Intensive Care Competencies - Research Paper Example

 Intensive Care Competencies Competencies are the distinctive abilities of an individual to perform certain tasks in his or her area of duty and specialization. A proficient nurse should be able to combine both logic and reason so as to optimize the service delivery in case of critical care or even emergencies (Lunney, 2009). There are times when the resources are extremely minimal, and the nurse is forced to improvise to help needy patients in an intensive care unit (Joint Commission Resources, 2004). With this in mind, a skilful nurse should be able to communicate with a sense of clarity and confidence. This is because in circumstances of the intensive care, teams are used to salvage lives (Lundy & Janes, 2009). A nurse must be involved in team work. For team services to be optimized, good communication among the team of nurses should be practiced. The idea of critical reasoning involves convincing other team members to conduct some urgent procedures and to drop others. All the skills and experience of a skilful nurse should be passed through either writing or verbal communication (Lunney, 2009). Therefore, it is particularly beneficial for a nurse to have excellent communication skills to be able to persuade others to do what is right. Poor communication skills during critical care can prove to be fatal (Joint Commission Resources, 2004). However, excellent communication skills are not just about convincing the other members of the medical team but also about listening to them and embracing their ideas and proposals if they are going to be more effective in the critical care. Good communication is part and parcel of clinical reasoning (Kassirer, 2009). A qualified and effective nurse understands all the dynamics of patient advocacy (Kassirer, 2009). In the intensive care unit, a nurse becomes the patient’s advocate. If the patient is paralyzed, unconscious, asleep or in pain, the nurse becomes the advocate for his or her rights and integrity (Lundy & Janes, 2009). The patient must always be ventilated and properly positioned (Lipe, 2003). This takes a lot of courtesy and professionalism from a nurse. If the nurse is working in a hostile environment where the services are limited and resources are scarce, the integrity of service delivery may be compromised (Lipe, 2003). Therefore, the nurse has to use all the necessary means to shield the patient from embarrassment or unwanted happenings during the service delivery. Critical reasoning must always be tempered with clinical reasoning in the nursing profession (Brunt, 2008). The willingness and ability to take responsibility is one of the most prominent competencies during the intensive care (Joint Commission Resources, 2004). It is always easy for nurses to blame people and other players when things go wrong. Nurses can take advantage of their patients’ ignorance and fail to take the blame upon themselves when things go wrong (Kassirer, 2009). This leaves patients more confused. A professional nurse working in the intensive care unit should be able to take responsibility and blame upon both the team and the patient if need be (Elliott, 2006). This also involves recognizing one’s shortcomings (Lipe, 2003). During critical thinking, analysis and evaluation are used before a conclusion is reached (Joint Commission Resources, 2004). Some of the analyses and observations end up pointing at some professional omissions and laxity on the side of nurses in the intensive care unit (Brunt, 2008). This can be solved by admitting these omissions. The ability to think fast enough is also extremely necessary (Elliott, 2006). During clinical reasoning, trial and error decisions can be made in genuine faith. A competent nurse should be able to explain such decisions when called upon (Kassirer, 2009). Sometimes, some of the team members can run out of the ideas while carrying out some sensitive procedures. The ability of a nurse to observe and address the individual needs of team members is critical. Most of these procedures take place in life-saving situations (Higgs, 2008). Therefore, a RN should be able to help the team members who are stuck so that the result of the procedure will produce the expected results (Higgs, 2008). This involves creating conducive atmosphere in the team and diffusing tension among the team of nurses involved (Finkelman & Kenner, 2012). Clinical reasoning is inclusive in terms of operations and conduct. It’s about knowing what number of people should be involved in what procedure and how to handle them in the course of the procedure (Avillion, 2005). Clinical reasoning therefore, cannot happen without a proper attitude and adequate mental preparation (Finkelman & Kenner, 2012). It also must be accompanied by a passion for the job, this passion being complementary to the clinical reasoning process. In other words, the passion to excel in the job should enhance proper reasoning of a professional nurse (Higgs, 2008). This incorporates assertiveness in case of controversial incidences. There are times when some of the team members discourage a professional nurse or openly doubt or contradict a professional nurse who is conducting a critical operation in the intensive care unit (Adam, 2005). This calls for composure and superb temperament while handling such cases. Besides, a professional nurse should be assertive without necessarily being aggressive. Some of the team members, support staff or even colleagues can consider themselves older or more experienced and, therefore, discourage their colleagues during intensive care procedures. However, if handled well, this can end up improving the quality of services and not being a demerit (Adam, 2005). There are instances when a proficient critical care nurse is called upon to work in stressful conditions. This is in case of some disastrous happenings like earthquakes or fire disasters. A professional nurse should be able to work in a hostile environment with makeshift structures. There are nurses who attend people in the places of war or military conflicts. Some of them are trained soldiers. They are required to have extra vigilance while still showing excellence in their nursing skills. Therefore, an opportune nurse should easily adapt to harsh and difficult environments so that he or she can be of help to the people in any environment (Joint Commission Resources, 2004). In many times, a proficient critical care nurse will be encountered with situations of death. There are instances when a nurse does all he or she is supposed to do but still loses a patient. In such circumstances, the nurse may become discouraged (Rubenfeld & Scheffer, 2010). A proficient nurse should develop a deeper understanding of life. This is why a nurse should be a role model. This is because not many people experience some of the things that happen in the intensive care unit. However, a critical care nurse has a personal understanding of what quality health care means (Patronis & Beck, 1996). Therefore, he or she should develop an attitude of appreciating the real importance of life and use his or her experiences to be an inspiration to other (Brothers, 2007). This involves colleagues who are still in the learning process, e.g. the interns or even patients’ relatives who are in dire need of hope and direction from the nurse (Masters, 2005). When patients talk to nurses, they only imagine they are the first people to experience such kind of fate. However, when they see the nurse smiles about their situation, they realize that the nurse is in control of what they are going through (Rubenfeld & Scheffer, 2010). Besides, a nurse working in the intensive care unit meets highly religious people who use their faith to reason. This calls for the nurse to appreciate the patient’s background even if he or she does not understand the faith. There have been a few cases when nurses were required to offer critical services in the intensive care unit but have failed to do so just because they were incompetent. Incompetent nurses are increasingly becoming common in the world today (White, 2002). These are nurses who passed the examinations but have no idea how to carry out critical procedures in the intensive care unit. Some nurses are known to be alcoholics and abusers of other drugs (Swansburg, 1995). In case there is laxity in the management of human resource in the hospital, those nurses become a common scene (Patronis & Beck, 1996). For a nurse to be effective in developing and offering intensive care, he or she needs to be qualified in terms of the profession and other specializations. This can simply be called professionalism. It is about internalizing all the theoretical lessons that were offered in the training process. This also includes a thorough understanding of the nurses or doctors’ code of ethics. Professionalism is a basic competence which is extremely influential in the intensive care service delivery. Intensive care unit works closely with the high dependency unit in salvaging life. This is a stage of treatment that is extremely sensitive to the patient and the patients’ relatives. It is a point when hope is needed more than anything (Swansburg, 1995). A professional intensive care nurse should not give up easily. Nurses are also humans and can become discouraged or worn out (Sellman, 2011). However, in critical service delivery, a nurse should be careful about how he or she reasons with the guardians of the patient. Even in the face of frustrations and despair the nurse should not announce his or her intentions to give up working on the patient (Masters, 2005). Some patients in the intensive care are normally full awake and keep on hoping that the nurse is in control. Therefore, the nurse should build upon how the patients experience him or her and should hope to offer the best he or she can as long as there is still a chance to save a life (Swansburg, 1995). This also involves using the right message while addressing the progress of the patients. Some members of the medical team can also become frustrated and give up in the process of offering critical care (Scheffer, 2006). In such cases, the nurse should inspire hope and courage. This is because clinical reasoning involves moving out of the way to make sure that the indented results are achieved in the current medial case. The reality is that every medical case is unique (Scheffer, 2006). Clinical reasoning takes into consideration all this uniqueness, the factors surrounding the medical case in the intensive care unit and the level of motivation in the medical team. Clinical reasoning involves remembering and reevaluating of cases with a conscious understanding rather than emotionally. That is why clinical reasoning is the most effective when personalized (Sellman, 2011). However, positive results are achieved when personalized reasoning is shared so that the finest opinion can be voiced. Critical reasoning must precede clinical reasoning in intensive care nursing. However, the two should be mutually inclusive if the profession is to offer optimum services. In most cases, professional nurses in the intensive care unit use evidence-based decisions while dealing with the needs of the patients. It takes real compassion to offer excellent services that are based on clinical reasoning. The process of offering these services causes these competencies to be exposed. Nurses are trained to expect certain things based on the evidence of the diagnoses (White, 2002). Nurses are also trained in anticipating the path to take and the actions that are necessary in the intensive care unit. This explains why a professional can be an opportune critical thinker but fail to be beneficial as far as clinical reasoning is concerned (Scheffer, 2006). This is because dealing with the anticipated problems and offering the anticipated solutions in intensive care service delivery can vary depending on the environment and infrastructure present. Clinical reasoning calls for a good attitude from the professional nurse involved (Swansburg, 1995). While looking upon the competencies required in professional nursing in the intensive care service delivery in hospitals, the environment and infrastructure cannot be ignored. It must also be considered how poor infrastructure and remuneration affect the attitude of nurses who offer intensive care to patients. Research shows that poverty can cause people to downgrade the quality of life. It can also affect the competence and motivation of nurses. Professional competence must, therefore, be looked upon through the level of support that is granted to the nurses in the intensive care unit. For the registered and professional nurses to offer optimum professional services, they must have supportive structure that facilitates their work (Woodrow, 2006). For instance, professional nurses need to keep on assessing data while in the intensive care unit. The speed of interpreting the data is critical. This is because the data show the changes in the patients’ conditions and help in the process of problem diagnoses. Good technical and infrastructure support from the state helps reveal the level of competence in professional nursing. This is because at times the nurses are forced to work with faulty machines or outdated infrastructure, and their competence may be questioned due to this (Rubenfeld & Scheffer, 2010). For a professional intensive care nurse to identify a patient’s condition and assess what actions should be taken, all the players need to have done their parts. The result is that professional nurses can diagnose patients using state-of-the-art electronic devices, interpret the data in the right way and provide safe care to patients (Rubenfeld & Scheffer, 2010). Therefore, the competence of professional nurses must be viewed with a holistic approach. There are instances when intensive care nurses are coerced into working 24 hours a day without having a rest because of shortage of personnel. Therefore, the working conditions of a registered professional nurse should not be separated from his or her competence. This is because government support and the level of training are complementary to each other. Critical care nurses offer highly specialized care in an extraordinarily holistic way. This demands that such a nurse must be swift in maintaining his or her skills to avoid being obsolete. Diseases keep on changing with the discovery or new pathogens. The ways and methods of treating patients keep on evolving (Sellman, 2011). Better, highly sophisticated, and more efficient medical devices are being developed (Scheffer, 2006). A professional intensive care nurse must always improve his or her skills through constant learning, training, and research (Woodrow, 2006). Due to this, the nurse will be able to deal with the latest medical cases. Furthermore, a professional nurse to remain professional should have excellent research skills. Proper training boosts the confidence of the nurse. This confidence is an important competency in professional nursing. A competent nurse must be detail-oriented. This includes writing down all the things he or she does with the patients for the sake of records and further research. Such details give a sense of direction to a nurse offering the intensive care to the patients (Sellman, 2011). This includes bringing the medications and all the necessary tools in time. Some of these details are later posted on the internet for other nurses to use and conduct research. Insensitive care unit nurses must be emotionally stable at all times. This is because they are exposed to extreme conditions while offering the intensive care services. They know the joy of welcoming newborn babies and, at the same time, the agony of losing long time patients. These nurses must be able to handle their emotions on a daily basis (Rubenfeld & Scheffer, 2010). In conclusion, intensive care nursing needs development of exceptionally strong competencies. These competencies range from the ability of the nurses to work with the professional team to the ability to abide by personal ethics. Clinical reasoning demands that all these competencies be put into proper use. Most of the competencies of intensive care nursing are intertwined and interdependent. However, they are all focused on excellent service delivery aimed at saving the lives of patients. Some nursing competencies depend on external factors. Some of the external factors include the goodwill of the government and the quality of management in the hospital. References Adam, S. K. (2005). Critical care nursing: Science and practice (2nd ed.). Oxford University Press. Avillion, A. E. (2005). Competency management for the intensive care unit. Hcpro Incorporated. Brothers, J. (2007). Essentials of critical care nursing. Jaypee Brothers Publishers. Brunt, B. A. (2008). Evidence-based competency management for the intensive care unit (2nd ed.). Hcpro Incorporated. Elliott, D. (2006). 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