The Nature of Nursing - Essay Example

The Nature of Nursing Total Number of Words: 3,000 Table of Contents I. Introduction ……………………………………………………….. 3 II. Basic Aspect of Nursing Knowledge ……………………………… 4 a. Organization of Care: Personal Hygiene and Infection Control ………………….………………………. 4 III. Skill Mix …………………………………………………………… 8 a. Nursing Skills in Respiratory Ward ………………………. 8 b. General Knowledge ………………………………………... 8 c. Attitude …………………………………………………….. 10 d. Importance of Combining the Skills, Knowledge, and Attitude ……………………………………………….. 11 IV. King’s Goal Attainment Theory (Nursing Model) ………………… 11 V. The Contribution of Nursing Theorists on Personal Hygiene and Infection Control ………………………………………………….. 12 VI. Conclusion …………………………………………………………. 13 Appendix I - King’s Goal Attainment Theory ……………………………. 14 References ………………………………………………………………….. 16 - 19 Introduction Respiratory diseases is one of the major challenge in the health care service. For many years, asthma and tuberculosis has been the leading causes of disability and premature death within the United Kingdom. (Royal Brompton and Harefield, 2007) According to the British Thoracic Society (BTS), roughly more than 70,000 British individuals die from respiratory diseases such as emphysema, bronchitis, and asthma annually. Despite the high incidence of death among the patients suffering from respitarory diseases, it is unfortunately that the British government and the National Health Services (NHS) focuses more on cancer and heart diseases only. (Derbyshire and Fleming, 2005) Patients with respiratory diseases such as occupational and environmental lung diseases, fibrosing lung diseases, chronic lung infections, cystic fibrosis, and acute respiratory failure among others often experience difficulty in breathing and sleeping disorders. Within the respiratory wards, nurses plays a critical role in providing a good delivery of health care services to patients and minimizing the spread of contagious diseases through proper hand washing technique. Concerning the handling of respiratory care for patients, each nurse should be knowledgeable not only with the basic health care provision for patients with respiratory diseases or illnesses but also the ethical principles and legality of the nursing practice in order to avoid facing legal charges from these patients. This study will discuss about the basic aspect of nursing knowledge particularly in the organization of care in personal hygiene and infection control within the respiratory ward. The necessary skill mix of nurses working in the respiratory ward particularly the importance behind a combined skills, knowledge, and attitude (SKAs) in the nursing profession will be noted. Upon analyzing the importance of personal hygiene and infection control, the author will incorporate the King’s Goal Attainment Theory model in explaining why it is necessary to provide the patients with proper personal hygiene particularly the need for hand washing and implement infection control measures within the respiratory ward. The study will also mention some of the contribution of several nursing theorists such as Martha Rogers (1950s); Virginia Henderson (1966); Rosemarie Parse (1992); Nightingale (1969); Roper et al. (1980s); and Orem (1980) in personal hygiene and infection control within the respiratory ward. Basic Aspect of Nursing Knowledge Organization of Care: Personal Hygiene and Infection Control Personal hygiene refers to the physical act of cleaning the body to ensure that hair, skin, oral, and nails are in good condition and free from infection. (DOH, 2001) The maintenance of an acceptable level of cleanliness is part of promoting comfort, safety, and the well being of the patient. (Young, 1991) It is in fact the most basic human right that all nurses should give to the patients. One of the key aspects of personal hygiene is hand washing. Hand washing, among the nurses and patients, is very important in the respiratory ward because it is one of the most effective infection control measures we have in the service of health care. (Nicolle, 2007; Goldmann, 2006) Both nurses and client should wash their hands before eating, before and after using the toilet, and after having a physical contact with any body substances especially the sputum, blood, urine, and/or drainage that comes from cleaning an open wound, when changing the bed linens of the patients’ bed, and when assisting the patient with urinary and bed pan. (Nicolle, 2007; Chan-Yeung and Yu, 2003) The practice of personal hygiene, which is being overlook by a lot of health care providers, is proven effective in the prevention of dangerous type of blood infection that kills thousands of patients each year. (Seward, 2006; Goldmann, 2006) Specifically infections caused by the use of central-line catheters, injection through a vein in the neck, chest or groin can be prevented with constant hand washing and wearing of protective clothing, gloves, masks, etc. (Seward, 2006) Nurses wearing protective devices such as sterile gown, gloves and masks is not only for the protection of the health care professionals but also to protect the patients from getting infected due to virus or micro organisms that comes from other patients. The main purpose of hand washing is to reduce the number of microorganisms on the hand of the nurse. Since it is the job of a nurse to constantly get in touch with his/her clients, hand washing is necessary to minimize the possibility of transmitting these micro organisms to our clients as well as to our own self. Cross-contamination of these bacteria and viruses, etc. would only cause more harm to the patients. The concept of keeping our fingernails short and clean is another important part of hand hygiene. Long fingernails are proven to collect micro organisms from the environmental surroundings including the contact with infected patients. In fact, the World Health Organization (WHO) (AORN, 1997), the Centre for Disease Control and Prevention (CDC) (CDC, 2002; p. 46), and other related or similar organization has already implemented a policy that every nurse and other health care providers should keep their fingernails short and clean all the time. The spread of infectious bacteria methicillin-resistant Staphylococcus aureus (MRSA) – an antibiotic resistant bacteria (Goldmann, 2006) and other air-borne viruses such as within the respiratory ward is inevitable especially when the hospital has the ratio of one nurse for every 250 beds. Respiratory diseases such as acute respiratory syndrome, a form of atypical pneumonia (Chan-Yeung and Yu, 2003), could easily spread and endanger the health and wellness of human beings. This is one example wherein nurses should prevent the spreading of infectious disease within the respiratory ward via implementation of infection control. Infection control within the respiratory ward is one of the major concerns among the hospital management staffs. Since hand hygiene or hand washing is the most effective prevention method in the spread of infectious diseases within the respiratory ward, it is vital for each nurse to follow the appropriate and proper hand hygiene technique with the use water and soap. (Barker, 1997) Complying with the hand washing guidelines before and after delivering care to a patient could lessen the spread of pathogens and other microorganisms within the ward. There are evidenced-based research studies that hand washing can really minimize the risks of mortality causing diseases like diarrhoea (Stephen, 2004) and the transfer of upper respiratory infectious diseases such as colds and flu (Leslee et al., 2000). Prevention of the spread of these controllable diseases is important way of ensuring the health safety of the patients. Considering that the immune system of these patients is below the normal level, it is easier for them to get infected easily. Another research study also recommends the use of an alcohol-based hand gel dispenser within the ward area as a way to increase the hand washing compliance within the hospital setting. (Earl et al., 2001) According to Donald Goldmann (2006), there are a lot of cases in the hospital whereby the safety of the patients are being violated by the health care workers. By simply not complying with the basic hand washing guidelines, there is a high possibility that nurses could pass on preventable fatal infections such as MRSA to the patients’ body. Failure of each nurse to comply with the hand washing requirements is considered as unethical. Regardless of whether there is an inadequate hand washing facilities within the respiratory ward (BMJ, 1999) or because of the possible damage to the skin caused by hand cleansing agents (Heenan, 1992), is not a reason not to perform hand washing. Not washing hands is similar to violating the ‘principles of beneficence’ wherein nurses were not able to perform their responsibility in protecting and maintaining the overall wellness of the patients. (Ascension Health, 2007) In the end, the personal choice of nurses not to practice proper hand hygiene would only contribute to complicating of the spread of infectious diseases within the respiratory ward. It is the responsibility of a nurse to wash his / her hands before and after giving care of any kind including the wearing of hand gloves, masks, and sterile gown when needed. In order to ensure that each nurse comply with the organisation’s hand washing guidelines, the head nurse constantly remind us the importance of hand washing in the nursing profession. Skill Mix Nursing Skills in Respiratory Ward Among the nursing skills required in respiratory ward includes a good communication skills, ability to do team work, perform cardiopulmonary resuscitation, intravenous therapy, preparing infusion, removal of CVP catheter, proper gloving, gowning, and other infection control measures, checking and monitoring of the patient’s vital statistics, assisting with bedpan or urinal, nebulizer therapy, respiratory care, chest drain removal prevention of pressure sores or bed sores, and rendering personal hygiene such as bed bath, oral care / mouth care for dependent patients, facial shave, washing hair in bed, caring for finger and toe nails, etc. Since nurses regularly deals with the patients, nurses should be highly skilled in building patient-nurse relationship in order to ease up and prevent unnecessary friction when delivering health care service to the assigned patients. (WHO, 2003; p. 35) The ability of the nurse to participate in teamwork is very important in the field of nursing. Nurses regularly collaborates with the other members of the health care team and other related sectors in order to achieve the best quality health care service for the patient. It is most likely for nurses to encounter difficulty working within the respiratory ward in case of an ineffective communication and poor professional relationship among the team members. General Knowledge Knowledge refers to nursing theories or framework which nursing students mostly acquired from school, reading, and research activities. In line with the constantly changing medicine technology and health care regulations, all nursing students and nurses by profession are required to update their basic knowledge on respiratory care, the use of technology and techniques regularly. Knowing by heart the nursing ethics and legality of the nursing practice including the proper management of an outbreak of infection within the respiratory ward are some of the most important part of nursing profession. The principles of nursing ethics such as autonomy particularly the informed consent, beneficence, and confidentiality are some of the critical nursing ethics issue that all nurses need to conform. (DOH, 2001) Failure to do so may eventually cause the nurses to some legal charges. Since nurses are also responsible in delivering health promotion to the people, nurses should be very well read about the causes and prevention of the common respiratory diseases. Smoking for instance, the nurse – as an educator should be well versed and able to gradually convince chain smokers to slowly cut down the number of cigarettes a person smokes per day. Other information such as the consequences and effects of sudden withdrawal of smoking to one’s health, the access to a free nicotine-replacement therapy, should be clearly explained to these people. (WHO, 2003) Health promotion on proper personal hygiene should also be extended to the patients to make them aware of their own personal hygiene and health safety against respiratory diseases, diarrhea, and other highly preventable diseases. Nurses should always keep in mind the importance of personal hygiene and hand hygiene in controlling infectious diseases within the respiratory ward. Nurses should constantly go through important health-related care trainings in order to update their general knowledge on care provision to patients with respiratory illnesses. Aside from attending trainings, it is advisable for nurses to go through a higher level of education in order for them to remain competent in the field of nursing profession. Attitude The most important part of nursing profession is a positive attitude with regards to having ‘on-time’ attendance. A good attitude with regards to the practice of good discipline and right conduct is the major factor that makes an outstanding nurse. Regardless of the health condition, ethnicity, gender or race, nurses should always treat all patients with equal respect. In line with delivering proper care for the patients, nurses should always practice a good personal hygiene in order to minimize the spread of infectious diseases within the respiratory ward and ensure that the patients are experiencing a good feeling about themselves. Nurses within the respiratory wards work not only with the patients and other health care team but also with the patients’ family and relatives. When necessary, respiratory nurses are also required to deal with the community and society when extending some respiratory health care advices or health promotion. Importance of Combining the Skills, Knowledge, and Attitude As a nurse in a respiratory ward, a combination of proper skills, knowledge, and good attitude (S.K.A.) is necessary to ensure that a good quality health care service will be delivered properly to the patients. In the absence of one of these three important characteristics of a nurse, the nurse loses his / her qualification as a competent nurse. King’s Goal Attainment Theory (Nursing Model) The main focus of Imogene King’s theory (1960s) is that man’s perception of objects, persons, and events continuously influence his behavior, social interaction, and health. (King, 1971) This nursing model provides us the idea that human beings are open systems that continuously interacts with the environment. (King, 1981) The three interacting systems in King’s conceptual framework include: personal systems, interpersonal systems, and social systems. The three systems serve as the basis in the development of her theory of goal attainment. The personal system refers to the patient as an individual. It includes the understanding of human perception, self, body, image, growth and development, time, and space. The interpersonal system refers to individual’s interaction, transaction, and communication with other people. Lastly, the social system is referring to the personal interaction of the individual with the community or society including the family, friends, etc. (King, 1981) Based on the first and second system: the personal and interpersonal system; the patient and nurses regularly interact with each other. The communication between the patient and the nurse allows the health care professionals to render the necessary health care services such as administration of drugs, providing personal hygiene such as oral care and bed baths in the case of fully dependent patients, etc. Considering the fact that communication between the patient and the nurse can either be verbal or nonverbal such as facial expression, posture and touch (Seiloff, 1991); it is possible for the nurse to act as a carrier of several virus from one patient to another. This is the main reason why patients are constantly at risks of getting infected by microorganisms and other disease causing pathogens that comes from his continuous external activities such as dealing with nurses and other people. In order to avoid affecting the health condition of the patient negatively, it is crucial for nurses to practice proper hand hygiene in order to control the spread of infection within the respiratory ward. (See Annex I - King’s Goal Attainment Theory on page ) The Contribution of Nursing Theorists on Personal Hygiene and Infection Control Holistic health care is about providing a comprehensive care based on a total patient care. This includes physical, emotional, social, economic, and spiritual needs of the patient. (Anderson, Anderson, and Glanxe, 1994) Josephine Paterson and Loretta Zderad (1976) developed a lot of concept related to Humanistic Nursing theory. (Paterson and Zderad, 1976) According to Paterson and Zderad, nursing is a constant interaction between the patient and the nurse including the primacy between the nurse-patient relationship or human connection, call and response, authentic presence, and pathic touch. According to Henderson (1966), ‘a nurse does for others what they would do for themselves if patients had the strength, the will, and the knowledge.’ It means that the job of the nurse is to constantly provide the patients the needed services to keep them comfortable despite their physical condition. Based on the physical needs of patients, ensuring that the patient is clean and free from harmful microorganisms is one of essence of nursing care. (Kitson, 1999) Personal hygiene is part of the holistic health care that nurses should provide the patients. The idea of ‘patient-centered care’ or holistic care is derived from the theory of Martha E. Rogers –1950s (Biley, 2005); Virginia Henderson – 1966 (Henderson, 1966); Rosemarie Parse – 1992 (Parse, 2007) and Nightingale – 1969 (Nightingale, 1969) among others. Due to the constant physical needs of the patients, Roper et al. (1980) adapted the nursing theory of Henderson’s original concept of nursing to reflect the activities of daily living. (Roper et al., 1981) Another good nursing theorist is provided by Orem (1980) regarding the universal self-care requisites of the nails, hair, and skin’s condition. (Orem, 1980) Conclusion Respiratory ward is highly at risk of infectious diseases. In line with implementing an infection control system within the respiratory ward, nurses and other health care providers should first make it a habit to frequently wash their hands with warm water and soap before and after having a physical contact with a patient. Implementing the personal and hand hygiene especially hand washing and keeping the fingernails short is necessary in order to prevent the spread of contagious microorganisms from one patient to another. It is the practice of proper hand washing techniques that effectively minimizes the transmission of these highly contagious bacteria, viruses and other ill causing pathogens within the vicinity of the respiratory ward. Nurses should always practice a combination of updated skills, knowledge, and right attitude in order to deliver the best care to the patients. The combination of these three nursing characteristics is what makes a competent nurse successful. Nurses can fully understand the need for constant interaction between the nurses and the patients by looking at King’s Goal Attainment Theory. This theory has clearly shown us the picture regarding the necessity for constant verbal and non-verbal communication between the patients and the nurses. Nursing theorists such as Paterson and Zderad (1976) also emphasized the importance of constant interaction between the patients and nurses. On the other hand, nursing theorists such as Rogers –1950s; Henderson – 1966; Parse – 1992 and Nightingale – 1969 among others has shown us the importance of holistic care within the clinical setting. *** End *** Appendix I - King’s Goal Attainment Theory References: 1 Anderson, K.N., Anderson, L.E., and Glanxe, W.D. (1994) ‘Mosby’s Medical, Nursing, and Allied Health Dictionary’ 4th Ed. Mosby-Year Book, Inc. in Sipes, H.K. ‘Holistic Health Care in Nursing’ 2 AORN (1997) ‘Fingernails Must Be Kept Short, Clean, and Healthy; Artificial Nails should not be Worn’ Association of Operating Room Nurses (AORN) Standards, Recommended Practices, and Guidelines. Denver, CO: AORN, Inc. 1997. pp. 197 – 202 3 Ascension Health (2007) ‘Health Care Ethics’ Retrieved: July 5, 2007 < http://www.ascensionhealth.org/ > 4 Barker, K.F. (1997) ‘Infection Control in Hospitals – Sink or Swim?’ BMJ 1997;315:1315 – 1316. Retrieved: July 4, 2007 < http://www.bmj.com/ > 5 BMJ (1999) ‘Hand washing Liaison Group: Hand Washing’ BMJ 1999;318:686. (March 13) in Kesavan, S. ‘Hand Washing Facilities are Inadequate’ BMJ 1999;319:518 (August 21). 6 Biley, F.C. (2005) ’Unitary Health Care: Martha Rogers’ Science of Unitary Human Beings’ Retrieved: July 4, 2007 < http://medweb.uwcm.ac.uk/ > 7 CDC (2002) ‘Nails should always be kept short and filed; Do not wear artificial nails or extenders when providing patient care’ CDC Guidelines 2002 Draft Revision of the Guideline for Hand Hygiene in Health Care Settings, Centres for Disease Control 1992. p. 46 8 Chan-Yeung, M. and Yu, W.C. (2003) ‘Outbreak of Severe Acute Respiratory Syndrome in Hong Kong Special Administrative Region: Case Report’ BMJ 2003;326:850 – 852. (April 19) Retrieved: July 4, 2007 < http://www.bmj.com/ > 9 Derbyshire, D. and Fleming, N. (2005) ‘NHS ‘neglects’ Lung Disease, Britain’s Third Biggest Killer’ March 1, 2005 Retrieved: July 3, 2004 < http://www.telegraph.co.uk/ > path: news 10 DOH (2001) ‘Reference Guide to Consent for Examination or Treatment’ March 2001. pp. 1 – 30. Retrieved: July 4, 2007 < http://www.dh.gov.uk/ > 11 Earl, M.L. et.al. (2001) ‘Improved Rates of Compliance with Hand Antisepsis Guidelines: A Three-Phase Observational Study’ American Journal of Nursing, 101(3). pp. 26 – 33 12 Goldmann, D. (2006) ‘System Failure vs. Personal Accountability – The Case for Clean Hands’ The New England Journal of Medicine. 2006;Vol. 355; No.2:121 – 123. Retrieved: July 5, 2007 < http://content.nejm.org/ > 13 Heenan, A. (1992) ‘Hand Washing Practices’ Nursing Times 1992;88:69 – 70. in Kesavan, S. ‘Hand Washing Facilities are Inadequate’ BMJ 1999;319:518 (August 21). 14 Henderson, V. (1966) ‘The Nature of Nursing’ Collier Macmillan, London. p.15. 15 King, I.M. (1981) ‘A Theory for Nursing: Systems, Concepts, Process’ New York: John Wiley & Sons. p. 19 16 King, I.M. (1971) ‘Toward a Theory for Nursing: General Concepts of Human Behavior’ New York: John Wiley & Sons. in Williams, L.A. (2001) ‘Imogene King’s Interacting Systems Theory: Application in Emergency and Rural Nursing’ Online Journal of Rural Nursing and Health Care. 2001;2(1) [Online] Retrieved: July 4, 2007 < http://www.rno.org/ > 17 Kitson, A. (1999) ‘The Essence of Nursing’ Nursing Standard. 1999;13(23):42 – 46. 18 Leslee, R. et.al. (2000) ‘Effect of Infection Control Measures on the Frequency of Upper Respiratory Infection in Child Care: A Randomized, Controlled Trial’ Paediatrics. April 2000. Vol. 105 No.4, pp. 738 – 742 Retrieved: July 5, 2007 < http://pediatrics.aappublications.org/ > 19 Nicolle, L. (2007) ‘Hygiene: What and Why?’ CMAJ. March 13, 2007;176(6). Retrieved: July 5, 2007 < http://www.cmaj.ca/ > 20 Nightingale, F. (1969) ‘Notes on Nursing’ Dover Publications, NY. 21 Orem, D. (1980) ‘Nursing Concepts of Practice’ 2nd Ed. McGraw Hill, NY. 22 Parse, R. (2007) ‘Rosemarie R. Parse’ Retrieved: July 4, 2007 < http://www.nurses.info/ > 23 Paterson, J. and Zderad, L. (1976) ‘Humanistic Nursing Theory: Notes on Nursing Theories’ Retrieved: July 5, 2007 < http://www.nurses.info/ > 24 Roper, N. et al. (1981) ‘Learning to Use the Process of Nursing’ Churchill Livingstone, Edinburgh. 25 Royal Brompton and Harefield (2007) ‘Respiratory Medicine’ NHS Retrieved: July 3, 2007 < http://www2.rbht.nhs.uk/ > 26 Seiloff, C.L. (1991) ‘Imogene King: A Conceptual Framework for Nursing’ Newbury Park, Ca: Sage. in Williams, L.A. (2001) ‘Imogene King’s Interacting Systems Theory: Application in Emergency and Rural Nursing’ Online Journal of Rural Nursing and Health Care. 2001;2(1) [Online] Retrieved: July 4, 2007 < http://www.rno.org/ > 27 Seward, Z. (2006) ‘Hygiene Is Shown to Cut Hospital Blood Infections’ The Wall Street Journal Online. December 27, 2006 Retrieved: July 5, 2007 < http://www.texasmed.com/ > 28 Stephen, L. et.al. (2004) ‘Effect of Intensive Hand Washing Promotion on Childhood Diarrhoea in High-Risk Communities in Pakistan – A Randomized Controlled Trial’ Vol. 291 No. 21. Dated: June 2, 2004 Retrieved: July 5, 2007 < http://jama.ama-assn.org/ > 29 WHO (2003) ‘Adherence to Long-Term Therapies: Evidence for Action’ Retrieved: July 5, 2007 < http://www.who.int/ > 30 Young, L. (1991) ‘The Clean Fight’ Nursing Standard;5(35):54 – 55. Read More