Introduction
Nursing as a profession is unfortunately among those careers whose roles and functions in society have been significantly misconceived; the nursing uniform is often seen to symbolize caring. Majority of people are only familiar with the caring aspect of nursing, however, they cannot be faulted since this image of nursing was created by the pioneers of nursing like Florence Nightingale who embodied the caring attribute in their definitions of nursing. Further, it continues to be reinforced by current nursing icons like Jean Watson who, through various theories conceptualize caring as the central tenet or the core theme of nursing. Others presume that nurses are there to carry out the doctor’s directives. Nursing is a unique profession that encompasses practitioner, leadership and research roles regardless of whether a nurse is a registered nurse, clinical specialist or specialist nurse. Nursing is guided in its practice by the nursing process framework through which it diagnoses and manages human responses to illness and to health and helps patients re-construct their life stories.
Body
Basically, a nurse can practice as a registered nurse whose core function revolve around providing care, education and follow-up management for their patients, clients and their significant others. Alternatively, a registered nurse may opt to specialize in one or a combination of two areas like critical care nursing whereby the nurse provides care to very sick patients who require frequent and close monitoring as well as complex medication therapies or pediatric oncology nursing whereby the nurse only attends to children suffering from cancers. Nurses may also opt to practice at a more advanced level either as a clinical nurse specialist who is more or less a consultant in one of the nursing specialty areas or a nurse practitioner who provides a blend of primary and specialist nursing care. Typically, a nurse can work within hospital and hospice settings, educational institutions as a nurse educator and in a community (United states Department of Labor).
Nursing care is not practiced within a vacuum but is guided by a framework termed the nursing process (Lashaunda). This implies that nurses do not wake up in the morning and decide their patients need this type of care. The nursing process is defined as a deliberate problem solving approach that aims at meeting the health care and nursing needs of a person. It comprises of five steps; assessment, formulation of a nursing diagnosis, planning, implementation and evaluation (Smeltzer and Bare 34). Therefore, a nurse does not simply sit and decide that patient Y needs oxygen, rather the nurse systematically evaluates patient Y using the 5 steps of the nursing process.
A more amazing function of a nurse practitioner is to help with the reconstruction of the narratives and life stories of their patients. Goldie (4) posits that every individual life is structured in form of a narrative, that is life consists of a structured sequence of actions, emotions, thoughts, and events which are interconnected and unfold according to the person’s point of view. In other words each and every individual has created a mental picture of how their life story is going to unfold. Life stories significantly influence a person’s sense of self as well as their identity. Illness and disease alters the coherence and orderliness of the patient’s life story such that they are left feeling confused, frustrated and with a diminished sense of self and identity (Crossly 10). Whilst acute illnesses disrupt the patient’s life story on a temporary basis, chronic and terminal illnesses cause significant physical impairments that subvert the patient’s life story in its entirety. Therefore, the nurse is the health care provider who is constant contact with the patient for a longer period and hence is in a better position to interpret both the verbal and non-verbal cues in regard to how the patient is communicating or trying to re-build his/her life story. As such, the nurse plays the central role in helping the patient reconstruct the stories of their lives shattered as a result of illness.
Arguably, the roles of the nurse professional are constantly being redefined and have shifted from the ‘bed-side nurse role’ perception that existed in late 18th and early 19 centuries. Currently the nurse professional has three major roles that is practitioner, leadership and researcher roles regardless of the working context. As a practitioner, the nurse assumes responsibility and initiates measures aimed at meeting the nursing and other health care needs of patients, their families as well as their significant others(Smeltzer and Bare 14). For example, nurses have to care of the elimination needs of patients who may not be able to go to the toilet by providing them with a bedpan or a commode to use at the bedside. Moreover, they have to give medications to patients as per the doctor’s prescriptions.
The research role of the nurse on the other hand supports the practitioner and leadership roles by determining through research which nursing interventions as well as leadership practices are most effective. In effect therefore, research provides a rationale for nursing activities such that even actions performed by nurses though perceived by many as being inconsequential have been proven effective through research (Smeltzer and Bare 15). For instance, a simple nursing measure for managing hiccups is to hold one’s breath or alternatively to breath into a paper bag, whilst these measures may be construed by many as mere myths, they have been validated in innumerable research studies as being effective. Hiccups occur due to a sudden contraction of the diaphragm which is triggered by a carbon dioxide imbalance within the blood stream. Holding one’s breath or breathing in-and-out of a paper bag increases the partial pressure or amount of carbon dioxide in the bold stream correcting the imbalance and hence stopping the hiccups. Research therefore adds to the scientific base of nursing knowledge and hence fosters evidence-based nursing practice (Smeltzer and Bare 15).
Of further note is that contrary to the traditional view that leadership in nursing is a specialized role for nurses with titles suggestive of leadership or persons’ in-charge of a group or groups of nurses, present day conception of nursing leadership perceive leadership as an inherent role of all nursing positions. This concept of leadership in nursing is best captured in the simple definition of nursing leadership as being the process via which nurses utilize interpersonal skills to alter the behaviors of others. In this respect even nurses practicing at the clinical level have a role in imparting desirable change in the behaviors of their patients (Smeltzer and Bare 15).
An interesting fact about nursing that departs from the myopic view that nurses like doctors are only involved in the management of the disease processes wrecking havoc in patients was best articulated by the American Nurses Association in their 1995 definition of nursing as being the “diagnosis and treatment of human responses to health and illness” (as cited in Smeltzer and Bare 5). The management of these human responses shifts the focus of nursing away from the disease process to aspects like self care processes, patient’s decision making abilities and affiliate relationships, perceptual orientations like self-image, the emotions patients experience in relation to health and illness, physiologic processes like sleep and sexuality amongst others (Lashaunda; Smeltzer and Bare 5).
In conclusion, therefore, the roles of the nurse have expanded from the traditional concept of providing care to encompass broader practitioner, leadership and research roles as well as functions in diagnosing and management of human responses to diseases and health as well as helping patients reconstruct their personal life stories subverted by illnesses. All the aforementioned roles and responsibilities are guided by the nursing process framework.
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