Contemporary Nursing Practice
Nursing practice has drastically changed from nurses having very little training, and nursing involved women taking care of the sick. When nursing began, it was not considered a profession, nor was it respected since nurses were women, and being a woman was not perceived as a respectable gender (Keeling, 2015). Nursing was more of an extension of the roles women played at home of taking care of their families, and skills were passed down from mother to daughter with no formal training. There have been radical changes in the nursing field that have significantly contributed to the efficient delivery of healthcare services. The purpose of this essay is to discuss the evolution of nursing and current nursing practices.
Evolution of Nursing Practice
Nursing training has evolved, and nurses today have in-depth training, and there are specific qualifications for one to become a nurse. There is currently a wide range of nursing training programs and specialties with nurses having trained up to the Doctor of Nursing program (Keeling, 2015). Besides, nurses are offered different practicing licenses depending on their level of education. Initially, the care setting for nurses was mostly in battlefields and homes, but the setting has now changed to consultation offices, hospitals, home-based care services, schools, and correctional facilities.
Nursing responsibilities in the past involved offering only basic care services such as dressing, cleaning patients, and nurses worked under doctors’ instructions (Masters, 2018). Nursing training programs have changed the scope of practice for nurses over time with their responsibilities now involving patient assessment, making diagnoses, prescribing treatment, performing complex procedures and offering emergency care independently (Masters, 2018). Therefore, in the contemporary dispensation, nursing is an independent profession, and education qualifications dictate the scope of practice.
To become a registered nurse, one can pursue an Associate Degree in Nursing (ADN) program or a Bachelor’s of Science in Nursing (BSN) program. Both programs include courses that train nursing students on the competencies of nursing and clinical practice to equip them with practical skills for healthcare settings (Ghaffari, 2017). However, the BSN curriculum has courses that are not offered in
the ADN program. The courses include management, leadership, critical thinking and communication, public health, social sciences, nursing theories, nursing practice, and specialized courses (Ghaffari, 2017). The ADN program focuses on training clinical skills, while BSN focuses on management, leadership, nursing research, and also clinical skills.
ADN and BSN nurses have similar tasks in the healthcare setting, such as providing direct patient care, administering treatment, and monitoring patients (Ghaffari, 2017). However, the scope of practice is a bit different, and the ADN nurse is not qualified for some roles that require one to have additional education such as nurse educator, hospital unit coordinator, and managerial position.
Approaches to Decision-Making in a Patient Care Situation of a BSN vs. ADN
An example of a patient care situation would be a patient with a history of hypertension and diabetes who present with a persistently high blood pressure despite taking antihypertensive medication. A physician then prescribes an intravenous antihypertensive, and the ADN nurse will prescribe the medication to the patient since they are trained on clinical skills and may not provide health education, which is key in managing hypertension. On the other hand, a BSN nurse will take a comprehensive patient history to identify the current medication the patient is taking, previous history of hypertensive crises, family history of chronic illnesses, and social history. The history will help in understanding why the blood pressure is not controlled by medications and the patient’s behaviors that could be worsening the condition. The BSN nurse will be able to take the role of the nurse educator and educate the patient on lifestyle modification to help lower blood pressure and prevent complications of hypertension (Ghaffari, 2017). Furthermore, the BSN nurse will advocate for the patient to be initiated on lipid-lowering medications to avoid cardiac complications since the patient is at risk of atherosclerosis due to a history of diabetes.
The Significance of Applying Evidence-Based Practice to Nursing Care
Evidence-based practice (EBP) has developed over the years to be the gold standard of care and significantly influenced the BSN program. EBP involves taking into consideration the latest healthcare research when deciding the course of treatment and nursing care (Kalb et al., 2015). The adoption of EBP in nursing care has had an impact in promoting better health outcomes in patients. EBP has helped lower complications and morbidities associated with chronic illness, and in lowering healthcare costs (Kalb et al., 2015). The BSN program has incorporated EBP in the curriculum, and it supports the adoption of EBP by focusing on increasing students’ knowledge and professional accountability (Kalb et al., 2015). Besides, the program emphasizes on the usage of scientific research to guide in deciding the best interventions for patient care. BSN students are trained in nursing research and are familiarized with research methodologies that equip students with EBP research skills.
Interdisciplinary Communication and Collaboration in Nursing Practice
Interdisciplinary teams in healthcare include physicians, nurses, pharmacists, and other health care professionals. The team works together in decision-making and problem-solving to prepare patients’ care plans (Gausvik et al., 2015). Nurses communicate with the interdisciplinary teams through several tools such as the situation, background, assessment, and recommendation (SBAR) and during Structured interdisciplinary bedside rounds (SIBR). The SBAR tool is used to briefly communicate a patient’s condition, assessment findings, the current plan of care, and recommendations (Gausvik et al., 2015). The SIBR is a validated structure that enhances interdisciplinary communication by bringing together health professionals at the patient’s bedside. The SIBR allows the health team to interact and provides the chance for members to give opinions on how to best improve patient outcomes (Gausvik et al., 2015). Interdisciplinary communication and collaboration help improve patient outcomes, reduce medication errors, lower healthcare costs, and improve interactions with members of other disciplines.
Gausvik, C., Lautar, A., Miller, L., Pallerla, H., & Schlaudecker, J. (2015). Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, and understanding of care plan and teamwork as well as job satisfaction. Journal of multidisciplinary healthcare, 8, 33.
Ghaffari, M. (2017). Preparing Nurses for Community Health Care: A Comparative Study of the ADN and BSN Programs. International Journal, 5(2), 32-45.
Kalb, K. A., O’Conner-Von, S. K., Brockway, C., Rierson, C. L., & Sendelbach, S. (2015). Evidence-based teaching practice in nursing education: Faculty perspectives and practices. Nursing education perspectives, 36(4), 212-219.
Keeling, A. W. (2015). Historical perspectives on an expanded role for nursing. OJIN: The Online Journal of Issues in Nursing, 20(2).
Masters, K. (2018). Role development in professional nursing practice. Burlington, MA: Jones & Bartlett Learning.
Topic 5 DQ 2
Discuss the importance of advocacy as it pertains to client care. What is the nurse’s role in client advocacy? Describe a situation in which you were involved with client advocacy. Explain what the advocacy accomplished for the client, and what the repercussions would have been if the client would not have had an advocate.
Being an advocate for patients is something nurses do daily. But how do we advocate for them? When do we advocate for them?
Lampert (2016) makes a good point stating “The first step in successfully advocating for your patient revolves around knowing your patient’s wants and needs” (para. 2). Lampert goes on to remind nurses of the importance of advocating for the patient and what they want not the wants of others such as family members or even the wants of the nurse (2016).
Advocating for the patient requires the nurse to be assertive in discussing the wants and needs of the patient. Being assertive is different than being aggressive according to Lampert (2016). Learning this balance is important.
What are your thoughts on these things? How do you find you can be assertive in advocating for patients?
Lampert, L. (2016). How to advocate for your patient.
Lampert brings up a great point between aggression and assertiveness. I think bedside nurse and advocating for your patients is a huge and very important part of our job because we have a responsibility to keep our patient safe from harm. I believe one can be assertive without being aggressive when advocating for their patient by collecting as much objective information about the patients as possible and presenting it to whomever in this case most likely the hospitalist in charge of the patient in a manner where you have to show legitimate concerning information and direct advocation for your patients health and well being. I believe if you present information in this manner it is assertive and shows concern without being aggressive.
Advocating for your patient helps build trust and overall helps that patients wellbeing and outcome. You’re putting that patients needs and wants above all else, and involving them in their care. We must listen to what our patient wants and think about what is best for that patient when following through with their care plan, making sure they are involved also!
We can advocate for our patients by being diligent in our documentation, paperwork, charting and directions. Make sure to carefully read all orders and double check with doctors, pharmacists, nurse practitioners to prevent errors, misinformation or oversight. When do we advocate for our patients? All the time. Anytime we see or have the hunch that things might be wrong, we have to follow up on it and make sure we are doing everything we are supposed to do to ensure patient safety.
Advocating for patients can help improve patient wellbeing and help to improve patient outcomes. It’s important that nurses advocate for their patients because it gives patients a voice in their own care and helps them to keep up with their treatment and procedures. By having a voice patients can also communicate confidently with physicians and the ones that are invested in their care. Those advocates will take the time to explain and answer questions that they may have (2022).
I’ve advocated for this particular patient because of the lack of care the patient was receiving. The patient had a Specialist a nephrologist as her primary care physician, under normal circumstances the hospitalist will act as the primary medical physician and the specialist would be consulted to suit the patient’s needs and care. The patient was seen earlier that day by the specialist in the office for follow-up but complained about having periods of confusion, Patient was sent to the ED and admitted under his care. The family complained that they felt that the patient their mom was only worsening and requested to see someone else. The nursing staff also complained of the objective data and asked for a consultation with other disciplinaries, neuro, cardiology, and pulmonary. The specialist refused and stated that this was a result of the patient’s kidney injury and wanted us, the nursing staff to agree to that. This without doubt goes against the standards of care, (2017), therefore we as nurses disagreed and were asked by the family to seek help for their mom elsewhere, I advised the primary nurse to immediately contact the patient advocate and explain the situation we were dealing with. Within an hour the patient had a primary medical doctor, and consults, for neuro, cardiology, and pulmonary. Although there was a delay in patient care, in the end, the patient was able to receive the proper care she deserves. The family even requested that he to be removed as her nephrologist. Once the other doctors came on board, we noticed a significant change in patient status.
Avoiding Liability Blog (2017) Are There Limits to a Nurse’s Duty to Advocate for Patients Retrieved September 2022 from https://www.chins.com/are-there-limits-to-a-nurses-duty-advocate-for-patients/
Haft, J. (2014) What is Advocacy Communication Retrieved September 21, 2022 from eliteplusmagazine.com