Advancedpractice nursing and nurse competencies
Advancedpractice nursing is a recent term that is used to denote a certainlevel of nursing practice that is characterized by the use ofcomprehensive skills, knowledge, and experience in the accomplishmentof nursing duties. In light of this definition, administration,education, and research masters prepared nurses are considered partand parcel of advanced practice nursing. As Angela (2009) notes, nomatter what path a nurse chose, advancing one’s professionalcapabilities through additional education and clinical experiencemakes one an advanced practice nurse. Masters level nurses possessthe high degree of skill, knowledge and experience that forms thebasis of advanced practice.
Oneof the major objectives of the nursing practice is to ensure thatnursing care is professionally carried out and that only safe,evidence-based, and high quality care is delivered to the patients.Competence and capability is integral to the understanding of thecomplex role of the nurse practitioner (Gardner, Hase, Gardner, Dunn,& Carryer, 2011). Both the nurse educator and the nursepractitioner play crucial roles that ensure that the nursingprofession continues to progress through improved patient care andpatient outcomes. Registered nurse practitioners apply the knowledgeand skills of nursing care within the healthcare system to ensurethat patients receive quality care and health outcomes are improved.Nurse educators, on the other hand, serve the important function ofdeveloping and applying sustainable educational curriculums thateffectively and efficiently meets the needs of the registered nursepractitioner. The following are the NP and NE competencies
Demonstration of leadership in translating knowledge into practice. This enables the NP to continuously improve the practice.
Knowledge generation to improve practice and patient outcomes. This entails involvement in research activities and supporting cost-effective, safe, and quality care. As the nurse learns and builds experience, patient outcomes will be improved.
Demonstration of an understanding of the theoretical and conceptual foundations of nursing, their applications in various academic contexts, and relation to health promotion.
Ability to build effective communication networks, advocate for health care policy, and understand health care financing and organization through the application of economic principles.
Barriersto professional role transition and role socialization
Nursesface unique challenges as the undergo the transition process fromsimple nursing practice roles to more complex settings. Some of thebarriers that they face when transitioning include additionaljob-related workloads, increased dissatisfaction with the new workingenvironment, overwhelming feelings of being undervalued, increasedstruggles due to the enhanced dependence on others for assistance andguidance, and the general difficulties of getting a grasp of thenuance and workings of the new environments.
Nursesocialization refers to the process through which nurses learn thevalues, skills, attitudes, norms, behaviors, and roles of theprofession. In other words, it is the internalization of personalconcepts and behavior with the norms and values of the profession.Therefore, different environment may hinder the process ofprofessional role socialization. Zarshenas et,al (2014) investigatedprofessional socialization in nursing and established that bothprofessional identity and sense of belonging affect the socializationprocess. Since these two factors can both be affected by theenvironment, it is sufficing to say that the environment in turnaffects the socialization process. I strongly believe that mypersonal characteristics cannot influence role socialization.
Levelsof nursing proficiency
Benneridentifies five levels of proficiency in nursing education. The firstlevel is novice. This level encompasses beginners with no experienceof the tasks and situations that they are expected to carry out orwork under. McHugh & Lake (2010) state that nurses at the novicestage use learned rules and procedures to determine actions needed inthe immediate situation hence the help in the handling of situationsthat require quick responses. The next level is the advanced beginnerwho can marginally showcase the acceptable levels of performance.Albeit needing little support, nurses in this level of proficiencycan formulate comprehensive clinical action guidelines making themvaluable assets. The third level is the competent nurse who, after afew years on the job, has now developed the ability to formulatelong-term goals and plans. These nurses help in the attainment ofhigh levels of organization and efficiency through deliberate andconscious planning This facilitate the process of preventingmistakes, saving lives, surveilling patients, and understandingdisease processes (Rhodes, Morris, and Lazenzby, 2011). Theproficient proficiency level nurse analyzes the situations as a wholewhile the expert proficiency level nurse, due to his/her vastexperience and knowledge, no longer relies on analytics butintuitively grasps problem solutions. The proficient nurse allows forfaster decision making while the expert nurse enables highly skilledanalysis new situations with zero prior experience (Benner, 1984).
Myphilosophy according to the metaparadigm is to make patients feelthat I care for their well-being and health, enhance the health ofthe patients and increase their access to health care, provide anenvironment that facilitates quick recovery from illnesses, andactively contribute towards the advancement of the nursing practice.
Timelineof historical trends in nursing evolution
Thenursing profession has evolved all through history with numerouschanges taking place in the practice itself, the roles of caregivers,types of caregivers, and policy issues. The five major historicaltrends in the evolution of nursing are nursing education, advances inpractice, war and its effect on nursing, nursing workforce issues,and research in nursing. In the middle ages of the 16thand 17thcenturies, nursing moved from an informal and unregulated practiceinto a formal educational practice where nurses attended nursingschools. The 18thand 19thcenturies saw advance in practice where many innovations in termshealthcare technologies and new approaches to treat diseasesmushroomed. During this same period, nursing was closely tied to waractivities where nurses primarily provided care for soldiers,civilians, and the enemy. However, during the 20thcentury, the demand for more qualified nurses increased and licensingwas introduced. The 21stcentury has been largely characterized by increased focus inevidence-based practice through research and more participation inpolicy issues. Stevens (2013) reiterates the importance of nursing asa profession while looking at current evidence-based practices.Nursing education is one of the areas that is still evolving.Marzuki, Hassan, and Nantsupawat (2012) state that continuouseducation help reduce issues of unsafe practices, incompetence, andunproductiveness in nursing.
Thecaring conceptual framework is comprised of several interrelatedcomponents. The establishment of positive relationships with thepatients, identification and sympathizing with the various patientsituations, ensuring inclusion and access, preservation of ethicaland moral standards, and accountability are all elements thatfacilitate effective caring in nursing.
Oneof the ethical provisions states that the primary commitment of thenurse is to the patient be it an individual, a group, a community ora population. For instance, when taking care of a patient, a nurseshould ensure that the patient or his/her family enjoys fulldisclosure of every element that influences their treatment. Personaland organizational interests should never be put before that of thepatient. The second ethical provision states that the nurse shouldadvocate for, protect, and promote the rights, health and safety ofthe patient. For example, in a situation where a patient is in acomma, it is the duty of the nurse to make productive decisions onthe patient’s behalf. The third provision states that the nurse hasauthority, responsibility and accountability to make decisions andtake actions that promote optimal care. This signifies that a nurseshould never hesitate to intervene in matters that he/she feels doesnot promote optimal care.
Inchapter 26 of DiNisco and Barker (2016) book, reality checks thatrelate to ethical principles are discussed. In one of the realitychecks ‘maximizing happiness and reducing suffering’ Daniel, aCEO interviewee is asked how he would maximize allocation of $100000to improve patient care aside from capital expenditure. He respondsthat he would use the funds to ensure that staff are trained well andpossess the necessary skills set to effectively care for thepatients. This response fits with the utilitarian theory which is tothe effect that the best moral action is the one that maximizesutility. By improving the skills set of the employees, Daniel wouldimprove both employee as well as patient satisfaction through betteroutcomes thus maximize utility.
CaseStudy: Virtues and moral values
Thedeontological ethical theory ascertains that actions should be judgedaccording to how such actions have adhered to set rules.Deontological ethics is also referred to as a duty-based theory(DeNisco & barker, 2016). According to this theory, rules shouldnever be broken unless a change is effected by the body that makessuch rules. Therefore, the airport workers were right in denying Mr.Jones permission to fly home early despite the fact that he was goingto visit his very sick wife and early flights were readily available.However, despite the rightness of the decision, granting himpermission to fly on the 5 pm flight would be a violation of thedeontological ethical principles. Utilitarian theories focus on whatis right and wrong judged by the consequences of actions. Here, rulescan be bent or broken to accommodate one’s own, or others,interests as long as the consequences of such an action are notdetrimental. Virtue ethics emphasizes moral character and notnecessarily adherence to rules. Therefore, rules can be broken, andrules are made by the immediate persons in a given ethical situation.The right thing to do in the situation would have been to allow Mr.Jones to fly home early. Both the Utilitarian and the virtue theoriesallow such an action.
Nursingpractitioneering involves a variety of tasks that rage fromperforming physical examinations, conducting laboratory tests,ordering radiological procedures, charting, and writingprescriptions. However, defining the nurse practitioners’ role thisway is a little superficial as it only touches on the duties andprofession but bypasses the unique role of the practitioner. Theseunique roles cover a much wider scope and include effectivecommunication, continuous education, coaching, diagnosis, and theestablishment of reciprocal relationships with the patients. Nursingpractitioneering is unique since it bridges the gap between
Medicineand nursing. While nursing focuses solely on suffering and illnessand medicine on disease, nurse practitioners incorporate elementsfrom both sides of the divide making the profession unique from bothmainstream nursing and medicine.
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