The Quality Caring Model of Nursing - Term Paper Example

The Quality Caring Model Of Nursing As healthcare drives towards greater levels of technical sophistication, attention must be paid to the mechanisms of healthcare administration in the interest of superior patient service. Otherwise, there is a danger that the healthcare system itself can become as much of an enemy as any particular organic disease. As technology improves, the core fundamentals of compassionate care must be incorporated into standard operating procedures not only to ensure the best chance of a positive outcome for patients, but also to remove the risk of the system itself impeding care and recovery. It is not difficult to imagine that an uncaring hospital staff and bureaucracy lead to an enhanced potential for medical errors and other dysfunctions. When the perception exists that the staff is simply doing the job, that they have become hardened to the suffering around them, and that each patient that enters their doors is simply a number and a disease, the consequences to patients’ morale could be as damaging as delivering the wrong dosage of morphine. Here, the prospect exists of elevated stress levels, pain or discomfort that may go ignored, and general disappointment and/or dissatisfaction. It is a noteworthy issue in the sense that not only could patients’ medical outcomes be negatively impacted, but also, even from the most pragmatic and cynical perspective, extremely dissatisfied patients – even when they do recover – may lead to a bad reputation of the hospital, which could impact potential donations. Even if serious complications do not occur, inconsistent or inattentive medical staff and procedures can also delay healing and recovery, and this can create a financial burden for the patient and increase the risk of nosocomial infections through extended hospital stays, if surgery and healing are not expedited with efficiency. Thus, the issue of caring in nursing is not only a matter of bolstering spirits but also a matter of added medical burdens that can be avoided by the staff which is deeply passionate both about the job and the patients’ health. A strong discontinuity can exist between the noble professed values of the healthcare profession and the actual performance of healthcare professionals, whose behavior may devolve into a factory mindset, with a minimum of investment towards any particular outcome. On the one hand, some level of detachment is a necessity in the medical field. Excessive emotional investment in any particular patient could compromise judgment or debilitate the healthcare provider if that patient should in fact perish or take a turn for the worst despite the implementation of all appropriate procedural measures. There is always another patient, so doctors, nurses, and allied health professionals would be doing a disservice to other patients if the previous one consumed too much of their attention and emotion. Yet detachment is also an enemy promoting the carelessness described above, making the patient feel uncared for and unappreciated, and enhancing the statistical likelihood of a medical error. Thus, there must be a corporate culture that institutes an appropriate level of attention and compassion in the implementation and management of medicine. It is a standard to teach nurses and doctors to 'care', but with the constant demands of a large hospital, with an endless patient-after-patient time consuming process and a great deal to be accomplished independently, the reality rarely lives up to the rhetoric. Time constraints in a large setting also limit the prospect of getting to know a particular patient on an individual basis. Bereft of the potential for attachment, one is easily dehumanized. Thus, a balance must be sought between an emotional entanglement, especially in terminal patients that can emotionally damage doctors or nurses, and a laissez-faire factory farm attitude where no outcome has any emotional impact, leading to frequent mistakes and a clear perception of indifference on part of the patients, enhancing the negative consequences of medical errors even further. With respect to medical errors, the issue is a thorny one, and solutions are not always easy. Estimates indicate the occurrence of 100,000 hospital deaths due to medical errors in the United States alone, in addition to reports of life-threatening medication errors effecting nearly one-fifth (18%) of hospitalized patients (Institute of Medicine, 2001). A knee jerk reaction might be to simply fire those whose errors seem to contribute to deaths. But it might not always be easy or apparent which error from which person was most responsible. Even in cases where guilt can be established, if too many nurses are fired, then the burden on other nurses will increase. Patients will receive less attention overall. There are cases of gross negligence where termination, suspension, or reeducation are needed, but hospital administration must be cautious regarding the elimination of long-term, seasoned employees performing highly technical work. Relatively simple medical issues that could be easily corrected may to go untreated if the hospital patients’ burden is too high due to insufficient employees. THEORIST On the other hand, firing a few of the worst offenders could serve as a motivating drive for others to improve their performance. At the same time, this could create an atmosphere of fear, which could distract nurses and allied health personnel from the needs of the patients. There are a number of perspectives on this proposed middle-ground between emotional investment and utter indifference. A model of quality caring must be sought, corresponding to the writings of Parker and Smith (2010) and Joanne Duffy (2010). In many ways, a potential solution must center on nurses and the practice of nursing. Nurses are the ones with the most regular contact with the patient, the ones best able and most likely to recognize problems and identify needs. Where a patient takes a turn for the worst, nurses are likely to be the first responders. It is difficult to overstate the impact, whether negative or positive, that nurses can cause with respect to patient outcomes. It would not be difficult to find laundry lists of various medical errors and careless oversights in a variety of hospital systems, including surgical procedures conducted on the wrong organ, all the way down to very simple and easily recognizable oversights such as infrequent hand washing prior to any surgery (Kowalczyk, 2007). It isn't difficult to find examples that would allow a characterization of a crisis in healthcare. This could be true in almost any country with a complex healthcare system. Even if not a definitive cause, the decrease in direct patient care and attention is a likely culprit for medical errors and general decline in patient care due to inattention. But there are always practical limits to the amount of time a nurse can spend with any one patient as well as the number of qualified nurses any institution can hope to maintain. And, of course, there are always practical limits to the number of qualified nurses available in any event for any hospital. Thus, a balance is needed to prepare procedures and standards that minimize these dangers in a systematic way. It may not be possible for overworked nurses to truly care about every patient in their wing of the hospital, but the procedures that health personnel are trained to follow must be developed with the utmost compassion in mind. Within Nursing Theories and Nursing Practice, there is a model devised by Joanne Duffy (2010), an excellent theorist concerning techniques to move the medical profession forward. Duffy employs the quality caring model. This model intends to accentuate the true value and effectiveness of the nursing profession. One method by which this is accomplished is the use of evidence-based practices and improvement protocols, which are blended together with timeless principles of compassionate nursing. The quality caring model provides a framework for the management of relationships, specifically the patient-nurse relationships, integral to an improvement in the healthcare system. The objective is to quantify all forms of decision-making, medical interventions, and personal interactions by which nurses can be measured and which are at the nurses’ discretion. Collaboration is fostered not only between nurses and patients but also between doctors and other allied health professionals. With nurses as the bridge between other medical professionals and patients, a new standard of relationship based on professionalism can be achieved for the improvement of the nursing profession as a whole. In essence, it all begins with managing and overseeing the patient-nurse relationship. By systematizing relationship interactions, even if the nurse is incapable of the true emotional investment in a wide range of patients in a busy hospital, these protocols are intended to improve the patients’ perception of caring. Bedside manner should become easier, communication and the flow of information between nurse and patient is projected to be more efficient and collaborative. The approach is challenging, in a busy hospital it is rarely considered proper or efficient use of time to simply sit down and chat with patients concerning personal matters. But change is possible through the implementation of relationship centered protocols by the administration. Duffy recommends appointing a consultant or an expert to advise on the implementation of relationship based quality care protocols (Duffy, 2010). Improvement will require willingness on the part of nurses to go above and beyond and take the initiative in strengthening relationships with the patient. But before this can happen, a change in practice on part of the administration is essential to permit the deeper level of intimacy that will enable the relationship-centered quality care procedures. SCENARIO Jill Gomes is a 32-year-old biracial schoolteacher suffering from abdominal pain, cramps, and diarrhea. Her situation is made all the more pressing by the fact of her pregnancy with twins. The night nurse who was on duty when Mrs. Gomes was admitted had accidentally misplaced test results of another patient into Jill's file. Glancing at the list of symptoms and noticing in the blood work of the wrong patient an elevated eosinophil count, the night nurse assumed that the diarrhea and abdominal cramps were a result of trichinosis infection. Records to that effect were entered into the computer. Meanwhile, Jill's widowed mother, Elian, had repeatedly stopped by several times over the past several hours to inquire about Jill's health and that of the unborn children. I learned from a simple chat in answer to her questions that the family is all seventh-day Adventists. Thus, it was extremely improbable for Jill to be infected by a parasite common in poorly cooked pork or beef, given the dietary restrictions of Seventh-day Adventists, some of whom are vegetarians. When I questioned the results, additional tests were conducted and the symptoms were explained by a simple case of food poisoning, based in part on an elevated neutrophil count in Jill's blood work. The simple friendly act of engaging family members on the way to other duties prevented a medical error and probably saved the life of Jill and her unborn children. While it is not always possible to become engaged to the extent necessary to find contributing factors to the disease in the patient's background, possible interactions with patients and family members could be worked into other duties. If the overall administration of the hospital is unwilling or unable to implement a new quality caring protocol, the individual nurse herself may still attempt limited engagements in the course of normal duties, both to create an atmosphere of caring and, as the above example shows, to identify information that may have clinical relevance. For maximum effectiveness, Duffy advises modifications of the demand presently placed upon nurses and allied health professionals. If more time can be devoted to the interaction with patients, then the caring relationships that have the potential of averting medical errors can be fostered. Despite the severe limitations both in the number of available nurses and in the hospital's hiring budget, there is much to recommend in the field of the duties of nurses. A busy hospital will undoubtedly create considerable pressure, but when corners are cut to meet that pressure, the quality of care diminishes. Some administrators may find it prudent to budget funding or obtain specialized liability insurance against error or malpractice lawsuits. The administration might then consider scaling back these contingency resources in order to hire additional personnel who can remove the work burden from other nurses. Where new nurses cannot be hired, the administration should investigate the possibility of modifying the typical work schedule away from the traditional 12 hour shift. If schedules can be reevaluated to allow less consistent stress on the individual, this could also cut down on errors. Among doctors, there is a sense that grueling hours are necessary as a sort of trial by fire for those serious about the medical profession, and perhaps as a way of proving commitment to the field. But fatigue and mistakes are encouraged through the implementation of exhaustive schedules, and the benefits become highly questionable if available human resources permit more downtime and leniency while maintaining minimal staff levels. The perception that long hours are necessary for comprehensive, 24 hour care is balanced by the risk of error and exhaustion. Close attention should be paid to minimum staffing requirements to allow professionals more time to rest and recover; this, of course, has the potential to provide more opportunities for patient interaction if stress and exhaustion of the staff are minimized. Furthermore, patient details can easily seem to blur together during the course of exhaustive 12 hour shifts. Until scheduling requirements can be altered within the hospital, the individual nurse could attempt to engage in the interaction with the patient in the course of her normal duties, such as phlebotomy or, perhaps, bandaging injuries. Simple gestures of personal interaction can easily prevent medical errors and create an atmosphere of appreciation for the patient. But because such measures can be relatively simple, it is easy for their importance to be overlooked. With respect to the administrative side, for the implementation of any program of sweeping change, a slow and gradual transition is generally preferable. A quality care model can be implemented, in part by an individual nurse seeking to work in more interaction, but the methodology could yield tangible gains if utilized hospital-wide. In this instance, gradual change accumulating slowly will allow the healthiest adjustment. It may prove safest to start small, in a single department, and then phase in interaction strategies later for areas with the highest stress-levels. Flexibility is essential in implementation. An informal process of interaction would be difficult to enforce using traditional means. Possible inclusion strategies would be listings for daily patient-interaction checklists. Supporting this method and various strategies for the implementation of caring/compassionate strategies of interaction has the potential not only to improve patient care but also to make the practice of medicine more rewarding for nurses. REFERENCES Duffy, J.R. (2010). Joanne Duffy’s Quality Caring Model. In: M. E. Parker & M. C. Smith (Eds.), Nursing Theories and Nursing Practice (3rd ed.) (pp. 402-416). Philadelphia: F. A. Davis Company. Institute of Medicine (IOM). (2001). Crossing the quality chasm: A new health system for the 21st century. Committee on Quality of Health Care in America. Washington, DC: National Academy Press. Kowalczyk, L. (2007) March 17. Surprise check faults MGH quality of care. The Boston Globe. Parker, M.E. & Smith, M.C. (2010). Nursing Theories and Nursing Practice. Philadelphia: F. A. Davis Company. Read More