Roles and Responsibilities of The Qualified Nurse

Roles and Responsibilities of The Qualified Nurse VANITHA RAMAN INTRODUCTION A qualified nurse is central to the provision of safe, high quality nursing care and the backbone of the healthcare system. Qualified nurses are individually accountable for their own practice and have a personal responsibility to maintain their competency and meet professional standards in order to maintain their licence to practise. The role of the registered nurse has evolved with changes in advancing technology, newly defined client needs and changes in the way healthcare is delivered. In this way, it is not unreasonable to expect that the role of the registered nurse will continue to evolve and change. Qualified nurses are expected to develop their analytical problem solving and decision making skills throughout their nursing career (NMC, 2010) Benner (1984) proposed that nursing knowledge develops through research and integration into clinical practise and experience. Importantly, experience is not a time based activity but can only develop in the context of education and knowledge acquisition. Characteristics acquired throughout the registered nurse professional career contribute towards a sustainable profession through role modelling, clinical leadership, mentoring and coaching, supervision, teaching and research. The health reform environment will create opportunities for nurses to work in new models of healthcare delivery that provide quality health services to individuals, families and communities and enable nurses to practise to their full professional potential (North Hughes 2012) Clinical Governance The term clinical governance became prominent following the publication of New Labors first White Paper on health, The New NHS: Modern, Dependable (1997) and subsequently Quality in the New NHS (1998). According to Scally and Donaldson (1998) clinical governance is a ‘system through which organizations are responsible for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish. Clinical governance will not replace professional self-regulation and individual clinical judgement, concepts that lie at the heart of health care in this country, but it will add an extra dimension that will provide the public with guarantees about standards of clinical care (Sam Gilbraith 1998) In another word, it can be summarized that clinical governance is a way to increase managerial control of health professions (Flynn, 2004). Clinical Governance is composed of the following elements, Education, Clinical Audit, Clinical Effectiveness, Risk Management, Research and development and Openness. These elements are underpinned by the recognition of Communication, Teamwork and Leadership (Chambers et al. 2007). Flynn (2002) suggests that the proliferation of mixed metaphors (umbrella, model, framework, culture and mindset) indicate that there is an inherent ambiguity about the precise nature of clinical governance. While Travaglia et al. (2011) map the development of clinical governance as a mobilising concept in healthcare, we contribute to the literature by deconstructing prior definitions to clarify what is meant by the umbrella term â€Å"clinical governance†. The elements of clinical governance is composed of the following elements : Education. Clinical audit. Clinical effectiveness. Risk management. Research and development. Openness. Good clinical leadership is required to engage the entire practice team in a commitment to excellence. Education A good teacher not only imparts key pearls of wisdom, but also acts as an exemplary role model and has non-cognitive qualities such as the ability to inspire students in the learning process (Sutkin et al., 2008) and reflect on his/her teaching practice. Accountability Accountability is known as the key element for professional practice which is closely linked with delegation (NMC, 2010). A qualified nurse failure to comply with the issues of accountability such as accountable to the patient, her professional body, criminal law, employer through a contract of employment, and society generally through the NMC. The code: Standard of Conduct, Performance and Ethics for Nurses and Midwives (NMC, 2008a) As a nurse-leader, qualified nurses are professionally accountable to all the issues/problems that occur in their ward ( ICN, 2010). They further explained that as autonomous practitioners, nurses are accountable for their own action/practice. Simply, accountability can be referred as accepting ownership for all aspect of their practice and must be able to justify their decisions (NMC, 2008c). Mooney (2007) highlighted how ward managers’ expectations of newly qualified nurses were unrealistic, suggesting that pressures of the ward environment, being able to adapt and integrate quickly, and the added responsibility of accountability were particularly overwhelming. Maben and McLeod Clark (1998) also noted inconsistencies in preparation for management, suggesting that while the theoretical context was adequate, the practical aspects, such as drug administration, prioritising, decision making and clinical skills were variable. Caulfield (2005) states that maintains the patient’s trust in the individual nurse is important for professional accountability. Similarly, Ormrod and Barlow (2011) described explicitly that every nurse is responsibility to explain or answerability to offer justification of practice. The NMC (2010) code of conduct helped me how the laws and policies are set up to ensure safe and effective delivery of care given to service users under a patient group direction. Problem 1 Staff nurse A B were on night duty together with an assistant nurse. All three were working in the ICU. Suddenly one of the ICU patients went into a cardiac arrest. Staff nurse A announced a code blue .Four staffs from other units responded to the code blue. Staff A B started the resuscitation process. While this happened all four respondents stood idle as they were unaware of what to do. Solution for problem 1 Teamwork Teams and teamwork help to promote deep learning that occurs through interaction, problem solving, dialogue, cooperation and collaboration (Johnson Johnson,1995). Teamwork is defined by Scarnati (2001, p. 5) â€Å"as a cooperative process that allows ordinary people to achieve extraordinary results. Training must given to all qualified nurses and ensure that they understand the concept of teamwork so that they can build a strong team. In nursing, teamwork is essential for effective management and achieving positive results (Toofany, 2007). She further elaborated that NMC stressed all nurses must act to reduce errors and provide quality patient care by being part of healthcare team. A strong foundation which consists of creative leadership, clear goals and objectives (Clevenger, 2007) and trust (Blyth, 2006) determines success of a team. Team members must be flexible enough to adapt to cooperative working environments where goals are achieved through collaboration and social interdependence rather than individualised, competitive goals (Luca Tarricone,2001). Cipriano (2010) maintains that delegation is an underdeveloped skill among nurses which is difficult to assess as it relies on personality, communication style and mutual respect between the registered nurse and the healthcare assistant. Munn, Tufanaru, and Aromataris (2013), propose that there is a lack of clarity about the role of healthcare assistants complicates delegation processes. In order to build a good communication staff can be sent for team building courses so that can enhance their team work skills. According to Arnold B(1990), Team building is an effort in which a team studies its own process of working together and acts to create a climate that encourages and values the contributions of team members. Delegation can help others to develop or enhance their skills, promotes teamwork and improves productivity Sollivan.E.J et al (2009). When delegating, the delegator remain responsible for that care if he/she do not delegate appropriately as stated by NMC (2008) Heap (1996) affirms that the crux of the team building approach is love and spirituality which results in mutual respect, compassion, and humanity to work. West (1994) emphasised that organisations need to provide teams with adequate financial resou rces, administrative and technical support and professional education. Leadership Hershey and Blanchard (1977) life cycle theory explains that the leadership behaviour translates to the characteristic of the follower. Table below shows Hershey and Blanchard’s leadership behaviours and resultant leadership style: Task Relationship Leadership style High Low Telling Defines the task . Gives time frame for completion. One way communication High High Selling- balances concern for goal accomplishment with values. Leader in control but seeks input Low High Participating- getting the group to work together to accomplish the task Low Low Delegating Leader takes a low profile. Available for consultation Morse and Reimer (1956) suggest that different style of leadership is needed in different situation thus the concept of situational leadership. Vroom (1960) seem to agree with Hershey and Blanchard by suggesting that the leaders should modify their leadership style to suit the people they lead. In this situation, given that the four staff nurse that responded would have basic knowledge on performing CPR, the ICU nurse should have delegated the task. This given both task and relationship would have ranked low on the Hershey and Blanchard chart above. Delegating would have allowed the ICU nurse to assume the role of team leader to make major decision. Sarcevic, A., et al. Leadership structures in emergency care settings: a study of two trauma centers. [Erratum appears in Int J Med Inform. 2011 Aug; 80(8): e48]. International Journal of Medical Informatics. 80(4): p. 227-38. When leaders delegate responsibility appropriately, team members become more confident and autonomous in their work (Capko 1996). Kane (1975) suggested that leadership be allocated to the team member with the most expertise, rather than being linked to professional groups. Tan (2006:p.3) stated leadership as â€Å"influencing followers to do what is necessary to achieve organizational goal or vision†. So, to be a successful leader, leadership and management skills are combined to achieve a common goal (Tan, 2006). Capella, J, et al states that roles of the extra members need to be clearly defined to ensure optimum patient safety. Capella, J., et al. Teamwork training improves the clinical care of trauma patients. Journal of Surgical Education. 67(6): 439-43.PMid:21156305 http://dx.doi.org/10.1016/j.jsurg.2010.06.006 (Blegen, 1993, Irvine Evans, 1995) share that changing the staffing mix can impact the quality of supervisory relation and influence staff outcome. This if had been implemented would have allowed better relationship to be forged between the ICU staff and the wad staff , which would have resulted in the situation been better managed. Teaching and Learning Some studies have shown training does help define roles during resuscitation. Dagnone, J.D., et al. Interprofessional resuscitation rounds:a teamwork approach to ACLS education. Medical Teacher. 2008; 30: 49-54. PMid:18464132 http://dx.doi.org/10.1080/01421590701769548. This would have helped when the ward staff responded to the code. Such training not only improves knowledge but also help define the roles and responsibility in the advent of such situation. Bradley, P., S. Cooper, and F. Duncan, A mixed-methods study of interprofessionsl learning of resuscitation skills. Medical Education. 2009; 43: 912-922. PMid:19709016 http://dx.doi.org/10.1111/j.1365-2923.2009.03432.x One notable theory to consider is, David Kolb’s Experiential Learning Model (ELM).According to Kolb (1984, p.41) Learning is the process whereby knowledge is created through the transformation of experience. Kolb seek to argue that learning can exist without a teacher and merely through personal and environmental experience. Sabet (2005) recommended centralised, decentralised and mixed staffing system. As such having the staffs rotated at critical areas will allow them to get used to the practices and locations of item when handling an emergency situation. Solution. Leadership Mock code simulation training helps to improve registered nurses and first responder It should include reflections on incidents and situations and what you have learned from them. A good model of reflective practice that can be used is that of Gibbs (1988). Find out what happens if a member of staff is not performing as they should or is giving cause for concern A good model of reflective practice that can be used is that of Gibbs (1988). This teaching strategy enhances learning, skills and knowledge retention, and subsequently improved advanced cardiac life support outcomes (Scherer, Bruce, Graves Erdley, 2003). Wannan and York (2005) report that students’ knowledge could be acquired either by watching a video or through role play. Supervision on the staff during the code and give feedback for their improvement Doing statistic on improvement of resuscitations References Gordon, J. (2002) Team building. Journal of American Academy of Business, 2(1), 185-189. Tuckman, B. (1965). Developmental sequence in small groups. Psychological Bulletin, 63(6), 384 399. VanZile, J. (2002). Team building. In Corporate and incentive travel. Retrieved February 16, 2004, from http://www.corporate-inc-travel.com/CIT/Archives/stories2002/stories-jan2002.htm#five Bateman, A. (1990), Team building: Developing a productive team, In Nebraska Cooperative Extension CC352. Retrieved February 16, 2004, from http://ianrpubs.unl.edu/misc/cc352.htm

Book Report & Stephen R. Essay

Stephen R. Covey is a well-known writer of many self-help books. He is one of the leading writers in this genre of writing. His book, ‘The Seven Habits of Highly Effective People,’ was published over twenty years ago. Its fifteenth anniversary edition was released in the year 2004 to mark its amazing success. Apart from being a writer, Stephen R. Covey is also a humanist, an academician and a renowned speaker. His clarity of thought and his ability to convey the same to his readers is seen in this book too. This ability if his has also made him a highly influential guru in the field of business management. He has a flair for writing in a style that helps the readers not only understand the intensity and gravity of his ideologies and thought processes, but also helps them apply the same principles and logic to their own lives, sooner or later. This goal of truly helping people attain what they want and need is perfectly achieved in Stephen R. Covey’s books. Stephen R. Covey’s book, ‘The Seven Habits of Highly Effective People’ begins with a quote by David Starr Jordan’ There is no real excellence in all this world which can be separated from right living. ’ One of the main reasons the world has loved this book all these years is that Stephen R. Covey has written about the key elements like integrity, honesty and self-management in a very simple, clear and precise manner. A few key points that will remain memorable forever include the fifth habit of highly effective people where he writes the need for people to first develop the ability to understand others before wanting to be understood. According to Covey (1989), â€Å"You don’t have much confidence in someone who doesn’t diagnose before he or she prescribes. But how often do we diagnose before we prescribe in communication? † (p. 120). Stephen R. Covey touches a different chord with the readers because in this book he also gives a lot of examples from his own life, be it the problems with his son that he was concerned about and the methodology he sought to adopt to help his son out as a devoted father or the fact that his marriage has reached a dead end. Not because his wife and he had fights or difference of opinion. But, due to the reason that they couldn’t love each other anymore and they felt they would never be able t rekindle that same kind of love and affection they felt for each other earlier. When an author of his stature chooses to tell the readers stories of his life to use it effectively as point of reference to better their own, it translates itself into a genuine self-help book. Before introducing the readers to the seven habits, he prepares them mentally by helping them understand that the bottom line is we need to understand our own â€Å"paradigms† and how to make a â€Å"A Paradigm Shift TM. † According to Covey (1998),† A thousand-mile journey begins with the first step. † (p. 18). Stephen R. Covey has seamlessly integrated all the seven habits as highly essential and necessary elements. Not a single word seems repetitive or out of place as Stephen C. Covey has given this book a very practical and pragmatic outlook. The book is a beautiful amalgamation of the basic instincts and reaction patterns humans have to every situation in their life and what needs to be done in order to receive the most suitable results either at home or at the workplace. A few principles that I have been able to introduce successfully into my life are Stephen R. Covey’s very first habit of being proactive, the third habit that clearly lists how to prioritize objectives in a given time frame and the sixth habit that refers to synergy. My ability to be more proactive has helped me at my work place and has also allowed better and more optimal utilization of my hours at work. I’ve understood the best way to prioritize my meeting at works and my tasks at home, so I never feel stressed out and at the same time I get a lot more time with my family, friends, my loved ones and myself. Stephen R. Covey’s concept of synergy aids the process of developing and establishing better human rapport and interaction. When you think about a particular situation from another person’s or party’s point of view, you in turn, gain a lot insight to turn it into a win-win situation. Stephen R. Covey’s fourth habit is tough as he asks us to think like a winner to ultimately be a winner. He clearly explains the six paradigms of human interaction and stresses on the importance of integrity, honesty, maturity and special term coined by him called ‘Abundance Mentality. ’ According to Stephen R. Covey (1989)† It is the paradigm that there is plenty out there and enough to spare for everybody. It results in sharing of prestige, of recognition, of profits, of decision making. It opens possibilities, options, alternatives, and creativity. † (p. 110). References Covey, R. (1989). The 7 Habits of Highly Effective People. New York, NY: Simon & Schuster

Cold War: Cuba and Latin America Essay

Cold War: Cuba and Latin America There were several motivations for United States policy in Latin America during the 1950’s and the 1960’s. Some of these motivations included the applying of the policy of containment in Latin American to stop the spread of communism. Another motivation was to stop the growing alliance between Cuba and the Soviet Union. All of these motivations were set in place to avoid the development of a second Cuba in Latin America. It was urgent for the United States to act since now there was Soviet Union presence in Latin America offering to be an ally. The United States had numerous justifications for the polices that it followed during it’s presence in Latin America. One of them being President John F. Kennedy’s Alliance for Progress. The United States offered Latin America countries that were developing economically aid; this was a method of applying the policy of containment. The United States need to stop communism motivated them to pass the Alliance for Progr ess. The United States justified the policy by arguing that they needed to have a policy in Latin America that went beyond the Roosevelt Corollary. After 1959, the United State was still devoted to ridding Fidel Castro’s presence from Cuba. The United States policy makers saw the alliance between Cuba and Soviet Union as dangerous thing, particularly after the critical Cuban Missile Crisis. In the Dominican Republic, the Johnson Administration justified the assassination of Rafael Trujillo since his dictatorship had become a liability to the United States. Trujillo was at one point a United States ally because he was willing to protect its interests but he was cruel to his own people and the United States feared he would spark a revolution in the Dominican Republic, much like the one that had brought Fidel Castro to power. There were many things that the United States ignored as it followed the polices that they had enacted. One, being the lack of evidence that there was a relationship between Castro and the Soviet Union before 1959. Another being that the Alliance for Progress was modeled on the Marshall Plan for Western Europe but Latin America was not Western Europe (92). There was also the contradiction between the Alliance for Progress, that it was nice than the method that it followed in Latin America during the 1960’s.

Summary Of Jonathan Swifts A Modest Proposal - 918 Words

18th century Ireland was most certainly one of the worst places in the world to be poor at the time. Persecution was all around and men, women, and children were suffering from famine due to the poor condition the land was following the war in the mid 1600s (Turner). Most of the poor lived as tenant farmers who struggled to get by while under the thumb of their unforgiving landowners. Many had to sell most of their crops to pay rent and survived simply off of the potatoes they grew on their own small plots. The sad part is that many people just viewed this as the way of life and did very little to fix anything. The Protestants enacted many laws against the Catholics that put massive restrictions on them. Many bishops were banished and the†¦show more content†¦He also explains how the system would work. The children would be bought from the breeders at the age of one year old. They would then be cared for by the government, and eventually be converted into food for the people . Teenagers, he says, are too lean if they are males, and the women would also be a loss to society for they would almost be to the age where they would become breeders themselves. Another point Swift brings up is ending the feud between the Protestants and the Catholics. He brings this up towards the end of his essay where he is speaking of things that he does not want to hear from people to counter his idea of eating the children. However, this is one of Swift’s real points that he truly means in his essay. In 18th century Ireland the persecution was ravaging the country. Many laws were enacted against the Catholic population that not only were demeaning to them, but also gave them no way to fight back. They were physically disarmed and they also had no say in the government. This caused many people to end up in poverty because of how they were segregated from the rest of the people. Swift compares them to the Jewish people that started slaughtering each other when their city was take. This like the Irish because they are assaulting each other even though they are of the sameShow MoreRelatedJonathan Swifts A Modest Proposal949 Words   |  4 Pages â€Å"A Modest Proposal† by Jonathan Swift takes place in Dublin Ireland in the 18th century. The narrator is a very ironic character. His â€Å"modest† proposal is anything but modest. This short story takes place during a famine. Since there was a famine, Swift proposes the idea that people sell their one year old children to the rich so they would not be a burden to their family. One important way in which the author engages the audience’s attention and tries to help his readers see deeper politicalRead MoreOutline: a Modest Proposal Essay1044 Words   |  5 PagesOutline: A Modest Proposal I. Introduction A. Audience Participation 1. How many of you see poverty and hunger as a problem in the world? 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