Nurses' scope of responsibilities is broadened as they coordinate care across the health care continuum, lead health care teams, and participate in health care decisions (2003).
Contemporary nursing requires that the nurse possess knowledge and skills for a variety of professional roles and responsibilities. In the past, the principal role of nurses was to provide care and comfort as they carried out specific nursing functions. However, changes in nursing have expanded the role to include increased emphasis on health promotion and illness prevention, as well as concern for the client as a whole ( 2004).
It is essential that nurses be knowledgeable regarding health promotion and disease or illness prevention. When the nurse is providing total care, he or she should think beyond current health problems to the client’s general well-being and future risks for illness and injury ( 2004).
Nursing today emphasizes specialized education to support the work in health care. Nurses teach preventive care and health maintenance, assist medical treatment, aid rehabilitation, and attend the dying. Most nurses work in hospitals and nursing homes, with others in public health agencies, offices, schools, and industries. Nurses are also educators, supervisors, administrators, and independent practitioners.
Nurses have also tried to establish career ladders that affirm the value of bedside nursing; the nurse-clinician can advance in salary and authority without leaving her patients for supervisory position which is the traditional route for nurses upward. Nurse practitioners and nurse midwives have tried to carve out independent domains, challenging medical practice laws and reimbursement patterns that constrain autonomous nursing practice.
Expert clinical nursing practice is a result of commitment to the application of knowledge and clinical experience. The expertise required to interpret clinical situations and make complex decisions is the essence of nursing care and is the basis for the advancement of nursing practice and the development of nursing science (2004).
As a contemporary nurse, the nurse also acts as a manager. The nurse coordinates the activities of other members of the health care team, such as nutritionists and physical therapists, when managing care for a group of clients. To effectively manage clients, the nurse should implement solid clinical decision-making skills. As a clinical decision maker, the nurse should use critical thinking skills throughout the nursing process to be able to provide effective care (2004). The nurse should make any decision involving client care in collaboration with other health care professionals, the client’s family, and the client too.
Contemporary nurses are also involved in politics and this involvement is receiving greater emphasis in nursing curricula, professional organizations, and health care settings. Nurses are also becoming more involved in health care reform. Political activism and commitment are a part of professionalism, however, and politics are an important aspect of the delivery of health care ( 2004). This is not bad as long as nurses do not get misinformed of their political involvement. Outsiders, especially politics, should not impose their will on nursing and nursing practice.
Nursing practice can now be found in multiple care settings, including health care institutions and foundations, the community, and the home. In addition, nurses are active in political and lobbying groups, social and not-for-profit agencies, and work on establishing social health care policies. These activities increase nursing’s public viability and, at the same time, increase the public’s awareness of professional nursing (2004).
As contemporary societies become more developed and economically sound, the education of people in professional roles changes, often accompanied by increased status and empowerment. Concomitantly, the potential contributions of these people to society increase (Muc, 2000).
Nurses are complicit in perpetuating these stereotypes, if they will not talk to the media or promote their work in a credible and compelling manner. It is this failure to communicate that leaves the public, policymakers and bureaucrats in the dark about the value of nursing work, to the detriment of patient care (2005).
Nursing's value and the efficacy of nursing care is slowly being documented by research (such as the study by at the University of Pennsylvania, which found nurses with higher levels of education reduced mortality rates, and another which found that for every patient added to a nursing caseload there was a 7% rise in mortality) ( 2005).
According to an article, the failure of many doctors to listen to advice from experienced, often expert nurses, is threatening patient care (Armstrong, 2005). However, what the article has not pointed out that the situations that arte happening in hospitals are not always like this, as could be gauged from the newspaper article written by the doctor with a fictitious name - . There are also many nurses out there that have sort of overstepped their bounds and do not listen anymore to doctors.
As quality and safety research is increasingly indicating, if doctors and nurses can't talk to one another effectively, patient care suffers. 'Policy makers, hospital administrators and doctors all need to realize that if they want to keep health care costs down, they had better create an infrastructure of communication between physicians and nurses and other people on the health care team and help them learn communication and negotiation skills ( 2005).
However, more opportunities for collaborative activities, such as the one mentioned in the previous paragraph, does not necessarily mean that nurses have less bedside care responsibilities. Rather, nurses are often expected to take on collaborative roles in addition to their traditional patient care roles, thereby increasing their overall workload. Increasing the complexity of the nursing practice role, particularly without adequate preparation, may actually cause some nurses to leave their positions for other, less demanding jobs or even other professions ( 2003).
I do not think that what is being exhibited by the doctor with the fictitious name in the article is a feeling of being threatened by the nurses’ claim for status and legitimacy. What the doctor felt was a lack of cooperation from the nurses, which could be a detriment to patient care.
When there are errors that occur in patient care, these are often due to 'barriers created by hierarchical power relationships', and by the fact that many people have 'little, if any, education in how to communicate effectively.' In the article, the nurse can be accused of having poor communication skills as well as a seemingly lack of interest in her job.
It is easy in times of challenge and rapid change to present nursing as a troubled and embattled profession. Expressions of negative points of view about nursing practice and the profession of nursing, itself, gained public notice as many groups tried to convince the governments to re-authorize and adequately finance the nursing education (2005).
While nursing's long history comes with a culture of downplaying nurses' contribution to patient care, this attitude is counterproductive to nurses and misrepresents their role. The public need to know that nursing represents high quality cost-effective care; something the community can ill-afford to be without (2005). However, nurses such as the ones portrayed in the article bring the views of people to nurses on an all-time low.
There is thus a need to call for excellence for the nursing profession. The call for excellence through reform and innovation can be enhanced and extended through identifying, describing, and increasing understanding of the common experiences and shared meanings of excellence in contemporary nursing education (2005).
Furthermore, decisions about what should be learned, how students learn, and how students should be tested for competence are made by faculty rather than by the learner, based on the more traditional modes of learning. Often these faculty members remain removed from clinical practice, isolated from the realities of profound changes in the current work environments (2001).
Nurses must be educated that although they are allowed to do a variety of things in their practice, even perform those that are performed by the doctors sometimes, they should not act as if they are the boss. This kind of behavior is just like the nurse in the article who has just been reading all the time the doctor was busy taking care of the patient. Whatever angle we view it, the nurse’s action is not professional and merits some careful attention. This should therefore serve as a lesson to nursing educators to instill in future nurses what constitutes professionalism.
Herein we see the value of identification of roles. Identification is a participative, dynamic process by which individuals are connected with or linked to other persons and elements of the social world. It is a process by which individuals communicate with others to create an identity for themselves and to become part of a larger social collective.
Communication promotes a sense of belonging among individuals, allowing them to learn desirable identity characteristics and make decisions congruent with group norms, values, and ideals. For example, by communicating with senior nurses, less-experienced RNs "learn the ropes" of their jobs and understand what it means to be a nurse. Such interactions build strong relational connections and may influence a new nurse to have a strong professional affiliation ( 2003).
Throughout the nursing profession’s history, nurses have studied and tested new and better ways to help their clients, their families, and their communities. Nurses have been leaders in expanding knowledge in nursing and other health care disciplines through health care research. Most nurses enter the profession with the goal of providing direct client care. The nurse providing direct client care accounts for the majority of practicing nurses, as could be seen in the situation presented in the article.
This paper has emphasized that nursing is not a static, unchanging profession but is continuously growing and evolving as society changes, as health care emphases and methods change, as lifestyles change – and as the nurses themselves change. Nursing at present continuously draws on the social sciences and other fields as the focus of nursing care expands.
In conclusion, the nurse therefore has various responsibilities and roles. Aside from providing care and comfort to the patient, they also carry out other nursing functions. Over the years, the nursing profession has evolved to include many functions. Nurses are active in social policy and political arenas. Nurses and their professional organizations lobby for health care legislations to meet the needs of the clients, particularly those who are medically underserved. Nurses are also active in local government planning to ensure that health care resources are available in all client communities.
However, although this is generally good, some nurses have sort of abused this power and overstepped their bounds. It is recommended that outcomes of complaints such as this article on the newspaper embody many new modalities to support the practice of nursing, the continuing professional development of practicing nurses, and the education of students and new faculty.
This brings to mind that perhaps nurses have to be further educated regarding what constitutes professionalism and their limitations of functions. Nurses after all are just humans and also have to take into consideration the other individuals around them.
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