HNN750 Inquiry Into Specialty Nursing Practice

Introduction  

The current study focuses on the importance of personal knowledge in nursing professionals. The nursing care professionals working in an acute care setup need to be developing a certain amount of expertise with regards to effective decision making and management of emergency and trauma care situations. The individual expertise can help in enhancing the overall productivity of an emergency and trauma care ward (Nagle et al., 2017).  Some of these are based upon mindfulness where the nursing profession needs to be aware of the space, time and surroundings. The emergency decision making is solely based on exposure to similar critical and trauma care incidents (Ellis, 2016).

Therefore, based on individual expertise and exposure to acute care setups the professional practice models are developed. The professional practice model differs from individual to individual are subject to variation and improvement. The professional practice models are established through a number of standardised forms which helps in improving the quality of care. The professional practice approaches and guidelines are further based on the Nursing and midwifery board of Australia (NMBA).

In the current study and actual clinical setup has been taken into consideration for the development of the professional practise model. Here, the nurse was placed in a renal or urology ward for a night shift, there were six patients in the ward at all.  However, one patient suddenly developed d a chronic pain in her abdomen.  Using the pain assessment, she recorded a score of 8/10.  On further inspection, it was found that the patient had undergone a kidney transplant and was blessing from the abdominal area.  Therefore, a practising nurse attending to a series of patients within an acute care ward a number of effective steps could be taken over here. For example, measuring the level of consciousness in the patient could be helpful. Therefore, based on the responses the patient could be put under an advanced life support. In the current assignment, a reflection through the actual nursing scenario had been taken into consideration.   A number of themes and patterns have been developed over here which has been related to professional nursing practice. The various challenges and opportunities faced in implementing the nursing professional practice model have been further discussed over here.

Reflection upon a day in a nursing professional’s life  

Working as a nursing professional in an acute care ward I come across a number of varied situations. Some of these situations are emotionally tiring and put heavy demand on the nursing profession. These are situations where sufficient expertise of the nursing professionals is called required. The actions depicted by the nursing professionals are further guided based on the professional NMBA standards (Ingham-Broomfield, 2015). The standards as mentioned in the NMBA ensure safe and effective nursing care practices are delivered.  Some of the most crucial challenges, which are faced over here, are with respect to taking effective judgment or decision making. As mentioned by Cusack et al. (2016), the actions undertaken within an acute clinical care setup are often guided by instincts. This is because in the absence of sufficient guidance from the healthcare professionals it often becomes challenging to deal with the pressurising situation or take an apt and just situation. In dealing with the regular nursing care activities one needs to ensure that the NMBA standards and guidelines are effectively followed (Nursing and Midwifery Board of Australia, 2014).  However as argued by Manojlovich and Ketefian (2016), it places the importance upon sufficient adequate training a support to be provided to the nursing professionals. As suggested by Townsend and Morgan (2017), the heavy and pressurising clinical situation often results in the development of phenomena known as compassion fatigue in nurses. In an acute clinical care setting the nurses often have to put longer work hours which results in physical and emotional burn out within them.  From my personal experiences, I have felt that the longer shift durations followed by insufficient communication during handover often affects the quality and the standards of the support and care services provided.

Therefore, focussing on my last clinical setup I have realized that I need to hone my personal level of knowledge further. For example, acting on time and putting the patient on advanced life support could help in saving the life of the patient. However, it was an instinctive reaction undertaken by me where I followed up the excessive bleeding in the patient to put the patient on a life support machine after checking the level of consciousness in the patient. It was a much approve move based on the current situation. However, I had no idea regarding the underlying pathophysiology in the patient and had to wait for the intervention of the after-hours educator for enlightening me regarding my present set of action.  Based on this experience, I felt that I need to hone my personal level of knowledge which will help me to be more confident and affirmative regarding my actions in the future.   Though, my past experience with a transplant patient helped me in taking effective measures.  I felt a certain pressure and obligation towards the patient and her family. Additionally, in my mind, I contemplated all possible and worrisome options for the patient.  I often felt emotional burnout or a gust of crying and felt it difficult to control myself. Hence, I felt that I need to develop a certain amount of emotional and mental resilience which will help me in coming up with the situation better.

Knowledge derived from the five ways of knowing in nursing practice

In order to develop the professional practice and improve the quality of nursing care one needs to focus on more than one patterns of knowing which are could be described as –empirics, esthetics, personal, aesthetic and emancipatory knowing etc. The empirics are the science of education which refers to the amount and the kind of knowledge gathered using the physical senses such as hearing, touching and hearing etc. It is based on traditional problem solving,   which are further guided and supported by theoretical constructs (White, Dudley-Brown & Terhaar, 2016). These are based upon gaining sufficient scientific knowledge. In this respect, sufficient emphasis needs to be provided upon the gathering of knowledge during the theoretical sessions. The theoretical sessions are very important in the development of effective problem-solving skills in the nursing professionals. In this respect, special emphasis needs to be given to the implementation and inculcation of the nursing professional standards.

The ethics refer to the moral knowledge acquired by the nursing professionals.  Some of the ethical standards of care help in improving the quality of nursing care. It requires empirical and experiential knowledge of social norms and values. It focuses on knowing one’s responsibility better, which helps in differentiating the right from the wrong. As mentioned by Déry, D’Amour, Blais and Clarke (2015), the ethics are guided by different philosophical aspects affecting duty and social justice. The sense of ethics often helps in removing the various dilemmas faced in an acute clinical setup with respect to effective decision making (Erickson, 2017). For example, the decision to shift the patient to an ICU is guided by the feeling that putting the patient under critical care can bring in specific health improvements within the patient.  However, the move may be questioned significantly by the extended family of the patient. Therefore, it is the moral duty of a nursing professional to inform the family members of the patient regarding any particular move taken.

 The personal knowing is one of the most pivotal components of nursing literature and depends upon the marketing skills developed by individuals. It varies from individual to individual based upon the knowledge and values inherited by then along with the in-house training sessions that one had been exposed to. As mentioned by Keyko, Cummings, Yonge and Wong (2016), the person knowing refers to the therapeutic use of self. It refers to the interactions, relationships and transactions between patients and clients. The personal knowing refers to knowing encountering and actualization of own self. The objectives of personal knowing focuses on developing an effective bond between two persons (Gullick & West, 2016). It emphasises an open environment which helps in the full potential development of a nursing professional. It helps in addressing the personal weaknesses which helps one emerge out as a mentally strong person. This is because the pressure within an acute nursing care setup can often result in a professional burnout. It focuses much upon the therapeutic communication approaches for analysing the mental and emotional levels of the patient.

The estheric pattern of knowing highlights the level of empathy depicted by an individual for connecting with others.  As mentioned by Douglas et al. (2014), the nursing profession needs to put sufficient emphasis upon the feelings and the beliefs of the patients which helps in them in designing of an effective care plan and services.

The emancipatory learning better comprehends the environment, the modulators and their journeys which can help one in learning or adopt sufficient skills which are a pre-requisite within a professional care environment (Ellis, 2016).

Therefore, as a nursing professional, I need to develop my knowledge further into individual domains which would help me practice more efficiently within an acute clinical care setup. In my opinion, one of the most pivotal components over here is the presence of an efficient course modulator which can facilitate the process of authentic knowledge absorption within the nursing professionals which can help improve the quality of support and care services. Additionally participating in more in-house practical session can help me develop my clinical skills better along with effective decision-making skills. Some of these have been seen to develop my personal knowing skills better.

Emerging themes and patterns form practice descriptions  

A number of common themes and patterns could be focussed upon here based upon the practice descriptions. Some of the themes are person-centred care and informed decision making. These two themes have been developed further through personal practice model.   Additionally, acting in accordance with the professional nursing guidelines can help in improving the quality of care. The person-centred care places more importance upon apathy and values, which helps in relating with the patient on a personal level.  As mentioned by Taylor (2017), the patient centred approach takes into consideration the culture and values of the patient.  In this respect, an acute healthcare setup admits huge number of patients from multicultural and multilingual setup. The different cultural beliefs often lead to disputes within an acute care setup.  Hence, the undertaking of a patient centred approach helps in removing the biases within a clinical setup.

Additionally, informed decision making can help in making the patients aware of the nursing care plans and the reasons for implementing a particular care approach. In one of my past clinical setups, I had to undergo sufficient pressure put by the family members of the patients where they insisted that I share with them the confidential details of the patient. As mentioned by Farquhar (2018), the decisions making needs to be done with proper approval and information to the family members of the patient.

Additionally, the current decade has seen the emergence of evidence-based nursing practices. These are developed around common standards or guidelines and helps in improving the quality of care. The evidence-based nursing practices are further customised in order to meet the requirements of the patient (Birks, Davis, Smithson & Cant, 2016).

Relationships between different concepts   

The relationship between different concepts could be highlighted over here for proving the efficacy of the nursing code of ethics and standards. Three different concepts have been highlighted over here which are person-centred approach, policy of informed decision making and implementing evidence-based practices in nursing. As mentioned by Halcomb, Stephens, Bryce, Foley and Ashley (2017), the person-centred approach helps in promoting the concepts such as informed decision making. The patient centred approach further helps in the practice and implementation of evidence-based practices.

The evidence-based practices help in the development of the full potential of the nurses which helps in supporting personal knowing. As mentioned by Cashin et al. (2015), the personal knowledge can help in improving the nursing quality and standards. The patient centred approach undertaken by the nursing professionals can also help in supporting the five domains of nursing centred knowledge, which can help in improving the quality of care. The patient centred approaches undertaken over here help in the provision of sufficient grounds for the development of new knowledge and skills (Nagle et al., 2017). Some of these approaches can help in improving the quality of patient care.

Comparison of personal practice model with other relevant areas of nursing care  

The personal practice model which had been highlighted over here has been compared with the relationship-based care model proposed by UC Davis. It consists of a pyramid structure which places patient and the family at the top. It focuses upon a number of aspects such as the environment of care, optimal resources, respect for the patient and their respective families, development and implementation of effective clinical practices, which aims in receiving optimal outcomes (Prak & Wivatvanit, 2018). The care environment places much importance upon appropriate staffing along with implementation of skilled communication (Mather, Gale & Cummings, 2017). The communication approaches have been seen to improve the quality of patient care. It also places sufficient importance upon the use of effective knowledge and expertise for the development of clinical expertise in the patient. As mentioned by Anderson, Kent and Owens (2015), the acquiring and development of knowledge is guided by standard nursing practices and guidelines. The leadership approaches adopted over here further governs the rate of success.  Within an acute clinical care set up a situational leadership is used. The efficacy of the leadership depends upon the skills and the expertise of the course modulator. As suggested by Dmytryshyn, Jack, Ballantyne, Wahoush and MacMillan (2015), in the lack of effective leadership there is a huge probability of mishap occurring within a professional clinical setup.

On the other hand, the model used by us uses an evidence-based approach to improving the quality of care. The Evidence-based approaches are mainly tested solutions applied within an acute clinical setting. Therefore, they are focused more upon nursing research rather than placing importance upon the development and inclusion of skilled staff.  The UC Davis model Palaces more importance upon the care staff quality. Hence, it could be referred to as a staff centred approach, whereas the model used over here places much importance upon a patient centred by promoting policies such as informed decision making, which focuses upon maximum inclusion of the patient within the care and support services. However, as argued by Feo et al. (2017), the realization of the standards in full potential is dependent upon the organizational skills.

 The model developed over here could be further compared with model as suggested by John Hopkins, which places sufficient emphasis upon nursing education and research. The nursing education and research are further guided by a set of internal and external factors.

The internal factors could be divided into culture, environment, equipment, staffing standards. On the other hand, the external factors could be divided into –accreditation, legislation, quality measures and regulation standards. Therefore, the personal care model developed over here fails to take into consideration the legislation and regulation standards, which are pivotal to the optimal functioning of a healthcare organization.

Challenges and opportunities in implementing personal practice model  

There are a number of challenges as well as opportunities for implementing the personal practice model. The challenges are faced with respect to lack of sufficient expertise in the staff along with lack of effective guidance from the supervisor. As mentioned by Kimuyu (2018), the lack of financial resources can also hinder the implementation of particular nursing care models.

 In this respect, the lack of support from the supervisors and the lack of sufficient finance can further affect the realization of the professional standards within an acute care setup. On the other hand, the personal practice model provides a number of opportunities such as it provide sufficient space to the nursing professionals to improve their personal knowledge. Additionally, it helps in improving the standards of care by placing sufficient importance upon value and apathy. These aspects further help in the promotion of a patient centred approach. The patient centred approach further helps in raising the professional standards. The personal care model also helps in improving individual skill sets, which helps in providing quality care within an acute healthcare unit. Additionally, the personal practice model helps in resolving the ethical dilemmas within an acute care setup.

Conclusion

The current study focuses on the aspect of development of a personal practice model within a professional care unit. These are based upon individual skill sets acquired through exposure to actual professional scenario. This skill sets further helps in the process of personal knowledge which is pivotal to providing a safe and effective nursing care practices. Additionally, sufficient importance has been given to reflection within an actual clinical setup which helps in understanding the personal weaknesses or loopholes.

Additionally, focussing on the nursing knowledge and different perspectives can help in the improvement of clinical care standards. The assignment also places sufficient emphasis upon the development of a personal practice model, which helps in understanding the professional standards and requirements.

References 

Anderson, N. E., Kent, B., & Owens, R. G. (2015). Experiencing patient death in clinical practice: Nurses’ recollections of their earliest memorable patient death. International journal of nursing studies, 52(3), 695-704.

Birks, M., Davis, J., Smithson, J., & Cant, R. (2016). Registered nurse scope of practice in Australia: an integrative review of the literature. Contemporary nurse, 52(5), 522-543.

Cashin, A., Buckley, T., Donoghue, J., Heartfield, M., Bryce, J., Cox, D., … & Dunn, S. V. (2015). Development of the nurse practitioner standards for practice Australia. Policy, Politics, & Nursing Practice, 16(1-2), 27-37.

Cusack, L., Smith, M., Hegney, D., Rees, C. S., Breen, L. J., Witt, R. R., … & Cheung, K. (2016). Exploring environmental factors in nursing workplaces that promote psychological resilience: constructing a unified theoretical model. Frontiers in psychology, 7, 600.

Déry, J., D’Amour, D., Blais, R., & Clarke, S. P. (2015). Influences on and outcomes of enacted scope of nursing practice: A new model. Advances in Nursing Science, 38(2), 136-143.

Dmytryshyn, A. L., Jack, S. M., Ballantyne, M., Wahoush, O., & MacMillan, H. L. (2015). Long-term home visiting with vulnerable young mothers: an interpretive description of the impact on public health nurses. BMC nursing, 14(1), 12.

Douglas, M. K., Rosenkoetter, M., Pacquiao, D. F., Callister, L. C., Hattar-Pollara, M., Lauderdale, J., … & Purnell, L. (2014). Guidelines for implementing culturally competent nursing care. Journal of Transcultural Nursing, 25(2), 109-121.

Ellis, P. (2016). Evidence-based practice in nursing. Learning Matters, 145-165.

Erickson, M. E. (2017). Modeling and role-modeling. Nursing Theorists and Their Work-E-Book, 398.

Farquhar, J. (2018). Knowing practice: The clinical encounter of Chinese medicine. Abingdon: Routledge, pp.154-164.

Feo, R., Conroy, T., Marshall, R. J., Rasmussen, P., Wiechula, R., & Kitson, A. L. (2017). Using holistic interpretive synthesis to create practice?relevant guidance for person?centred fundamental care delivered by nurses. Nursing inquiry, 24(2).

Gullick, J. G., & West, S. H. (2016). Building research capacity and productivity among advanced practice nurses: an evaluation of the Community of Practice model. Journal of advanced nursing, 72(3), 605-619.

Halcomb, E., Stephens, M., Bryce, J., Foley, E., & Ashley, C. (2017). The development of professional practice standards for Australian general practice nurses. Journal of advanced nursing, 73(8), 1958-1969.

Keyko, K., Cummings, G. G., Yonge, O., & Wong, C. A. (2016). Work engagement in professional nursing practice: A systematic review. International journal of nursing studies, 61, 142-164.

Kimuyu, P. (2018). Challenges Faced by Nurses in Implementing Evidence Based Practice in the Clinical Setting, 45-78.

Manojlovich, M., & Ketefian, S. (2016). The effects of organizational culture on nursing professionalism: Implications for health resource planning. Canadian Journal of Nursing Research Archive, 33(4).

Mather, C. A., Gale, F., & Cummings, E. A. (2017). Governing mobile technology use for continuing professional development in the Australian nursing profession. BMC nursing, 16(1), 17.

Nagle, C., Heartfield, M., McDonald, S., Morrow, J., Kruger, G., Bryce, J., … & Hartney, N. (2017). A necessary practice parameter: Nursing and Midwifery Board of Australia Midwife standards for practice. Women and Birth, 30, 10-11.

Prak, M., & Wivatvanit, S. (2018). The development of neonatal nursing standards of practice for Cambodia: a Delphi study. Journal of Health Research, 32(1), 12-23.

Taylor, E. W. (2017). Transformative learning theory. In Transformative Learning Meets Bildung (pp. 17-29). SensePublishers, Rotterdam, 45-85.

Townsend, M. C., & Morgan, K. I. (2017). Psychiatric mental health nursing: Concepts of care in evidence-based practice. FA Davis, 55-65.

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2016). Translation of evidence into nursing and health care. Berlin: Springer Publishing Company, 105-212.

Ingham-Broomfield, R. (2015). A nurses’ guide to NMBA. Australian Journal of Advanced Nursing, The, 32(3), 34.

Nursing and Midwifery Board of Australia. (2014). Nurse and Midwife Registrant Data: March 2014.