Application of Concepts to Current Job
1. Health History
The information from health history is beneficial to both individuals and health care providers as the process of obtaining the data help in the establishment of trust and rapport between lay persons and medical professionals. The information also helps assist with development of diagnosis and in making treatment decisions as well as determining an individual's baseline values. The clinical interview is the most common method for obtaining a health history. With effective communication, the clinical interview can be a valuable means for obtaining information.
Obtaining a health history as part of admission process is very important to neonatal health. Maternal conditions such as hypertension, presence of sexual transmitted infection, pyrexia, use of medication during pregnancy, problems during pregnancy such as vomiting can affect the infants’ wellbeing during labor or at birth.
A maternal history of fever for example places the infants at risk for sepsis and many of the multiple organ dysfunction which ensue. Knowing this information preferable before the infant is born enable clinicians and nurses to plan appropriate care modalities that will assist infant in successful transition to extra uterine life. The information obtained in maternal health record, as well as admission history will also assist nurses and clinician in future cares of the infant because through experience and knowledge certain health issues in the neonatal period take a precise course.
2. Health Promotion
The concept is very useful in nursing as it shows that an individual health is determine by personal characteristic and personal history. Since health is determined also by lifestyle choices the importance of obtaining a thorough health history cannot be overemphasized. This part of nursing assessment will form the basis for developing and planning health promotional activities geared towards improving patient health status. Health promotion can be used for all individual and at any point on the health illness continuum. Health promotion is a fundamental role within the nursing profession, however a review of the literature highlights a gap in nursing knowledge about how and when to promote health and wellness.
Health promotion can take many forms. For example if a patient presented to the hospital post-myocardial infarction, nurses encourage the patient to exercise more frequently and eat more fruits and vegetables, reduce intake of food high in fats and cholesterol and information on programs to help them quit smoking is given.
In my experiences in nursing, promoting health comes without any deliberate efforts to neonatal nurses because it is a natural and automatic component of this special care unit. In the Neonatal Intensive Care Unit when an infant is admitted to the unit there are a number skills and knowledge they must master before an infant is discharge to the family. We call this the discharge checklist. One of the ways we promote health is that where relevant items on the list have to be checked and sign for by nurses indicating that a certain item was taught, return demonstration was given and that the family id competent at a certain skill. Another way we promote health of the child is that we ensure that the caregiver is ready and willing to care for the baby at home. We teach subjects sucking as management of a chocking infant, cardiopulmonary resuscitation (CPR) of the infants, sterilization of infants’ equipment, expression and storage of breast milk. We also make sure that an appointment for review is made within 48 –72 after the infant is discharge.
Health promotional activities can take various other forms. For example, one of the problems unique to the Saint Lucian culture it that it is customary the mothers would provide the daughters who have just delivered infants with some herbal mixture believed to cleanse their system of all illness and component of pregnancy. Older women believe that the body is unclean after birth and must be cleaned to prevent the just deliver mothers from becoming ill. In order to cleanse the body herbal remedies prepared and sold in local stores are taken by these new parents. However one of the detrimental effects of ingestion of certain substances is that these mothers continue to breast feed. Although some infants are able to withstand the transfer from breastmilk others are severely affected and exhibit multisystem organ failure. In order to prevent this devastating effects we educate mothers on the natural cleansing mechanism of the body and the multisystem effects ingredients in the remedies can have on the health of the infant. We ensure that each mother we come in contact with is abreast to that information.
The most common perceived barrier to promoting health in nursing practice is time, as well as education and training. Neonatal nurses know that health promotion works based on the number of admission with preventable illness we received. We believed as by evidence, that health promotion is an effective method for helping infants and families improve their health and prevent illness and complications. Nurses however have reported that patients can be barriers to health promotion activities because some patients are unwilling to accept information and frequently ignore advice given to them.
3. Self – Actualization
This concept is very useful in nursing profession. A self-actualized nurse is one who engages in the process of becoming true to herself and those with whom she goes through life’s experiences. Being self-actualized improve the nurse’s quality of care as she would place value in what she does within the nursing profession. The concepts teaches nurses to learn themselves and then know others. Values and meaning expressed by self-actualized nurses are internally generated and not externally imposed therefore more meaning is applied. They express these important values and manifest complementary behavior in both demeanor and action. Once self-actualization is experiences it becomes a continuous process of always striving to develop and achieve higher levels of excellence and gratification. Qualities such as confidence, competence emerge. The attitude of self-actualized nurses radiates to patients, families, co-workers and community. She is a locus for high quality care and patient satisfaction. By her mere presence makes a differences in the lives of everyone she encounters.
When nurses care for infants with chronic illness and continue to promote health, nurses are assisting the patients to be the best they can be with the diseases. By merely encouraging patients to continue living and take on new projects and activities can assist these patients to become self-actualized even with his present circumstances. For example, in a case where a man who suffered with paralysis after a vehicular accident, he becomes self-actualized because he leads an organization where people who has suffered from that same fate can openly converse and assist others in the transition of a new life.
4. Therapeutic relationship
A therapeutic relationship with clients is very important especially at the first encounter where information is needed from client to guide practice. In health assessment for example, because the nurse is usually the first point of contact with the health care environment a therapeutic relationship is necessary to encourage clients to provide necessary information to formulate nursing diagnoses and plan intervention.
For example a young mother who is HIV positive come to an obstetrical unit in labor and has decided to not to divulge information of her status because she has felt stigmatized in the past. However when the infants is born ill, prematurely and transferred to the Neonatal Intensive Care Unit she begun to form a trusting relationship with a particular neonatal nurse, and feels comfortable enough to provide this pertinent detail of her health status to that nurse. The neonatal staff provides her support and continue to provide the best of care to her baby and support to her. She feels so confident in the relationship that she has formed that she later shares with the staff details of her sexual relationship and the fact that the baby she has just given birth to is a result of sexual abuse by her step-father.
The importance of a therapeutic relationship with clients is paramount. Because infants are not able to communicate verbally, nurses are in constant interaction with the family members and therefore the establishment of a therapeutic relationship between the nurse and families of the infant promotes family centered care, a theme of this care environment. The kind of relationship which develops with the family of the newborn will determine the type of care infants received from their parents, how open parents are about divulging information, and how comfortable they are when visiting the unit. Because of the fragility of these set of patients, nurses are required to have special training and skills to offer support to families in their moments of weakness. NICU nurses are responsible for implementing care that vocalizes the physical mental and social development of the newborn. The nurse must be aware of certain boundaries which must not be crossed to keep this relationship with client as professional and be able to step back when the relationship is no longer therapeutic.
Highlighted in the care of newborn is the family participation on the care of newborns. Care must be individualized and focus on the development of the family and newborn. To achieve this the nurse must see the world according to the perspective of the family achieved from the development of a therapeutic relationship. However this relationship can only be developed if family is involved in the care of the baby. However as has been observed, some nurses feel that the presence of family members in the NICU hinders their performance and prefer the baby to be restricted to the incubators and tell parents that they will disturb the baby. This kind of attitude does not impact positively on the nurse client relationship.
5. Client Centered Care
The concept of client -centered care is not new to the nursing profession, however it is not readily practiced. One of the tool used by nurses which should help in the practice is the nursing process. The unique process provides a framework for nurses to follow and at each step it forces the nurses to explore the individual client. Nursing diagnoses have to be client focused and when it is not, it affects all the remaining components of the nursing process. Because patients’ needs are continually changing the nursing process call for continuous assessment and evaluation to ensure that individualized client center care is given. Person-centered care strengthens the nurse- client relationship, promotes communication relevant matters, and helps patients know more about their health, which facilitates their involvement in their own care.
6. Critical thinking
Critical thinking helps in interpreting data which is a challenge in nursing because signs and symptoms needed to form nursing diagnoses are often overlapping because of the complex, unique and holistic responses of persons. Being able to think critically, benefits the nurse and patients as it improves work productivity. Accurate nursing diagnosis can be formulated reducing diagnostic errors and ensures that the right nursing interventions are plan and implemented. The concept forces the nurses to look beyond the obvious.
For example, a neonate is born at 33 weeks gestation and brought to the nursery for clinical management. During the first hour of life the infant started presenting with signs of severe respiratory distress evidence by tachypnea, moderate respiratory retractions, nasal flaring and grunting. The nurse replies to the situation by placing the infant on oxygen via nasal prongs and attributes the clinical deterioration as the infants normal transitioning. A nurse who is able to think critically would look beyond what is presented and normal and would analyze both the infant maternal history and realize that the infants was at risk for early onset sepsis secondary to maternal pyrexia. Competent critical thinking would indicate to the nurse that the infants is already showing signs of inability to fight infection because of prematurity as manifested by RDS and that more invasive form of ventilation would have been necessary as she would anticipate a further decline in respiratory status.
Critical thinking is a skill that must be worked on. To become competent at it I must gain knowledge and competence in health assessment findings, gain more experience in the job, accept correction and learn from my mistakes. Teaching more junior staff will also boost my confidence and will forces me to be abreast with my clinical skills and knowledge.
7. Patient Advocacy
Patient advocacy includes many interventions such as explaining healthcare options, instructing patients about different procedures and treatments, and clarifying healthcare goals. By providing patient advocacy, nurses establish trust within the nurse-client relationship, distinguishes individual patient needs, and promote the patient’s active participation in healthcare decisions. Neonatal nurse are in active display of this role of nurses. Because infants are not able to communicate their needs, neonatal nurses are the voices of these set of patients and have the power to influence health care decision. The nurses’ role of advocacy in the nursery can been observe when nurse communicate to physician aspect of the care not beneficial of infants and family, decide on whether or not infants is ready for discharge, quarantine in born infants from more mature ones who have gone home and return for medical treatment, refusal to provide care that may do more harm than good to infants and family.
An example of patient advocacy can be seen in a neonatal nurse’s refusal to accept a 25 day old infants who had been discharge two days after birth who presented with whooping cough as well as pustule into the unit although there was a physician order to be admitted to the unit. Her refusal was based on the fact of unavailability of the required amount of space between individual infants in the unit although protocol suggested and that infants less than 28 days old should be care for in the unit. She protects the rest of the infants from what could have been an epidemic as the neonatal unit does not have negative pressures. She however makes arrangement with the physician for the infant to be cared for in the pediatric ward where mothers are allowed to sleep overnight. A practice not available in the Neonatal Intensive Care unit.
8. Delegating
Delegation directs care and determines the appropriate utilization of any assistant involved in providing direct patient care. Critical thinking and professional judgment are very important when following the Five Rights of Delegation, which are: 1.) the right task. 2.) Under the right circumstances. 3.) To the right person. 4.) With the right directions and communication and 5.) Under the right supervision and evaluation. The decision of whether or not to delegate or assign is based upon the nurse’s judgment concerning the condition of the patient, the members of the nursing team competences and the degree of supervision that will be required of the nurse if a task is delegated. The nurse must delegates only those tasks for which she or he believes the other health care worker has the knowledge and skills to successfully accomplish that assignment. The nurse must take into consideration the training, experience, cultural competence, as well as facility/agency policies and procedures in when delegating. The nurses’ individualizes communication regarding the delegation to the nursing assistive personnel and client situation and the communication should be clear, concise, correct and complete. The nurses must verify comprehension with the nursing assistive personnel and that the assistant accepts the delegation and the responsibility that accompanies it. Nursing assistive personnel should have the opportunity to ask questions and/or for clarification of expectations. In my experience with delegation I have observed that when it is done right charge nurses are better able to provide clinical care because they have the time to focus on other aspects of care. Delegating to family members also benefits the family as they feel like they can directly impact their loved ones health outcome.
9. Wellness
According to the National Wellness Institute, a professional can determine whether he or she practices within a wellness approach if he or she answers "yes" to the following 3 questions: "Does this help patients achieve their full potential? Does this recognize and address the whole patient? Does this affirm and mobilize positive qualities and strengths?" Wellness is a broad concepts. However nurses are in a critical position to promote the concept of optimal wellness during interactions with patients. Providing information however small can help a client in a significant way. For example, during a home visit to discuss newborn care, the nurse uses the opportunity to discuss the childhood vaccination schedule, makes recommendations for vitamin supplements and discusses the developmental milestones of both the infant and older sibling. Recognition of these subtle yet effective interactions is important in giving credit to the significance of nurses as health promoters.
In my personal experience however I have not achieved wellness in all dimension. As a professional we are so focused on the health and habits of persons in our lives and the patients we come into contact with, that we often neglect our own health. In order to improve on my social wellness which was one of the areas that posed the biggest issue for me, I have designated one day out of the month where I go out with friends and have a good time. I am also come to the realization that certain aspects of my marriage is not beneficial or healthy such as my total dependency of my husband for social and emotional needs. To address this problem I have engaged myself in activities which I once used to enjoy before I got married.
10. Pain
Nurse must be aware of the certain factors which can affect pain perception such as age, sociocultural factors. Establishing a positive nurse client relationship and teaching are essential when nurses are caring for patients treated with analgesia because its success is dependent of open communication and patient cooperation. The most success for pain management is the use of both pharmacological and non-pharmacological means. An important aspect of caring for patients with pain is reassessing the pain after interventions have been implemented. Nurse needs to consider other measures if intervention were ineffective. The presence of pain in the neonates have not been well understood by nurses and clinician in the unit. When various painful interventions are being implemented on these sets of patients it is not a usual practice to offer the infants some sort of comfort. One of the reason I think this is so because neonatal response to pain mimic response to other stimuli and therefore is frequently overlooked by many staff members. It is however a common practice with upper level staff to provide infants some comfort of pain relief during or after painful procedures by various intervention such as nonnutritive sucking, drops of dextrose 10% glucose on tongue, cuddles with mom, touching, and feeding.
Usefulness of Concept in Current World
1. Health History
The depth and length of the history-taking process is affected by factors such as the emergency of client complain or condition, the clients ability and enthusiasm to contribute information, and the kind of environment in which information is pursued. Whenever possible, a history must be complete and comprehensive. In cases where the history-gathering process needs to be curtailed, the history focuses on a person's medical experiences and only the most pertinent facts may be obtained. After the basic identifying data is collected, the health history should address in these circumstances the reason for the current visit in expanded detail. The reason is sometimes referred to as the chief complaint. When the purpose for the visit is recognized, additional data is petitioned in order to provide a more complete picture of the present clinical condition. In the case of pain for example, defining characteristics should be recorded such as pain location, duration, intensity, and factors that precipitate, aggravate, relieve the pain, as well as any symptoms associated with the pain.
Because of the subjectivity of the information obtained from the interview is subjective, it is important that the interviewer assess the accuracy of the information obtained by assessing the client’s level of understanding, education and communication skills and any potential biases. A clinician can obtain the maximum amount of information without upsetting the client in areas such as substance abuse and dependency, domestic violence, and sexual practices without disrupting the interview through the use of interviewing techniques such as open-ended questions, listening effectively. It is very important to do a review of the chart and introduce oneself to the client before the interview.
2. Health Promotion
Health promotion is more relevant today than ever in addressing public health problems. Health services is positioned at unique position as the world is facing significant challenges. Increased in the numbers of persons with diseases poses a burden on the health care system as well as society. Diseases arise form 3 areas: newly emerging and re-emerging diseases, communicable diseases, and rise of non-communicable chronic diseases pose the most effect. Factors which aid progress and development in today's world such as globalization of trade, advanced technologies, urbanization, and global travel have been recognized as having positive health outcomes on one hand and increase the vulnerability to poor health on the other hand because these factors contribute to sedentary lifestyles and unhealthy dietary patterns (Kumar and Preetha 2012).
Unhealthy dietary practices, increased in tobacco smoking and decrease in physical activity contributing to increase in biological risk factors which in turn leads to increase in non-communicable or chronic diseases. The incidence of chronic illnesses is rising worldwide and as a result there is an increased need to engage patients in health promotion activities in order to prevent further deterioration, to strengthen their health, and their capacity to participate in society. However patient education and wellness interventions in the context of chronic illness are often specific to particular diagnostic groups and are not designed to be applied across diagnostic categories.
The population for any disease can be divided into four groups: those who are healthy, those with risk factors, those with symptoms and those with disease or disorder. Interventions must be specific and targeted to each group in order to comprehensively address the need of the whole population. It encompasses prevention for healthy population to curative and rehabilitative care of the population with disease.
3. Self – Actualization
Because the concept and modes of acquiring self-actualization are very complex and even abstract, it may be difficult for a person to go on a journey of self-actualization. This process requires skills training, and scientific knowledge acquisition. The nurse for example who embark on this journey must become empowered to alleviate and overcome the dissatisfaction and frustration with current health care system and move to nursing practice that manifests strongly held believe and values. Literature indicates that self-actualized nurses have a mitigating effect on important issues such as nursing shortages, nurses’ job satisfaction, and patient and nurses safety issues (Kleinman 2005).These can impact positively on society as quality health care can be given to all clients. A decrease in nurse absenteeism or sick out can result and lead to reduced health care cost.
4. Therapeutic relationship
In order for nurse to be able to develop a therapeutic nurse client relationship she must meet certain standards according to Registered Nurses’ Association of Ontario. These standards include:
•Therapeutic communication- the nurse use a wide range of effective communication strategies and interpersonal skills to appropriately establish, maintain, reestablish and terminate the nurse-client relationship.
•Client centered care- the nurse work with the client to ensure that all professional behaviors and action meet the therapeutic needs of the client.
•Maintain boundaries- nurses are responsible for effectively establishing and maintaining the limits or boundaries in the therapeutic nurse client relationship.
•Protecting the client from abuse – nurse protect the client from harm by ensuring that abuse is prevented or stopped or reported.
To implement a successful therapeutic relationship the organization characteristics, work place values must be supportive and in place. A therapeutic relationship is beneficial to an organization because through it problems can be identified, individualize services or care can be implemented making it a cost effective approach. Clinician and nurses must be able to recognize when the relationship with clients has changes from professional and therapeutic to personal and measure must be taken to limit the effects. Because of the significant value patients place on health care providers it is easy for the relationship to gear towards nonprofessional. However healthcare providers should be the ones with the training skills, and knowledge to ensure that the relationship between them and the clients remains therapeutic as it is in the best interest of all parties involved.
5. Client Centered Care
There are growing numbers of older people and people living with long-term conditions and disabilities. However the health and social care budgets are very limited. To provide high quality care that provides people the best quality of life, we need to reconsider the relationship between people and the services that provide their care. In person-centered care, health and social care professionals work collaboratively with people who use services. Person-centered care supports people to increase their knowledge, and develop the skills and confidence required so they can effectively manage their health and also make informed decision in this regard. Client centered care must synchronized and personalized to the needs of the individual and must also ensures that people are always treated with dignity, compassion and respect. Although this may seem as everyday knowledge person centered care is not standard practice. Often, healthcare professional finds it difficult to include people in decisions, and views people’s goals only in terms of particular clinical outcomes. If the principles of client-centered care are employed, patient satisfaction with health care services will increase, increasing confidence in health care providers which would have the secondary effects of more person seeking health care services before the illness has advanced. This impact can be beneficial for the entire population.
6. Critical thinking
Critical thinking has many uses and can be applied to any setting. Critical thinking forces managers and employees to resist the temptation of categorizing problems that occur into categories of problems which have already occurred in the pass. The concept demands that employee avoid making assumptions and to look beyond conventional solutions to problems to identify new problem solving approaches. Critical thinking can lead to many viable solutions to the same problem and therefore a range of solution can be offered to clients. This allows the company to implement solutions that uses resources that are available as appose to purchasing other material. Therefore it promotes cost effective goods and services. The concepts also is beneficial in that it promotes and fosters team work. When more people are involve in the critical thinking process it encourages team work by giving employee a chance to impact on the future of the organization. When members of the organization think critically about one problem this can reveal information that can be applied to many other situation and impact positively on solving other problems in the workplace.
7. Patient Advocacy
Some healthcare professionals may view patient advocacy as simply acting on behalf of patients. While this is an important aspect of the concept and is evident throughout the literature, advocacy entails much more as nurses and other healthcare professionals care for culturally diverse patients with individual needs. All healthcare providers must understand the importance of informing the patient about available healthcare options and advocating for the patient’s decisions rather than acting only on what the healthcare professional may believe is best for the patient. Providing patient advocacy will continue to enhance healthcare encounters and outcomes and the effects will be evident in all areas of the health care system. The need for patient advocacy will continue to grow as healthcare consumers from diverse populations will require more information and control about the healthcare they receive.
President Barack Obama signed the public law 111 – 148: the Patient Protection and Affordable Care Act on March, 23, 2010, which permits quality, reasonably priced healthcare for all Americans. This an example of advocacy because the legislation will provide numerous healthcare benefits such as reasonable health insurance rates, no lifetime or annual limits, coverage of preventive health services and immediate access to insurance for those with pre-existing conditions. As a result of signing this legislation, patient populations from sundry backgrounds including uninsured African Americans, Latinos, Asian Americans and Pacific Islanders now have new healthcare opportunities. Until now, patient from these populations could not access these opportunities because of the high health insurance costs and other socio-economic concerns.
8. Delegating
Nurses have been delegating tasks to assistive personnel for some time. However, many aren’t aware of this according to experts familiar with the issue. Although nurses have been able to delegate a number of tasks to patients’ families, these relatives often find it difficult to be available to help because of time constraints and interference of schedules of care with other activities such as jobs, household chores etc. For example, family members may have to make a trip home during lunch to give a relative a bath or administer medication. Many nurses are stretched to the limit in the current healthcare environment. Increasing numbers of people needing healthcare combined with increasing complexity of therapies create a tremendous demand for nursing care. More than ever, nurses need to work effectively with assistive personnel and so the abilities to delegate, assign, and supervise care are critical competencies needed in this arena.
To assist and ensure effective delegation, the health care organization must allocate resources to ensure sufficient staffing so that the nurse can delegate appropriately. Documentation of staff competencies involve in providing direct patient care must be readily available to ensure that the nurse has access to competency information for staff to whom she is delegating patient care. Organizational policies on delegation should be developed with the active participation of all nurses (staff, managers and administrators).The organization must also ensure that the education needs of nursing assistive personnel are met through the implementation of a system that allows for nurses’ input.
9. Wellness
The concept of wellness is being introduced into Center for Disease Control (CDC) public health lexicon as CDC strives to meet its central health protection goal of ensuring that “all people…will achieve their optimal lifespan with the best possible quality of health in every stage of life”. This CDC’s stress on wellness reflects the organization belief that the mere absence of disease is not synonymous with the best possible quality of health. To help people achieve wellness across the lifespan, CDC is embracing a public health model that makes life stages the framework for its programs (Steinberg 2007 CDC).
The health model of wellness through the life stages is sometimes described as a holistic approach to public health. This life stages approach aims to help people maintain good mental and physical health throughout their lives rather than focusing on specific diseases or conditions. CDC has renewed its emphasis on external reviews of its programs to ensure a rigorous accounting of progress toward program goals based on explicit criteria for success (Steinberg 2007 CDC).
There are many factors that which will increase the need for services to promote the concept of wellness. These include a growing aging population, an increased focus on health care discrepancies affecting treatment and services, a rising rates of obesity, technology advances and imbalances in life roles.
10. Pain
The importance of addressing chronic pain as a multi- dimensional phenomenon has been stressed, along with the need to understand interrelation of factors which affects the individual perception of pain such as biological, psychological and social factors. There is evidence to suggest that the interaction between chronic pain and negative emotional factors triggers psychological effects and reciprocal behavioral in the illness process, influencing how clients express and adapt to the pain. Patients with moderate to severe chronic pain associated to sensory and affective components exhibited a higher degree of disability and depression. The results suggest that the chronic process of pain and its functional consequences vary between individuals and are influenced by emotional factors (Alcantara, Sampaio, Souza, Silva, and Kirkwood, 2013). Pain as have been found to be the number one reason why individual seek medical services. To effectively manage pain healthcare providers must understand the multidimensional effects pain has on individual, families, work and societies.