NRS430 Contemporary Nursing Discussion
NRS430 Contemporary Nursing Discussion
Nursing practice has changed over the decades from when nurses had minimal education to having complex nursing training programs and when nurses provided basic care to performing complex medical and nursing procedures. Nursing was initially a woman’s work where women cared for the sick at home in the era where there were no hospitals (Egenes, 2017). Modern nursing is attributed to Florence Nightingale, who developed nursing practices that created new standards for nursing practice. In this regard, this paper will discuss the evolution of nursing practice, the differences between ADN and BSN nurses, and the significance of evidence-based practice in nursing.
Nurses were formerly not provided formal nursing education but were instead given on-job training on how to provide basic care such as clean and dress wounds. They did not have autonomy and received instructions from physicians. As the nursing practice evolved and more hospitals were established, women began receiving nursing training in small to medium-size hospital systems (Egenes, 2017). However, the training was observation-based, taking two to three years, and the scientific rationale for interventions was not emphasized.
Advances in medicine and technology created a need for complex and specialized nursing education. As a result, nursing training shifted from hospital observation to the classroom. Certification programs have been created, changing the scope of nursing practice (Egenes, 2017). Nurses also have Master’s and Doctorate levels, which increase a nurse’s scope of practice to include duties similar to physicians such as taking history and physical exams, making diagnoses, interpreting diagnostic results, and initiating treatment plans. Furthermore, standards of nursing practice have been created to ensure quality nursing care, and nurses are educated on ethical practice and providing culturally sensitive care.
Nurses with an Associate Degree in Nursing (ADN) and with a Baccalaureate Degree (BSN) are both registered nurses (RNs). Both BSN and ADN programs prepare nursing students to deliver patient care that meets the set standards. Besides, both programs equip the future RN with nursing skills and ensure they attain the clinical practice competencies necessary for nursing practice (Northrup-Snyder et al., 2017). However, the BSN program emphasizes more on areas of informatics and research. It also has courses not offered in the ADN program, such as nursing theories, social sciences, public health, leadership, and management. The differences in the ADN and BSN training result in differences in the scope of practice. ADN RNs are generally more focused on technical, clinical duties and everyday direct patient care, including monitoring patients, administering treatment, performing basic nursing procedures, and updating charts (Ghaffari, 2017). On the other hand, the scope of BSN nurses includes nursing educator, research, public health, administrative, leadership, management roles, and direct patient care.
Approaches to Decision-Making in a Patient Care Situation of a BSN vs.ADN
Approaches to decision‐making would differ in a BSN and ADN nurse caring for a diabetic patient with uncontrolled sugars and a worsening foot ulcer. An ADN nurse will care for the patient by providing basic care such as dressing the wound, administering insulin or hypoglycemics, and monitoring blood sugar levels. Conversely, the BSN nurse will perform these tasks but get concerned about the uncontrolled sugars and delayed wound healing. As a result, the BSN will assess the patient’s diet and exercise patterns and educate the patient on the needed changes to promote optimal glycemic levels. Besides, the nurse will apply evidence-based interventions to promote healing of the ulcer and educate the patient on foot care.
Applying Evidence‐Based Practice to Nursing Care
In the past decades, evidence-based practice (EBP) has become a key element of excellent patient care. EBP is applied in various aspects of nursing as it offers valuable insight into clinical care approaches backed by evidence to address issues in direct patient care, infection control, and patient workflow (Mackey & Bassendowski, 2017). It enables nurses to apply the latest research methods in the patient care setting, including direct patient care. It focuses on established outcomes, thus promoting enhanced patient care. The BSN program equips students with knowledge and skills on EBP, which helps to analyze patient care approaches that can improve health outcomes (Mackey & Bassendowski, 2017). Students are trained on scientific research, gathering, and analyzing evidence, which they apply to establish the best patient care interventions.
Interdisciplinary Communication and Collaboration in Nursing Practice
Nurses today are part of the interdisciplinary teams and play a major role in developing patients’ care plans. Nurses communicate with the interdisciplinary teams using CUS and SBAR protocols. CUS is an acronym for Concerned, Uncomfortable, and Safety. It is a communication tool used by nurses to express concerns to the interdisciplinary team about changes in a patient’s health status respectfully and professionally. The SBAR protocol representing situation, background, assessment, and recommendations is used by nurses when having a clinical problem that needs to be conveyed to the team (Müller et al., 2018). Communication using the SBAR protocol is usually purposive, straight, and prepared and promotes information exchange between the nurse and the team. The CUS and SBAR protocols foster quality and safe patient care since patient information is communicated through an efficient and well-organized format.
Unlike in the past, where nurses conducted similar tasks, nurses’ scope today is determined by their level of education and the specialized courses they have undertaken. Both BSN and ADN nurses have the same licensing level; however, some of their roles are different. ADNs focus on technical, clinical duties, while BSNs focuses on research, management, leadership, and informatics. Nurses need to communicate accurately, succinctly, and purposeful with the interdisciplinary teams to promote collaborative care.
Egenes, K. J. (2017). History of nursing. Issues and trends in nursing: Essential knowledge for today and tomorrow, 1-26.
Ghaffari, M. (2017). Preparing Nurses for Community Health Care: A Comparative Study of the ADN and BSN Programs. International Journal, 5(2), 32-45. https://doi.org/10.18488/journal.9.2018.52.32.45
Mackey, A., & Bassendowski, S. (2017). The history of evidence-based practice in nursing education and practice. Journal of Professional Nursing, 33(1), 51-55. https://doi.org/10.1016/j.profnurs.2016.05.009
Northrup-Snyder, K., Menkens, R. M., & Dean, M. (2017). Student competency perceptions from associate degree to bachelor degree completion. Journal of Nursing Education, 56(10), 581-590. https://doi.org/10.3928/01484834-20170918-02
Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W. E., & Stock, S. (2018). Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review. BMJ open, 8(8), e022202. https://doi.org/10.1136/bmjopen-2018-022202
Topic 3 DQ 2
Sep 5-9, 2022
Discuss the difference between a nursing conceptual model and a nursing theory. Select a nursing theory used in health care and provide a concise summary of it. Provide an example of how this nursing theory would be effective in managing client care.
A nursing conceptual model is a set of abstract concepts with no specifics. A conceptual model provides a particular and distinct frame of reference through which people, their environment, and their health are perceived. Its main function is to provide a framework for reflection, observation, and interpretation of phenomena and, specifically, it provides guidelines and guidance for aspects of clinical practice. Nursing theories are organized, knowledge-based concepts that essentially define the scope of nursing practice. These theories enable nurses explain what they do for the patients and why. Nursing theories allows nurses to influence their patient in a positive way beyond the bedside. Florence Nightingale’s Environmental theory teaches personal hygiene, lighting, diet and good ventilation which improves patient’s health and promotes healing.
Fawcett J., Cariello F. P., David D. A., et al. Conceptual models of nursing: application to critical care nursing practice. Dimensions of Critical Care Nursing. 1987
What is Nursing theory: Regis College October 28, 2021: https://online.regiscollege.edu/blog/what-is-nursing-theory
Sep 9, 2022, 8:32 AM
- A theory is defined as “a belief, policy, or procedure proposed or followed as the basis of action. It refers to a logical group of general propositions used as principles of explanation” (Wayne,G. 2021). With that stated, a nursing theory would be described as a belief based on nursing, what we do as nurses, and why nurses do what they do. A conceptual model just shows many theories, ideas and thoughts that have been brought up through time. It will show us how these theories could be introduced into our practices. These theories through time are experimented and are what influences our way of practicing. “In 1952, Hildegard Peplau introduced her Theory of Interpersonal Relations that emphasizes the nurse-client relationship as the foundation of nursing practice” (Wayne, G. 2021). Everyone is different, we are not all expected to react the same way to treatment or even how we treat one another. It is up to nurses to be able to put everything aside and the initial patient-nurse interaction to get to know one another and for us to build onto that relationship for our patients health. It not only builds a relationship but it also gives the patient a sense of trust .
Wayne, G. (2021). Nursing theories and theorists: An ultimate guide for nurses. Nurseslabs. https://nurseslabs.com/nursing-theories/
As you rightly stated, the theory of interpersonal relations by Hildegard Peplau plays a great role in the way nurses provide care to patients and the way patients receive the care provided. As nurses, the relationship we create with our patients, the way we communicate with them either through our body language or verbally and the tone of our voice makes a whole difference in how they will perceive the quality of care that is been provided to them. This why we find ourselves in situations where a patient will refuse treatment from some nurses or will ask for another nurse because they don’t like the way nurse X or Y talked to them but will gladly accept treatment from another nurse. I believe a nurse’s initial contact with a patient or client is where the nurse should clearly explain the expectations from the patient and set boundaries for their nurse-patient relationship. And when this is done, conflict will be hopefully minimized with this nurse-patient interaction.
- Yusuf Kiggundu
replied toShelby Young
Sep 9, 2022, 6:48 PM
I definitely agree that the nurse-patient relationship is the foundation of nursing practice. The way we communicate and interact with our patients is significant. A patient may not remember that you were the most efficient nurse, or that you were the most technically sound nurse, but they will remember how you made them feel. “The factors that seem to set patient care encounters apart and make them memorable are the personal connections and the provision of comforting behaviors. Recently, I reviewed letters written by patients that highlighted the care provided by the perioperative nursing team. One of the patients remarked on a perioperative nurse who went out of her way to create a calming environment in a stressful situation by staying at the patient’s side.” (Saletnik, p.1)
Saletnik, L. (2019). Patients remember the little things. AORN Journal, 109(2), 153–154. https://doi.org/10.1002/aorn.12600