The central mandate of the nurses is to promote patient safety and ensure excellence in their nursing roles. For the nurses, patient safety is not just a part of their day to day engagements; rather it is a commitment to safe, ethical and competent care. Whether in clinical roles, research, education, management or leadership, nurses have to remain true to the code of ethics that calls for protection of the patient from harm as well as aiding to improve their quality of life and wellbeing. Nurses are regarded as the central point of care; the connection between the healthcare system and the patient population. Their day to day interaction with the patients from the initial point of presentation at the clinical setting to the day of discharge or even in end-of life care is the most critical element that has been retained and improved even within the revolutions that have occurred in the nursing sector. The care giving role of the nurse as well as the role modeling and teaching are all defined as a single bundle that helps increase the occurrence of positive outcomes (Longtin 57).
The first point of care and the first accomplishment at the clinical level is the assessment. The role of the nurse is to create an element of trust at the initial point of care. assessment takes into consideration the subjective and objective data and without this element of trust, there is a likelihood that the patient may not present or explain about their health, attitudes, perceptions ,beliefs and cultures in regard to care with a likelihood of incomplete patient assessment occurring. Such likelihood would imply that the diagnosis as well as the subsequent development of the care plan will not meet all the needs of the patient. Physical assessment, cognitive assessment, coordination and balancing assessment are all issues that are regarded as necessary at this initial point of contact. During such assessment, the nurse can make decisions as to the possible risk of the patient to falls based on their history of falls and the cognitive, coordination and balance assessments or the risk of pressure ulcers or skin disturbance/breakdown which could act as pre-disposure points for infection (Longtin 55). At this point decisions can be made for instance in regard to the importance of yellow bracelets for the patients at high risk of falls, the need to place restraints on patients where the levels of aggression, cognition and coordination are considered risky in the absence of falls and so on.
Further, the nurse can determine the alternative methods of restraints especially if the physical restraints may be viewed as posing further danger of pressure ulcers and skin disturbance for a patient. The role of the nurse in ensuring that despite the patient’s physical and psychological and emotional needs are managed well includes the need to eliminate the very restrictive options of care such as restraints and seclusion. As a nurse, advocacy of patient rights is a critical role especially in cases and instances where the workplace policies, processes and methods tend to limit the autonomy and self-determination of the patient. Nurses have over time sought and utilized new methods such as educating and informing the patients that the facility does not prefer the use of physical restraints. There has been an apparent need to initiate more responsive methods such as de-escalation and crisis management which have all helped increase positive patient outcomes especially at the emotional and psychological levels (Manojlovich, 946).
On the other hand, patients in clinical or hospital settings are in a state where the vital signs as well as their needs dynamically change over time either as a result of response or non-response to the medication and treatment techniques. The nurse as the caregiver has to monitor these changes for vital signs as well as elimination and hydration needs for patients in acute and long term care. When monitoring is limited, there is a possibility for development of adverse events which hamper the goals of the care plan as had been set. In acute care settings, patient mobility is a major problem and with the large amount of time spent on the bed, the possibility of patients developing pressure ulcers for instance is high (Longtin 61).
Appropriate monitoring though methods such as hourly rounds would help meet the fast changing patient needs and thus help initiate response mechanisms such as repositioning of the patient, aiding the patient to meet toileting needs as well as determine the impact of medication based on the patient response. Another critical element of the care process is medication. It is at this point that most errors and misses occur with adverse effects in a significant number of cases. When the medication process is wrong or erroneous, the safety of the patient is compromised. The role of the nurse is to protect the patient from such possible events. That includes putting into place all the safety measures such as use of gloves, wearing sash during medications as well as working closely with all other personnel involved in the pharmacy line to initiate communication and feedback which is critical in identifying misses and errors (Manojlovich, 942). TeamSTEPPS which is an evidence-based framework for facilitating team work, collaboration and communication within the nursing environment has been utilized by nurses to help integrate a workplace culture that recognizes the importance of multidisciplinary care approaches. TeamSTEPPS offers the nurses with an easily accessible platform from which they can seek materials and resources that support team work and collaboration. With evidenced based practice having become an important element within the healthcare sector, nurses have found it easy to utilize these TeamSTEPPS resources. The successes in quality and safe care cannot be mentioned without stating the role that TeamSTEPPS has played in nurturing and improving collaboration, communication and team work.
Nurses are the direct representatives for the patients and therefore, it is upon them to question every decisions and order on medication that is indicated in the care plan, They have a role to educate the patient on these medications and their use, their side effects and the possibility of adverse effects and this is only possible when the nurse is well informed of the choice of medication, dosage and the determinants used to make the choices for medication. On the other hand, the nurse as the patient advocate has to be guided by the eight rights of medication administration all which are guided by the need to prioritize patient safety. These include the right patient, right medication, right route, right time, right dose, right documentation, right reason and the right response. These are however not instantaneous events but the guiding principles at each single phase of the medication process that the nurse has to remember (Manojlovich, 943).
The care plan is usually not confined to the medication and the processes and procedures at the clinical point. It extends to the follow up period in post discharge whereby the outcomes in post-discharge are significantly determined by the patient education offered at the time of discharge. Patients especially those with chronic illnesses have a high likelihood of being required to make successive visits to the clinic at specific times to review the care plan or continue the medication. In such instances, the nurse has to develop a plan to remind the patient of the clinical visits or appointment other by taking their contacts, contacting their family or kin who can facilitate the processes for instance in elderly adults as well as helping the patient use technological devices such as smart phones to act as reminders for the critical milestones of the care process.
Nurses have always invented methods that afford patients safe and quality care. However, this has only been possible because of the concerted efforts from the nurse workforce. Nurses have always worked together and the nature of their work demands so. Patient safety is a multipronged issue that can only be managed effectively when there is coordination and communication across all the tiers of healthcare. Nurses in management and leadership have to work towards policies that insist on quality and safe care, nurses at the informal leadership roles have to work towards nurturing new leaders within the workforce and those in informatics have to work towards innovating new measures to improve outcomes. Nurses, in spite of their specialties or settings have worked and should continue working as a common body that seeks to recognize patient safety as the primary goal.
Works cited
Longtin, Yves, et al. "Patient participation: current knowledge and applicability to patient safety." Mayo Clinic Proceedings. Vol. 85. No. 1. Elsevier, 2010: 53-62.
Manojlovich, Milisa. "Nurse/physician communication through a sensemaking lens: shifting the paradigm to improve patient safety." Medical care 48.11 (2010): 941-946.
