Chapter 7
My general observation is that the society considers nurses as people who enhance the healthcare experience, while the real credit of serving healthcare, are taken by the physicians and the administrative staffs. Probably, a person admitted as an inpatient or admitted to the ICU would have realized the true value of nurses, but in general, the services of the nurse are often unappreciated and unrecognized. Though nurses engage in important healthcare activities, they are treated as subordinates and not as leaders of healthcare. Nurses rarely participate in decision making and in making a health plan. Lack of clear guidelines and regulations, can create confusion and restrict nurses from clinical practice.
The main reason for this scenario is the lack of confidence and communication skills on the part of the nurses. The healthcare operations are very intense and nurses are expected to be at their best all the time. Rule and regulation have become rigid, that mistakes and errors are less tolerated. Nurses entering practice should have the knowledge and skill to do so. Nursing programs and licensing does not guarantee that the nurses are ready to practice. As knowledge and technology evolve, so is the healthcare procedure. Nurses are expected to know what is best for the patient and recommend procedures that are safe and efficient. To do this, nurses must have a personal interest in updating their knowledge and skills. Though nursing education is about introducing changes to match with the practicing requirement of the 21st century, the nursing students for some reason have difficulty aligning with these high demands. Too many goals and less focused approach of nursing education could be the reason for this scenario. It is also necessary to offer orientation and training for nurses, based on the field they choose to practice. Though higher studies can help improve skills and knowledge, a number of restriction can prevent talented and capable nurses from opting for higher education.
Value based (and respectively – value guided) practice in nursing may be characterized as performance of nursing duties based on core and universal values. The main groups of such values include the following:
Relationships. Proper friendly and professional relationships are the basics of successful and effective nursing experience. Such relationships are not merely represented internally, between specialists, but also externally – between a nurse and a patient, between a nurse and visitors as well as between a nurse and the entire community.
Rights. Professionals in nursing have a set of rights defined by the legislation, professional standards and codes of conduct. A nurse has to know and exercise his or her own personal and professional rights and have a full tolerance and respect towards the rights of others, both colleagues and patients.
Respect. Apart from formal respect which is an absolute must for every nurse, a specialist in this field has to be free from bias and misunderstanding of others. Listening to what others have to say, taking others into consideration and contributing to the people’s well-being – these are the cornerstones of respect in nursing.
Recovery. The job of a nurse is to enhance recovery of his or her patients and promote hope in them.
Reaching out. A nurse has to apply all the resources that are at his or her disposal in order to carry out own tasks with the highest effectiveness.
Responsibility. Apart from the legal and organizational responsibility that every nurse is entitled to, he or she has to demonstrated conscious responsibility for the success of the mission of the entire team and healthcare institution.
The difference between problem-solving and theory-guided practice in nursing is best demonstrated by the general difference between theoretical and practical problem-solving. There is a saying the past experience (and respectively – the theory that is derived from it) is a lantern that only lights the road behind, but not ahead. While theory-guided elements of nursing practice are essential and deeply related to the daily routine, problem-solving practice provide far greater flexibility, as there are no two absolutely identical cases in nursing, and a professional always has a room for innovations. While the problem-solving practice is mainly based on particular cases, the theory-guided practice derives from a qualitative analysis of such cases and respective theoretic research in the past.
EBP stands for evidence-based practice in nursing, meaning the professional practice based on a method of critical analysis of the presented evidence in order to develop the most suitable healing plan for the patient. The evidence may be allocated in thematic groups, with several basic approaches attributed to each group. While it would be an exaggeration to claim that such approach grants an automatic solution to a particular nursing challenge, it is nevertheless true that it assists with narrowing down the problem and understanding the possible range of solutions to it.
Evidence-based care, although relevant to the concept of EBP, stands for a slightly different area of activities. The area of care is different from EBP in terms of cause and effect, as well in the flexibility of application. While diagnosis has more or less universal features, the process of subsequent care is much more individualized, and needs to be applied in combination with abundant data regarding a particular patient.
This basically explains the difference between EBP and EBC. While the theoretical basis- evidence – is the same for both concepts, they nevertheless differ considerably.
