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Dimensions of Everyday Nursing Practice

Dimensions of Everyday Nursing Practice


Nursing

Nursing is considered as one of the most trust worthy occupations. Nurses are responsible for taking care of patients whether they are in operating rooms or in the wards. "Bedside nurses" are primarily responsible for taking care of the patients.

"Nursing, everyone believes, is the caring profession. Tomes of text on caring line the walls of nursing schools and student shelves. Indeed, the discipline of nursing is often known as the "caring science". Because of their caring reputation, nurses top the polls as the most trustworthy professionals. Yet, in spite of what seems to be an endless outpouring of public support, in almost every country in the world of nursing in under threat, in the practice setting and in the academic sector. Indeed, its standing as regulated profession is constantly challenged". (Nelson and Gordon, 2006)

"In the practice setting, how nurses deliver care is under attack. In the US, nurses are constantly fending off efforts to replace registered nurses with poorly educated workers. Nurses are under pressure to justify their very existence at the bedside. Nurses are floated from units in which they have great expertise to units in which they have little, because administrators seem not to grasp that nurse is not simply an extra pair of hands and feet but also a knowledgeable worker with specific skills. This pattern is true all over the world as health care consultants try to sell administrators new schemes that base cost-cutting and so-called efficiencies on the elimination of nurses at all levels of the organization". (Nelson and Gordon)

"Nursing like medicine, involves a rich, socially embedded clinical know how that encompases perceptual skills, traditional understandings across time and understanding of the particular in relation to the general. Clinical knowledge is a form of engaged reasoning that follows modus operandi thinking. In relation to patients' and clinical populations particular manifestations of disease, dysfunction, response to treatment and recovery trajectories. Clinical knowledge is necessarily configurational, historical, perceptual, and based upon knowledge gained in transitions. Clinical knowledge exists in communities of practice and progresses in those communities through dialogue and often becomes manifest through emotional reactions elicited when things do not go as the clinicians expect, or when the course of events appears dangerous". (Benner)

With the passage of time, the role of nursing has become an increasingly complex, demanding, research based, communicative, and widely diversified. The types of services that the nurses are providing these days cannot be simply put down into points, because the role of a nurse changes and becomes modified with every field of medicine, the health care setting, the age group of patients under care, the type of care system being delivered down to the individual requirements of the patients. This makes nursing a highly challenging profession, as apart from the technical and medical efficiency nurses must display, they are also expected to show the humane side of care to the patients and their family members. (Foley, 2004)


Patients' Knowledge

"A patient knowledge is the largest, most complex domain and is absolutely critical to the working of nursing. While case knowledge is limited to biomedical knowledge, the content of patient knowledge include knowledge of how an individual becomes identified as a patient, knowledge of the individual's response to treatment, knowledge of hot to get things done for the individual within and between institution and knowledge of the many other who are involved in providing services across time and space". (Liaschenko, 1999)


Technology and Nursing

"It has become commonplace in contemporary nursing literature to describe, laud, or lament the impact of technology on nursing. The technology that nurses began to incorporate into their practice after World War II was, in many respects, very different from the technology that prevailed in nursing before that time, and it engendered problems, especially ethical dilemmas, for nurses who had not previously encountered it". (Sandelowski, 1997)


Nursing Crisis

"Nursing is facing a major worldwide crisis. The nursing workforce is aging. The profession is plagued by poor rates of nurse retention in hospitals and other health care institutions. Because of changes in women's roles, it is more and more difficult to attaract the tradional recruit-young women to nursing. Nursing has also been stubbornly unable to change the proportion of men in the profession. A recent report in the journal Health Affairs found, for example, that young men are leaving the profession at twice the rate of their counterparts. These factors combined with an again population and soaring rates of chronic illness that demand active care and management are producing a global nursing shortage of potentially devastating dimensions. The United States and Canada will face a shortfall of one million and 113,000 nurses respectively in the next decade and a half". (Gordon and Nelson, 2006)


Evolution of Nursing

Nursing has evolved from its humble beginnings into a multi dimensional facet, where nurses are performing as writers, technologists, political health reformists and representatives, and contributors in the emergency, critical health care, and operating room services. (Foley, 2004) with time nursing has been recognized as a discipline itself and now studying nursing is carried out in many countries in the form of masters etc.

Bedside nurses carry out many responsibilities. Nurses ensure provision of safe and quality health care to the population whether it is in a hospital, clinic, school, homes and workplaces. They have become the network between the various health programs and provide a connection between these programs that rarely other programs or professions do. They teach disease prevention and promote wellness and are responsible to provide for the acutely or terminally ill, and provide expert and skilled clinical care to them

With the development of the profession, bedside nursing has become not a profession of the sidelines but rather works as an equal partner in patient health. (Foley, 2004)

This role becomes further enhanced in the rural locations, where access to many health care facilities may be limited. It is working in these settings that have encouraged the promotion of nursing specialties like pediatric nursing and midwifery. Nursing programs in community and home based settings have received mass approval both on the patients and the health care front, and with time this system of care delivery is developing more and more. Nurses are also the bridge between the traditional health care delivery techniques and emerging complementary medical services. (Foley, 2004)

Bedside nurses perform the role of being patient's advocates because it is them who spend the most time with the patients. In other words, they act like "contact points" for clients. (Fact sheet, 2002) they perform tasks of case management, diagnostic, treatment, preventive and palliative care.

This profession is important because of the human factor that is so deeply entwined in it. The profession cannot be simply sent overseas or be outsourced. It requires the care of human touch and cannot be served with robotic technologies. It is the provision of the hands on care that is essential in the health care delivery. The profession becomes demanding on all levels of human performance, intellectually, physically and spiritually. And the nurse all at once becomes a carer, a confidant, a helper, a soother, a communicator, an educator and an advocate to the patient and his or her family. (Pierce, 2004)

Bedside nurses are better able to observe and monitor the progress of their patients during routine care procedures, and in this way help to identify factors that can promote quicker healing in them. This is due to the fact that the patients are under the observation of the nursing staff 24hours a day whereas the doctors spend a margin of this time with the patients. The nurses are also responsible in carrying out different therapeutic procedures for the patients, which in the past were done by the doctors themselves. With more and more access to the care of the patient, the nurses are now better able to understand and diagnose, and thereby manage the patient's condition. They are able now to give physical assessments to the patients, whether ambulatory or bedridden, and are at better knowledge in understanding the needs and the demands of the patient's circumstances.

Bedside nursing is one of the most demanding and challenging jobs in the nursing profession. Bedside nursing involves direct care of the patient in the hospital setting, and may even involve the critical care of the patient. It aims to provide care for the physiological and psychological needs of the patient, and implementing strategies to address the needs. Other areas of bedside nursing also include medical and surgical care and mental care. (Hinds, 2004)

Bedside nursing includes constant evaluation of the patient's health whether he or she is ambulatory or bedridden. There is not much difficulty encountered when the patient is ambulatory, but in cases of bedridden patients, more care and more attention is required. For this reason many strategies have been developed to help in providing assessments of the patient in compact single procedures. For example, while giving a patient a bed bath, the nurse can also make a detailed assessment of the patient's condition. This reduces the number of times the patient undergoes discomfort, while addressing two or three areas of care at once. Since bed bath is carried out daily, it becomes especially helpful to maintain log on bedridden patients' conditions. Bedridden patients are more at risk in developing bedsores and circulatory problems. This makes it essential to monitor the patients closely, as complications can be life threatening. And assessment during bed bath has proved to be an efficient way of doing so.

But with the realization of the role that nursing plays in provision of health care services comes the dilemma. Many policies have been carried out world wide that have negatively affected the nursing profession. Among these policies, the most controversial has been the cost cutting, which has lead to decreased number of nurses providing for increased number of patients. The effect has increased the work load on the nursing professionals while doing little in helping alleviate the problem. Also, by replacing qualified nurses with unqualified and cheaper professionals, the nursing professionals are under threat in securing jobs. Another main issue of critical importance is the aging of the nursing population, which by the year 2010 will lead to acute shortage of the nursing staff. This will further escalate the rising problems in the profession, as lesser number of people is now undertaking nursing as a profession. (Foley, 2004)

The general dissatisfaction among the bedside nurses regarding appreciation of their role by doctors is another issue. Doctors do not involve bedside nurses in the treatment planning and caring of the patients as much as they should, and this has led to a decline in the moral of the nurses. (Foley, 2004) These issues clearly emphasize the need to resolve the unrest among the nursing professionals. Steps like cost cutting have seriously undermined the trust of the nurses, while increasing the work loads on the already depleting work force.

In conclusion, nursing, especially bedside nursing, is a profession that has played a valuable role in the provision of health care under the most demanding circumstances. It acts as a connection between the various personnel of health care and the contributions they play in the patient's health care is vital for the system. It therefore is very important the role of nursing is recognized for its true worth and steps taken to help in promoting the profession, while addressing its various issues.






References
Barbara A. Guido, 2004. The Role of Nurse Practitioner in an Ambulatory Surgery Unit. AORN Jurnal, March 2004.

Fact Sheet,Canadian Nursing Association, 2002. HYPERLINK "http://www.cna-nurses.ca/CNA/documents/pdf/publications/FS11_Role_Nurse_Practitioner_March_2002_e.pdf" http://www.cna-nurses.ca/CNA/documents/pdf/publications/FS11_Role_Nurse_Practitioner_March_2002_e.pdf. Site accessed on 30th October, 2006

Pamela Sue Hinds, 2004.Bedside Nursing Research.A New Category of Clinical Nursing Research. HYPERLINK "http://www.virginiahenderson.com" www.virginiahenderson.com. Site accessed on 30th October 2006

Mary Foley, 2004.The Role of the Nurse as Part of the Health Care Team. HYPERLINK "http://www.pfizercareerguides.com/default.asp?t=chapter&b=nursing&c=nurseOverview" http://www.pfizercareerguides.com/default.asp?t=chapter&b=nursing&c=nurseOverview Site accessed on 30th October, 2006

Nursing's Agenda for the Future, 2002. American Nursing Association, HYPERLINK "http://www.nursingworld.org/naf" www.nursingworld.org/naf. Site accessed on 30th October, 2006

Susan F. Pierce, 2004. Why is Nursing Important. NC Med Journal, 2004. Volume 65, Number 2. HYPERLINK "http://www.ncmedicaljournal.com/mar-apr-04/ar030402.pdf" http://www.ncmedicaljournal.com/mar-apr-04/ar030402.pdf. Site accessed on 30th October, 2006

Katheleen Puntillo, 2001. Symptom Management at End of Life: The Importance of Nursing. American Nursing Association. 2001

Suzanne Gordon and Sioban Nelson. Moving beyond the virtue script in nursing: Creating a knowledge-based identity for nurses.
Sioban Nelson and Suzanne Gordon. The complexities of care. Nursing Reconsidered. ILR Press
Petricia Benner. The role of articulation in clinical nursing.
Joan Liaschenko (1999). Theorizing the Knowledge That Nurses Use In the Conduct of Their Work. Scholarly inquiry for nursing practicer: An International Journal, Vol. 13, No. 1, 1999
Margarrte Sandelowski. 'Making the best of things'. Technology in American Nursing, 1870-1940. Nursing History Review (1997).
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Posted by: Andrea Louise

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