Contemporary Nursing Assessment - Essay Example

Nursing Critical Assessment ____________ Nursing Critical Assessment ____________ Dated: Oct 21, 2007-10-21 There is no doubt in the fact that today nursing profession is confronted to many indifferences and apathies other than the decreased humanities integration in nursing courses. The reason behind this apathy that exists between understanding and implementing this profession is just like teaching and learning nursing. However it is not a matter of political apathy, but a matter of personal involvement and dedication, whose absence today has resulted in factors like lack of concentration of nursing faculty upon nursing students, content-driven faculty and time consuming factors behind formulating strategies. (Hermann, 2004) It is due to this reason that Australian nursing is confronting to challenges like lack of public reliance on hospitals, nurses', negligence towards patients etc. Other challenges include lack of community contact, some ethical issues which later escort towards loss of interest and defaming the profession. (Mant, 2002) Job dissatisfaction is also one of the reasons which escort experienced nurses to leave this field. (Goodwin, 2002) Under such circumstances where nurses are open to hear critics either in professionalism or ethical values, could one think that political apathy alone is to be held responsible for creating this situation In my opinion, the situation is all about what nurses understand and perceives the ethical and moral code of conduct. Therefore, it is not to blame the political apathy of professional values but the morals which a nurse has to follow throughout her nursing career. The Ethical Conflict By nursing ethics, it is meant the morals and duties of nursing which she must succumb to in professional patient care. Often nurses see 'morality' as involving more a personal or private set of values, in contrast with 'ethics', which is seen as involving a more formalised, public and universal set of values. The incorrect use of fundamental ethical terms and concepts has led to a certain degree of confusion in nursing ethics discourse. Therefore the responsibility of this confusion does not lie with political apathy, but with a nurse who understands and perceives in her own manner. In this situation where 'political involvement' and 'ethics' has, been misunderstood in today's nursing profession, one must think behind the hidden facts responsible for creating the chaos. Blaming the laws, nursing code of conduct or nursing schools is not the solution to the problem. Lack of sharing and understanding a common nursing ethical language has become the ground root for taking a correct or incorrect course of action on which the reputation of nursing is built. Here by correct or incorrect I mean the course of action that is morally correct for the patient. For example if two nurses are unable to share a common perception about nursing practice, they cannot meaningfully debate about moral permissibility due to conflicting views and these views could later result into the differences clearly seen while handling a patient. Therefore, the onus comes on the shoulders of those nurses who are dedicated to enter in this profession to research about the conflicting views. The Moral Problems of today's Nurse Nursing practise revolves around basic care and common sense and today's nursing care is the moral care of the patient without these two features. (Traynor, 1999, p. 69) Moral care involves dedication and emotional bonding and respect for the patient. Though the nurses who are new to the profession are dedicated enough to handle the patient and understand morality, but that dedication is devoid of basic 'care' and 'common sense'. However older ones that stick to this profession for years explicitly identify their work and values as 'traditional' but still they never realise what is ahead of them that requires true morality what it takes to become today's nurse who is willing to accept changes, changes that require some fundamental knowledge and realisation of basic nursing care and practice. So, the problem does not only remain with our younger nursing generation but with older nurses as well, as it is difficult for the experienced nurses to have the courage to amend their perceptions and technical attitudes towards their patients. According to Orr (2004) "Graduated nurses must know how to assess uncertain and unpredictable conditions". (Orr, 2004) I. Basic Common sense Nursing Practise The reason for why today the profession is suffering is due to decreasing common ability of sensing and realising patients' pain and grief. One example of such attitude is nurses' attitude towards elderly care. Nurses in their working lives, meet elderly people who are sick, frail or cognitively impaired due to old age effects. While considering their hopelessness and helplessness of old age, instead of caressing such patients nurses adopt attitudes that lead them towards a pure paternal feeling towards her/his patients, thereby subsequently eroding the patients' independence. Another basic norm which nurses do not follow is while being together with other professionals; they frequently take decisions without consulting with the elderly patient. Even when patients do make their wishes known they are largely ignored, the professionals believing that they know what is best. (Hunt, 1994, p. 55) This not only hurts the patient but is also responsible for alleviating the factor of trust and confidence in nursing. In other words, such attitude is responsible for defaming the profession. Clearly, the nurse should do what is good for the patients and avoid anything that will harm them. One of the reasons that elderly people are deprived of choice is that nurses are frequently caught by the dilemma that it would be good, for example, to help the elderly to return home (which is usually their overriding desire), but to do so might cause them to come to harm due to their age-related impairments. II. Blind moral decisions Nurses and allied health professionals often forget that it is the quality of life that their patient is expecting from them. They forget that a quality of life expresses some value or worth that is attached to the characteristic of the patient. For example, an evaluative quality of life statement might assert that 'the pain suffered by this person is bad' and 'the absence of pain in this person is good', or that 'the loss of functional ability experienced by that person is bad' and 'the regaining of function by this person is good', or that 'this person's dependency on others for care is bad' and the 'regaining of independence by this person is good', and so on. To say a person has lost quality of life in this sense would be to assert merely that some property or aspect of her or his life has lost value, not that life itself has lost value, although the attachment of value to certain qualities or characteristics, in this instance, often becomes the very basis upon which an individual human life might be judged worth living or not worth living, as the case may be. (Johnstone, 1999, p. 366) Australian Nursing Midwifery Code (ANMC) requires that patients must go through an admission assessment performed by a registered nurse. (Queensland Government) The nurse is then expected to prioritise the patients' considerations. However this is not what usually happens. A patient is prioritised in accordance with his/her financial position. Nursing Dualism - Blind decisions are often taken when financial priorities take over from the concerns of patient care. According to a staff nurse, "The priority is not the patient's comfort but the main concern that the patient can keep within budget". (Staff nurse, Australian Community Health Trust) In this statement 'Patient comfort' and keeping 'within budget' are set up as opposites in which the former term is implicitly, but clearly, privileged as the more legitimate, authentic concern and activity. 'Keeping within budget' is described as a supplementary concern that has usurped its proper position. These kinds of comments are often heard in nursing department which demonstrates one of the main reasons for the loophole in today's nursing. III. Hospital norms and etiquette One of the main reasons for nursing apathy is the basic nursing care for which nurses have not used historically those evidence upon which to base their practice. Critiqued by many publications and authors one of the common barriers to implementation has been the lack of easy and quick access to evidence based information. However, I do not agree with this opinion as the political apathy is the result of nurses not updating and adapting their practices to which they are committed. A nurse must abide by the 'best practice' followed in the hospital and for implementing those practices; nurses must take help from nursing organisations affiliated with the hospitals. Therefore nurses must identify high-quality nursing practices, analyse them thereby applying to the local nursing profession. Nurses, instead of relying upon their own sources of information, must seek assistance from colleagues and experts; rather he/she should initiate the nursing career through a team work which would provide her with a complete structure. Another example which reflects morality: A patient is in severe and intolerable pain due to not receiving pain medication. Now, instead of solving this problem morally i.e., to identify and manage patient's pain through clinical assessment it would be immoral if a nurse prioritises the 'technical problem' i.e., technically handle the problem while ignoring his pain. It is the core responsibility of the nurse to identify and assess the moral problems of the patients and in order to deal with moral problems appropriately and effectively it is evident that nurses need to know, first, what form a moral problem might take and how to recognise it; and, second, how best to decide when dealing with them. Nursing Accountability According to the ANMC (Australian Nursing and Midwifery Council) a nurse's competency to work safely is what makes a nurse personally accountable (ANMC, Jan 2003) With nursing accountability arises the concept of fundamental transformation not only in Australia but other European nations where 'transformation' means the age-old gap between nursing ideals and practice. On the one hand, accountability refers to the liberation of nurses - a new freedom, responsibility and professionalism. On the other, the evidence is of 'accountability' functioning as the central idea in a new ideology of disciplined accommodation to structural changes required by a quasi-market in public health care provision. (Hunt, 1994, p. 130) Nurses both in Australia and overseas are confronted every day with having to make morally relevant choices and to take action on the basis of these choices during the course of their work. Nurses deal with it so professionally that they hardly bother the fact that they are also accountable to someone. This 'everyday' occurrence should not be taken to mean, however, that deciding and acting morally in nursing care contexts is simply a matter of habit or 'daily routine' and therefore as something 'trivial' requiring little knowledge, skill or attention. To the contrary, dealing with everyday ethical problems requires of decision-makers an exquisite moral sensibility, 'moral knowing', moral imagination, life experience, virtue, being generally informed, and a deep personal moral commitment to 'doing what is right'. Therefore, nursing accountability does not refer to the notion that to whom and to what extent nurses are and should be accountable, but what we can perceive is again the fulfilment of moral standards to which a nurse must accomplish while considering a patient. Do's and Don'ts of Nursing Code of Conduct Codes themselves may insist upon the trust that the client must have in the profession, and that high standards of professional conduct are integral to the maintenance of such trust. Therefore nurses after walking into their professional lives must prioritise the patients ethically and morally. No doubt Australian nurses have faced many political and legal difficulties in relation to some work; an example is that of abortion-assisting work. The issue was marked as political controversy but after 1998, the issue was resolved and marked as illegal if taken in any favour of the patient or in case terminated. (Dr. Stephen, Abortion Law) Nursing code of conduct requires that ethical professional standards when kept before the community of nurses, must not only internalised them as a way of life, but more importantly, enacted. Technical Decision Making - are the decisions taken in favour of patient or nursing Individual decision making may involve a nurse refusing conscientiously to participate in a controversial medical procedure; reporting a troubling incident to a superior or some other authority; seeking nomination on an institutional ethics committee; or, quite simply or speaking out in either a conference or workshop. Whether the decision making is individual or collective, nurses must keep in mind that the decisions taken must be in favour and benefit of the patients. Even the most 'ordinary' of nursing actions can affect significantly the wellbeing, welfare and moral interests of their patients. Nursing codes of ethics around the world have made explicit that nurses have a stringent moral responsibility to promote and safeguard the wellbeing, welfare and moral interests of people needing and/or receiving nursing care. These codes also variously recognise the responsibility of nurses to balance the needs and interests of different people equally in health care contexts. Following Australian Nursing Code ANMC despite of planning 25 nursing schools and hospitals (ANMC) has failed to maintain the sense of nursing accountability which is evident from the nurses' perception of this generation. However ANMC is several times criticised for the conflict that occurs between the views of a young graduated nurse and an experienced nurse. But in my opinion, the basic reason behind the conflict is the code's function within the profession's disciplinary procedures which highlights the code as trivial. According to the ANMC, it is obligatory on a nurse to maintain trust and confidence in context with public as well as with the profession. (ANMC, Jan 2003) Nurses usually maintain this ethical code by forcing their patients towards a particular decision, while not taking into account any of their willingness or opinion. This is how nurses ruin their trust in public. Another example; It is often noticed in a series of situations that may provide problems to the pharmacist, and of which the code serves to make them aware. These include the sale of slimming and other non-medical products, sale of chemicals, and sales by post. Such annotations amount to a catalogue of the problems that have confronted pharmacists, and for which they may be expected to take responsibility. The professional is being warned not to take certain situations for granted. But even then, many nurses are found who habitually consider medical products for granted. Conclusion Political frameworks are there, formulated strategies are there. With many nursing schools in every Australian territory equipped with latest equipments and qualified instructors, if still nursing profession is unable to meet the century's demands it clearly indicates that our younger generation does not take their profession seriously. It is the need of time to develop and groom nursing professionals and practitioners. It is the requirement of time to develop the capacity for young nurses so that they may not stop or stuck with the challenges, instead the nurses must research and articulate the evolution going on within the profession. Today's nurse must take into account the transformation of the traditional picture of nursing, the development of a Code of Ethics and a Code of Conduct; the evolution of nursing research and the development of competencies for nurses. (Lumby & Picone, 2000, p. 49) She must understand that 'nursing' alone does not count unless combined with 'practice'. References Goodwin Kristine, (2002) "States Tackle the Nursing Shortage: The Lack of Qualified Nurses Is Reaching Epidemic Proportions. States, Universities and Hospitals All Are Trying to Do Something about It" In: State Legislatures. Volume: 28. Issue: 9: October-November 2002. Hermann L. Mary, (2004) "Linking Liberal & Professional Learning in Nursing Education" In: Liberal Education. Volume: 90. Issue: 4. p: 42 Hunt Geoffrey, (1994) Ethical Issues in Nursing: Routledge: London. Lumby Judy & Picone Debbie, (2000) Clinical Challenges: Focus on Nursing: Allen & Unwin: St. Leonards, N.S.W. Mant Julia, (2002) "A Casualty of Constructs: Ted Harvey's War" In: Journal of Australian Studies. p: 27 Johnstone, Megan Jane, (1999) Bioethics: A Nursing Perspective: Harcourt Saunders: Sydney, N.S.W. Orr, D. Robert, (2004) "Ethics & Life's Ending: An Exchange" In: First Things: A Monthly Journal of Religion and Public Life. Issue: 145. August-September 2004. Traynor Michael, (1999) Managerialism and Nursing: Beyond Oppression and Profession Routledge: London. Dr. Stephen Kylie, Abortion Law. Retrieved on Oct 25, 2007-10-26 from < http://www.prochoiceforum.org.uk/al5.asp> ANMC, Jan 2003 Code of Professional Conduct for Nurses in Australia. Retrieved on Oct 25, 2007-10-26 from < http://www.anmc.org.au/docs/ANMC_Professional_Conduct.pdf> ANMC, Welcome to the Australian Nursing and Midwifery Council Incorporated (ANMC), Retrieved on Oct 25, 2007-10-26 from < http://www.anmc.org.au/> Queensland Government, Queensland Health. Nurse Practitioner. Implementation Guidelines. Retrieved on Oct 25, 2007 from < http://www.health.qld.gov.au/nursing/docs/imp_guide07.pdf> Read More