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The quality of health care services at the nursing facilities is an issue of international concern. Nursing practices comprise of the interaction of the concepts of health, nursing, environment and people. It is a direct service that is provided to different patients or clients, groups and communities throughout the life cycle. The nursing practice context refers to any setting where a nurse interacts with a client with the intension of responding to the needs of the patient in request to the nursing services (Collins, Wolf, Bell, & Evanoff, 2004). For a better relationship, the nurse has to demonstrate that he cares about the client’s needs. In the event that the clients cannot respond to services from the nurse, the family or next of kin become the client.
The objective of nursing is to promote healing, health, growth, and development as well as prevent illness, disability, disease and injury. According to Jensdottir, et al. (2003), when people become disabled or ill, the purpose of nursing also includes minimizing suffering and distress and making patients understand their illnesses or disability, its consequences and treatment. However, when death is inevitable, the nurse is supposed to maintain the best quality of life up to the moment the patient dies. Nursing interventions involve empowering patients to enable them to recover independence. It is, therefore, an intellectual, emotional, physical and moral process that involves the identification of various needs, personal care and therapeutic interventions.
The specific nursing domain is the client’s unique responses and experiences of illness, health, disability, frailty, and other health related events in whatever circumstances. The responses of the people might be psychological, physiological, cultural, social or spiritual or even a combination of all. Nonetheless, nursing focuses on the entire human response and rather than a specific aspect of an individual or specific pathological condition. It is based on ethical values aimed at respecting the dignity, uniqueness and autonomy of human beings, the privileged patient-nurse relationship, and the commitment to personal accountability for actions and decisions. These values are represented in written codes of ethics (Collins, Wolf, Bell, & Evanoff, 2004). A system of professional regulation is also established to support these codes. A part from the direct care given to patients, nursing practices also involve teaching, management, and knowledge development. This paper seeks to elaborate on international nursing best practices.
According to Fairchild (1993), every profession needs standards to demonstrate to the government, public and other stakeholders that it is dedicated to upholding and maintaining public trust and the criteria of professional practices. The nursing profession has been the leader in the development of professional standards. Since it is the largest profession in the health care industry, providing care to families, groups, individuals, and communities in multiple settings, it is necessary that standards are put in place to guide the nursing practices.
Jensdottir, et al. (2003) states that nurses working in Nordic countries, England, the United States, Canada, and the Netherlands have been meeting for a long time to discuss a common nursing care, and evaluation of care issues. As a result, they agreed on the use of residential assessment instruments with standardized minimum data set. All the residents in health care facilities are assessed before admission and after every quarter. Accordingly, many efforts have been devoted to the development of quality indicators through funded research initiatives.
Pyne & Pyne (1997) address four basic nursing standards. The first one is professional responsibility. It indicates that a registered nurse is personally accountable and responsible for ensuring that his conduct and practices meet the standards stated by the legislative and professional requirements. The second standard deals with knowledge based practice: every registered nurse is required to continually strive to obtain skills and knowledge to provide competent nursing practices based on evidence. Thirdly, nurses are supposed to comply and adhere to the ethical practices. There is a code of ethics that every registered nurse should abide by. The last standard deals with the provision of nursing services to the public: registered nurses ought to provide services in collaboration with other health professional, clients and significant others.
Collins, Wolf, Bell, & Evanoff (2004) affirm that scientific literature based on the analysis dealing with safe handling and movement of patients and the peer review of a variety of research protocols by professionals in patient handling, best practice interventions include training workers on how to use lifts, use of mechanical lifting equipment, and medical management programs. All these strategies are meant to reduce the injuries sustained by nurses when dealing with patients with spinal code problems.
There are various education programs established to improve universal best nursing practices. According to McKinnon & Fealy (2011), service-learning gives the practicing nurses and nursing students opportunities to serve populations and communities in tangible and deliberate ways. It provides them with opportunities and learning experiences to develop strong and reliable skills to enable them to deliver effective health care to the public. The authors allege that students who take part in these experiences attain cultural competence and develop civic responsibility as well. The service-leaning program is governed by seven core principles: capacity building, compassion, courage, competence, curiosity, creativity, and collaboration.
Polit & Beck (2008) assert that the nursing profession has experienced an immense cultural change over the past years. Nurses are therefore encouraged to understand and conduct a research. They are expected to base their professional practice on the emerging evidence from the research. Research refers to the systematic inquiry that incorporates disciplined methods to solve problems. Its main objective is to develop, expand and refine a body of knowledge. Nurses are increasingly being engaged in research which benefits their clients and the profession in general and therefore improves the health care system.
Weiner (2006) alleges that currently, nurses are faced with immense challenges of responding to manmade, natural, and technological disasters. In the US, the National Council Licensure Examination considers disaster content but very little time is spent on learning and teaching about the disasters in the nursing programs. In a survey conducted by the National League for Nursing in 2005, it was discovered that not only the nursing students were lacking in knowledge about emergency preparedness; the faculty was equally poorly prepared. Researchers in other countries like Japan and China also found similar results. Practicing nurses also suffer from the same problem because they were not taught about various emergency disaster preparedness measures. For instance, the author alleges that baby boomers do not know how to give smallpox vaccination. All these factors call for the need to improve the nursing curriculum in education institutions. For this reason, competency-based education is being used to ensure that standard-set nursing criteria are met.
Institutions have come up with competencies to improve nursing standards. Weiner (2006) gives the example of ColumbiaUniversity which considers international best practices in its education programs. Various schools offer disaster preparedness and management programs. These programs have been exhibited in various international meetings such as the International Council of Nurses. The University of Glamorgan has also collaborated with various schools in the UK to offer a comprehensive online nursing curriculum. Students are also given survival training during summers. Such collaborations equip student and practicing nurses with skills to offer best-practice nursing with international standards.
McKinnon & Fealy (2011) state that global service-learning collaborates with international campuses-community partnerships to allow practicing nurses and students to establish strong global connections. Its success is based on proper planning and sound best-practice principles. The several principles stated earlier foster compassionate and ethical learning experiences and are significant to the successful implementation of sustainable and effective service-learning programs. It gives them a chance to engage in real world practices that help to improve their learning and social development. Service learning works on the idea that classroom learning alone is not enough to give nursing students the practical feel of the real nature of the health care industry. It therefore helps them to develop the health care and cultural context to build their nursing skills on.
Through service learning, specific academic objectives are linked to service experience. It incorporates various elements of experimental learning including civic engagement, community service, social responsibility, citizenship, and cultural competence. The level of competence of the nurses is closely related to their ability to provide health care services that are culturally responsive. Service-learning programs enable students to learn about other cultures and still develop necessary skills to provide culturally competent care. It helps them to develop nursing practices that are applicable in an international environment.
McKinnon & Fealy (2011) argue that community and learner outcome can only be achieved if the service delivery process is based on sound principles that include reciprocity, mutuality, and respect. Partnership is a very integral aspect of service-learning. Education institutions can partner with communities to overcome complex social problems. With an increasingly diverse health care environment, it is necessary that we have a corps of nurses dedicated to providing appropriate and relevant care to patients in diverse communities with respect to moral and social standards.
Mason, Isaacs & Colby (2011) allege that there has been an increase in the migration of nurses as well as other health professionals. This is fueled by the factors such as shortage of nurses in some countries, an opportunity for health professionals to advance their carriers, and the search for a better life. However, there are guidelines put in place by the International Council of Nurses to advocate for educational standards in all nurses regardless of their origin. First level nurses educated in foreign countries are generally baccalaureate prepared. Most immigrant nurses come from Philippines. There are very few diploma programs in India and the United Kingdom. Accordingly, in most parts of Canada, those entering the nursing professional are required to be baccalaureate prepared. The authors recommend that the US should hurry up with its conversion of registered nurses to the BSN entry standards or it will slow down the efforts by the global community in improving the nurses to meet the needs of the global health care system.
The growing increase in the migration of nurses calls for similar health care systems for the nurses so that they can be able to fit in any country. The clinical skills for the nurses should be the most important closely matched skills since clinical proficiency is vital for better healthcare. However, clinical experiences in various countries are different and therefore they might not prepare the nurses to the required global standards. Mason, Isaacs & Colby (2011) suggest that receiving institutions should institute policies that support transition programs that orientate the foreign-educated nurses to the required nursing standards.
According to Rosdahl & Kowalski (2008), there are national organizations which focus on the licensure, professional practice and education of nurses. The National Association for Practical Nurse Education and Service instituted in 1941 was the first national organization to come up with goals for improvement and development of practical nursing education. Another organization is the National League for Nursing whose main purpose is to propel excellence in the education of nurses and prepare them to meet the diverse needs of a variety of populations in an ever changing environment. It assesses, implements plans, establishes goals, and sets standards for faculty development, nursing education, services to the nurses, research in education, public policy related to education and nursing needs in the education settings and the work arena. Another organization is the American Nurse Association whose membership includes RNs. It sponsors workshops for the nurses and publishes several nursing literatures and periodicals aimed at instilling nursing best practices in the nurses and other health care professionals. The most common journal produced by the organization is the American Journal of Nursing which circulates globally.
Other than national organizations, there are state affiliates of various national organizations. These give every nurse an opportunity to become active by attending meetings organized by nursing organizations. Most of the organizations also have local chapters and student affiliates to nature the nurses while they are still young. The International Council of Nursing is the greatest international organization of nurses (Rosdahl & Kowalski, 2008). It is based in Geneva, Switzerland and has three important programs areas. For starters, it regulates the professional nursing practice aimed at classification of nursing practice, special health issues, and advanced nursing practice. It also regulates the standards of nursing and looks into the socioeconomic welfare of nurses.
Funnell, Koutoukidis & Lawrence (2008) affirm that best nursing practices are also promoted through the ethical and legal aspects of nursing. For instance, in democratic societies, the legal systems provide a framework of community interaction. Every citizen should be aware of his legal rights and responsibility. Accordingly, ignorance of laws is not considered as an excuse for violation of the law. All nurses have responsibilities that they should abide by. Nursing regulations should be followed without failure. On the same note, the nursing ethics indicates the expected standards of behavior for every nurse and guides a professional code of conduct and nursing practices.
Polit & Beck (2008) emphasize on the importance of clinical research to guide nurses and improve the quality of health care and the patients’ lives. There has been a remarkable growth in nursing research, providing nurses with evidence to base their practice on. However, there is more to be done to incorporate research based evidence into nursing practices. Although there is no consensus on which type of evidence research is appropriate for EBP, everyone agrees that research findings from intensive studies provide strong evidence for informed actions and decisions by nurses. Nurses are also accepting the need to base their decisions and actions on evidence since it demonstrates that their decisions are cost effective, clinically appropriate and result in positive outcomes for the clients.
In the US, research is considered a very vital tool in nursing cased on status and credentials. The AmericanNursesCredentialingCenter is the country’s largest credentialing organization. It developed a program that recognizes health care organizations that provided the best quality nursing services. One of the criteria to achieve the Magnet status is for the Chief Nurse Executive of the health facility to integrate research-based practices in the services delivered and the administration decision making about nursing practices. Because of the efforts by EBP, several changes are occurring regularly to nursing practices. In most cases, these changes take place at local level but broader clinical changes based on accumulating research evidence are also occurring.
Fineout-Overholt, Melnyk, & Schultz (2005) affirm that there is a need for change in the health care sector. Many health care and professional organizations as well as policy making bodies and federal agencies are emphasizing on the importance of EBP. Using this approach, nurses and other health care professionals can provide better services. The authors assert that health care that is conducted in a caring manner and evidence-based leads to better patient outcomes and clinical decisions. If nurses gain skills and knowledge in the EBP, they can transform the industry because they will be in a position to take ownership of the nursing practices.
Conclusion and Recommendation
As the paper has demonstrated, there are various strategies put in place to improve the nursing practices. The global service-learning program is one of the strategies. It gives the students and the practicing nurses an opportunity to interact with the marginalized and the vulnerable communities and therefore develop their capacity for development. However, it requires proper planning. The seven principles outlined in the paper form the basis for sound and ethical program development. There are various organizations that have been developed to improve the health care industry. Examples include the International Council of Nurses and the National League of Nurses among others. These have come up with nursing standards that should be adhered to by all nurses. This has developed common nursing practices across various countries to ensure that when nurses migrate to other countries, they still remain competent. However, similar health care systems need to be developed to promote uniformity in nursing practices.
Since it takes about 17 years to implement the research findings, there is need to accelerate EBP. There is a growing support for EBP and the consumers and clinicians must come up with means of fully embracing EBP as a health care culture (Jensdottir, et al., 2003). There are various ways to accelerate EBP into the health care and academic environments. First, there is a need to institute a new approach of teaching clinical and research courses in Master’s degree as well as baccalaureate programs to emphasize on EBP skills and knowledge. The greatest challenge for accelerating EBP in schools is that most programs teach students how to carry out research instead of teaching them ways of accessing and efficiently using the research findings in their clinical practices. Since the research process is somehow cumbersome, it has made students form a negative attitude towards research. Changing the teaching approach will make most students develop interest in the research thus accelerating the use of EBP in nursing.
Secondly, a new culture to support EBP should be developed in all health care organizations. Nurses and other health care professionals should have a strong foundation on the importance of EBP. Mentorship programs could be formulated to encourage nurses to use EBP. However, there is a need for continued commitment for all nurses on the use of EBP. They should consider it as the backbone of effective nursing services. Awards could be given for the best practices in the industry to encourage more innovative strategies from the nurses.
Another issue that has not been talked about in establishing the best practices in nursing is the use of information technology. With the increased developments in this field, it is necessary that the nursing services are boosted by using sophisticated machines that could make work easier for the nurses. For instance, it is difficult for the nurses to lift up bed ridden patients. With the help of powered sick beds, the nurses will only need to press a few buttons and the patient will be lifted to the right position. Computerized machines would also make it easier to conduct a patient’s check up. However, it is also important that the information technology used in nursing is universal so that nurses could apply their services in whatever community or environment they are taken to. Generally, there is a commendable progress in improving international nursing best practices. Nonetheless, there is a need for international cooperation from all the stakeholders in the health care industry to ensure that the process is accelerated. Developments in best practices in nursing should also consider the safety of nurses at the working place. They should be protected from accidents so that they could remain committed to their nursing practices.
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