Physical assessment: implications for nurse educators and nursing practice

AIM: In New Zealand, the physical assessment of a patient has traditionally been the domain of the medical profession. As a country implementing advanced practice roles, with an expectation that both nurse practitioners and registered nurses will use physical assessment skills, the relevancy of physical assessment for each scope of practice has currency. The aim of this literature review was to discover what could be learnt from the experiences of Western countries that already incorporate physical assessment skills into nurses' health assessment. FINDINGS: Nurses in the USA, and more recently Canada and Australia, readily incorporate physical assessment skills into their nursing practice as a component of health assessment. The international literature identified that any change to the nurse's role in health assessment, to include physical assessment skills, requires strategies that involve the regulatory, educational and practice components of nursing. CONCLUSION: Nurses and other health professionals must perceive that this role expansion will improve health outcomes for the diverse populations accessing health care. Teaching physical assessment skills within a holistic health model will enable nurses to contribute a more comprehensive health assessment to the planning and monitoring of people's health care.     

Nurses' perspectives on unconventional therapies.

Unconventional therapies have become increasingly popular with health care consumers in recent years. As patients seek information and attempt to make decisions about unconventional therapies, they often turn to nurses, asking the nurse's opinion about certain therapies. The nurse's attitudes and beliefs about unconventional therapies quite likely will influence the response to the patient's inquiries. This article represents the findings of interviews with 20 nurses regarding their perspectives on unconventional therapies. Without exception, all nurses who were interviewed emphasized that information regarding unconventional therapies needs to be available readily for both patients and health care professionals. Other themes identified in the interviews included the following: Various people use unconventional therapies; people seek unconventional therapies for a variety of reasons; communication about unconventional therapies needs to be open, and a place should be found for unconventional therapies. The interviewees saw a clearly defined role for nurses regarding unconventional therapies.     

The future nurse: selection and training; autonomy; should her health-care role be modified for future patient demands?*

This paper was presented in the context of an international interdisciplinary conference on Priorities in Health Care. The focus of the paper is the relationship between the nurse's role and the demands of patients, now and in the future. The incongruence between patients' needs and their demands is discussed and the question is raised as to whether the nurse's skills and knowledge currently acquired will be appropriate to meet patients' needs and demands in the future. Future patient needs and demands are not the only external pressures on changes in the nurse's role; advances in medical treatment and technology and changing roles of other health professionals are others. The paper highlights the dilemma between the profession having to give way to such external pressures or the risk of preparing nurses for irrelevant roles. A case is made for greater interchangeability of first level health care workers through a common portal of entry. It is suggested that diversion into the various professional fields should occur after the foundation course to health care and suitable counselling. Among the top level professionally qualified nurses should be both generalists and specialists. A speciality of nursing generalism, as a parallel with general medical practice, is advocated. A plea is made for a liberating rather than a restricting interpretation of professionalism so that necessary changes in the nurse's role can be initiated and directed by the profession rather than being forced upon it by external pressures.     

The psychiatric educational experiences of advance beginner RNs

The nursing profession is in an extraordinary position to improve educational experiences of prospective nurses, particularly within psychiatric nursing. To acquire an enhanced understanding of the nurse's instructive learning process and skills regarding psychiatric nursing, this study described and explored the experiences of advance beginner nurses employed in mental health facilities. It also denoted the registered nurses' (RNs) educational preparedness to function in their new professional role. Reflection of the nurse's personal experiences was acquired by using a qualitative study with a phenomenological approach. Colaizzi's Frame work [Colaizzi, P., 1978. Psychological research as the phenomenologist views it. In: Valle, R., King, M. (Eds.), Existential Phenomenological Alternative for Psychology. Oxford University Press, NY, pp. 48-71] guided the mode of data analysis by enlisting 15 advance beginner nurses to participate in in-depth, audio-taped interviews. Results from this study indicated a need for educational improvements to accurately reflect trends of psychiatric patient care in order to emphasize interpersonal relationships as well as multi-diagnosis and co-morbidity. Additionally, increased contact with diverse patient populations and responsibilities congruent with other clinical placements in managing the patient's overall care were noted to be critical. This study suggests that some nursing educational programs can improve their curriculum, methods of teaching and approach used to introduce students to psychiatric mental health nursing.     

Nursing advocacy during a military operation

Advocacy is an essential component of the registered nurse's professional role, yet experts provide no consistent definition of advocacy. The purpose of this study was to explore the experiences of military nurses as they engage in advocating practices and to describe their shared practices and common meanings. Heideggerian hermeneutic phenomenology, provided the framework and method for this study. Twenty-four U.S. Army nurses were individually interviewed and the researcher kept interview observational notes. The constant comparative method of analysis was used. The stories of these nurses revealed one constitutive pattern--safeguarding--and four related themes. The themes were advocating as protecting, advocating as attending the whole person, advocating as being the patient's voice, and advocating as preserving personhood. One conclusion was that military nurses must be prepared for the important safe-guarding role. They must be coached in how to deal with other members of the health team on the patient's behalf.     

An exploration of the relationship between patient autonomy and patient advocacy: implications for nursing practice

The purpose of this article is to examine whether patient/client autonomy is always compatible with the nurse's role of advocacy. The author looks separately at the concepts of autonomy and advocacy, and considers them in relation to the reality of clinical practice from professional, ethical and legal perspectives. Considerable ambiguity is found regarding the legitimacy of claims of a unique function for nurses to act as patient advocates. To act as an advocate may put nurses at personal and professional risk. It may also be deemed arrogant and insulting to other health care professionals. Patient autonomy can be seen as a subcategory of the right of every individual to self-determination, and as such is protected by law. However, it is questionable whether the traditionally paternalistic approach to health care provision truly respects the autonomous rights of each patient. The author considers examples and cases from the literature that resulted in professional and/or personal difficulties for the nurses involved, and also reflects on an incident from her own practice where a positive outcome was achieved that demonstrated compatibility between the concepts under consideration.     

Ethical dilemmas in caring for patients with SARS

This paper explored experiences caring for patients with severe acute respiratory syndrome (SARS), with a focus on the suffering between the "private" and "professional" selves, in order to describe the psychological impact and ethical practice of SARS events as related to nursing professionals. Eight small group interviews were conducted with a total of twenty-one nurses with experience caring for SARS patients. Group interviews were audio-taped and transcribed for analysis. Data, analyzed using the constant comparative method, revealed the following three ethical dilemmas: suffering in care giving, response to the calling, and distresses involved in decision making. In this study, the authors further addressed relationships between suffering and ethical practice, the calling and a nurse's professional responsibilities, and transcendence in intersubjectivity. The authors hope that the results of this study will lead to a new understanding of ethical practices nursing and help nurses develop reflected care that promotes personal and professional growth.     

District nurses' use of social networking sites: caution required

Although an increasingly popular form of online communication and social interaction, social network sites have to be used with caution by district nurses. In common with all health professionals, the scope of a district nurse's accountability extends to their online presence, and inappropriate remarks or pictures posted online can call into question the fitness to practise of the individual. In this article, Richard Griffith and Cassam Tengnah review your accountability, as it applies to your online presence, and discuss the Nursing and Midwifery Council's new advice to nurses and midwives on acceptable use of social networks.     

The challenge of interdisciplinarity

The restructuring of health services and the shift to ambulatory care has resulted in several institutions considering the adoption of program management. This approach intensifies interdisciplinary team work, the latest care delivery method for various services. But what exactly is an interdisciplinary team? And what is the nurse's role within that team? These two questions are often asked in the literature, as well as in practice. The answers to these questions are still confusing. The inability of the nursing profession to define itself clearly in comparison with other health care professionals has negative consequences. This article presents a vision of interdisciplinarity as a means for nurses to define themselves within an interdisciplinary team.     

Mental health: integrated network and family-oriented model for co-operation between mental health patients, adult mental health services and social services

Background. Co‐operation between mental health care units and the social services is important in the case of people with social problems who also suffer from mental health problems. However, participation of patients and their families in the treatment process, and co‐operation between them and the professionals, are also important. Communication between the professionals, patients and their family members, and the professionals is a crucial factor for co‐operation. Aims and objectives. The aim of this study was to elucidate the experiences and importance of co‐operation for the patients. The data consisted of interviews with 22 mental health patients who were also clients of municipal social services. Method. The grounded theory approach was used, focusing on the informants’ experiences of the integrated network and family‐oriented model for co‐operation. Results. The findings indicate the importance of the participation of patients and their social networks in psychiatric care or the treatment process. Meetings should be characterized by open and reflexive discussions with all participants’ points of view being included, so that fruitful co‐operation is possible. However, some negative experiences were also reported, all of which were connected with the professionals’ behaviour. Conclusions. Trust and honesty are essential elements in relations between professionals and psychiatric patients, but it cannot be assumed that they will develop naturally. It is the professionals’ responsibility to adjust their behaviour so that these elements can be created in a mutual process between patients and professionals. Multidisciplinary teams are a necessity in family‐oriented co‐operation between psychiatry and social services, and in a satisfactory caring process. Relevance to clinical practice. Nurses’ work is often individually oriented and nurses are ruled by routines in their work. The mental health caring process should be seen as a shared process between the patient, his/her human environment and professionals for which nurses need skills to their interaction with patients and their social network.     

Caring for patients who have eating disorders

This article gives an overview of the nurse's role when caring for patients with eating disorders. While mental health nurses are more likely than general nurses to be dealing with patients with eating disorders, such disorders can influence an individual's ability to recover from other illnesses so knowledge of this area is relevant in all settings.     

Death and dying in contemporary society: an evaluation of current attitudes and the rituals associated with death and dying and their relevance to recent understandings of health and healing

This paper develops a model which is intended to help nurses and other health professionals in the understanding of contemporary views regarding death and dying and the associated issues of health and healing. The author contends that in the first half of the 20th century, society lost sight of the importance of rituals associated with death and dying and of the need for appropriate death education. Consequently patients and professionals alike found themselves unable to cope with the inevitability of death. Fear supplanted hope, and the health and well-being of society was deleteriously influenced. During the second half of the century, there has been a proliferation of thanatology research and literature. Health professionals are realizing the inadequacy of their knowledge of an issue which fundamentally and unavoidably affects everyone including themselves. The holistic approach to health care has been recognized by many researchers as being essential to health and healing, and therefore death and dying have to be addressed. Often nurses are the professionals left to deal with the patients' grief and anger, and it is therefore critical that they are conversant with the contemporary parallel issues of death and dying and health and healing. The author also firmly believes that before nurses can help people to overcome the fear of death and to optimize their lives, it is essential to examine the traditions of other cultures as well as personal experiences and coping mechanisms, before an understanding of other people's fears and beliefs concerning death and dying can be reached.     

Perception of "no code" and the role of the nurse

CPR is now the rule rather than the exception and death is often viewed as the ultimate failure in modern medicine, rather than the final event of the natural life process (Stevens, 1986). The "No Code" concept has created a major dilemma in health care. An interagency collaborative study was conducted to ascertain the perceptions of nurses, physicians, and laypersons about this issue. This article deals primarily with the nurse's role and perceptions of the "No Code" issue. The comparison of nurses' perceptions with those of physicians and laypersons is unique to this study. Based on this research, suggestions are presented that will assist nursing educators and health care professionals in managing this complex dilemma.     

“They have no idea of what we do or what we know”: Australian graduates' perceptions of working in a health care team

Globally it has been suggested that interprofessional education can lead to improvements in patient safety as well as increased job satisfaction and understanding of professional roles and responsibilities. In many health care facilities staff report being committed to working collaboratively, however their practice does not always reflect their voiced ideologies. The inability to work effectively together can, in some measure, be attributed to a lack of knowledge and respect for others' professional roles, status and boundaries. In this paper, we will report on the findings of an interpretative study undertaken in Australia, focussing specifically on the experiences of new graduate nurses, doctors and pharmacists in relation to ‘knowing about’ and ‘working with’ other health care professionals. Findings indicated there was little understanding of the roles of other health professionals and this impacted negatively on communication and collaboration between and within disciplines. Furthermore, most new graduates recall interprofessional education as intermittent, largely optional, non-assessable, and of little value in relation to their roles, responsibilities and practice as graduate health professionals. Interprofessional education needs to be integrated into undergraduate health programs with an underlying philosophy of reciprocity, respect and role valuing, in order to achieve the proposed benefits for staff and patients.     

Consumer-directed teaching of health care professionals involved in the care of people with spinal cord injury: the Consumer-Professional Partnership Program

The Consumer-Professional Partnership Program (CPPP) was developed to increase patient participation in the education of nurses and other health care professionals. Its goal is to inform nurses about disability and health issues from the perspective of people with spinal cord injury. This article discusses the development of this program and the first experiences with its implementation. Forty-three nursing professionals took part in CPPP training. Initial participant responses were positive, especially with regard to hearing from consumers about care preferences, barriers to care, and ways to improve patient-provider interaction.     

Home health nurses' assessments of cognition.

Assessments of mental status in elderly persons admitted to home health agencies are the basis for decision-making related to resources provided. A home health nurse's perceptions of an elderly client's capacity for self-care determines whether community services will be prescribed. In institutional settings, evaluation of cognition by professional nurses is often incomplete or inaccurate. It was the purpose of this study to compare the judgements of cognition made by nine home health nurses who were admitting elderly clients to a visiting nurse association with scores from an objective measure of mental status. Findings suggest that these nurses relied primarily on orientation as an indicator of cognitive abilities.     

Computer mediated conferencing - a hope or hype for healthcare education in higher learning?: A review of the literature

AIMS AND OBJECTIVES: In view of the increase use of computer mediated conferencing (CMC) by nurses with other health care professionals in health care education, this literature review provides insights into the experiences and issues surrounding the use of the technology by nursing students and their use with other health care students. It is an important initial step in designing and developing strategies in the use of CMC. This literature review also aims to structure the available research findings of needs and experiences of other health care students and students from disciplines other than health care to provide the best approximation of what nursing students will experience in diverse groups for inter-professional learning. METHOD: Literature review. RESULTS: The literature review indicates a substantial amount of students' experiences and expectations in CMC. The problems thus far, are more complex than access and use of the technology, and emerged as six different, but related issues associated with technology and reflective and collaborative online learning in a constructivist learning environment. RELEVANCE TO PRACTICE: Priority needs should be central in the preparation of student in the constructivist learning environment. Concerted efforts should not be just about increasing students' technological competence, but on addressing the socio-psychological dimensions in CMC.