Professional Values and Evidence Based Practice

The Role of a Nurse

The role of the nurse has developed massively from the times of Florence Nightingale to the modern 21st century. Florence Nightingale became an extremely famous heroine after her great efforts during the Crimean war. She fought to get all the wounded bandages, fresh bedding, food and cleaning supplies. Nightingale showed empathy and sympathised with the wounded and dying soldiers, she took the time to comfort and take concern for them. She was also able to manage others who worked around her, directing what could be done, such as assisting with letter writing and helping to wash or dress the men that were incapable. These are all factors that are now necessary skills for a nurse. (M.L.Lobo, Cited in J.B.George pg.43, 2002) Nightingales main priority was to secure and protect the environment that her patients were in. This consisted of keeping them clean and in a condition where infection could be minimised. These main features have been taken on board and have developed a vast amount to provide the most effective and safe practice of health care to date. This essay will aim to talk about the role of the nurse through the 4 principles of the NMC code (2015) and also express the importance of the 6 Cs of nursing whilst integrating them and linking each one to the NMC code. It aims to express the importance of communication, commitment, confidentiality, team work , fundamentals of care and professionalism.

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The NMC code (2015) have set out 4 main categories that describes everything a nurse should be able to do and what a nurse needs to abide by. These categories are; prioritise people, practice effectively, preserve safety and promote professionalism and trust. The first  section to be focused on is Within prioritise people of the NMC Code (2015) it states “treat people as individuals and uphold their dignity” this statement explores the importance of being non-prejudice when working within the nursing profession. Prejudice is defined as “preconceived opinion that is not based on reason or actual experience” (M.Waite, 2012) this is creating a judgement on someone from visual appearances and body language before you get to know a person. Prejudging someone, gives an overall first impression of a person. These are solely controlled by the nonverbal communication that happens when we first come in contact with someone. Therefore, the impressions we make are based on how a person looks, smells and sounds.  This is not always a positive impression. For example, if a new school teacher were to arrive to school in clothes that were creased, and their hair was not fixed, then we would assume that the teacher is incapable of teaching and is as disorganised as their appearance. However, these impressions can change; if the teacher were to perform extremely well and happened to be an outstanding teacher, then our first impressions are completely forgotten as they have over ruled them. Hence why a person should never judge a book by its cover. (Six degrees, 2018). However, regardless of the person, their background or what they have done, nurses and doctors take an oath to treat and care for all patients that come through the health service and prejudice is not even thought of.

Prioritising people also consists of upholding the patient’s dignity. This is key in the profession. Upholding dignity allows for the patient to feel comfortable and respected. Patients are extremely vulnerable in times of care and are exposed to situations that may be distressing for them. Nurses must be mindful of a patient’s morale in these circumstances. In cases where patients need to undress and get into a hospital gown, a nurse must ensure that they have their own private space, even if that means it’s closing the curtain from other patients around them. It consists of listening to a patient’s point of view and understanding how they feel. Its concentrating solely on them and giving them the person centred care that they deserve. There are ten elements of dignity that have been previously described by Dr Hicks in her book “Dignity, its essential role it plays in resolving conflict” that are beneficial in a health care profession. The most important that are relevant to nursing include; the acceptance of every persons individuality and identity, being understanding- taking into account what others are feeling at a distressing time, safety- ensuring that people are to feel at ease, fairness- treating all patients equally and lastly the most important is allowing the patient to have independence- this is to encourage people to have autonomy and to reiterate how they always have a say as to what happens during their care experience; it enables empowerment. (D.Hicks, 2011)

The Fundamentals of care was set out to improve the quality of care for adults. It is now the basis of nursing. The NMC have defined the fundamentals of care as “The fundamentals of care include, but are not limited to, nutrition, hydration, bladder and bowel care, physical handling and making sure that those receiving care are kept in clean and hygienic conditions… making sure you provide help to those who are not able to feed themselves or drink fluid unaided.” (NMC, 2015). The fundamentals of care aim to treat patients with dignity and respect but also ensuring that people’s physical, social and psychological needs are assessed and managed. Consent must be gained before carrying out any needs, such as assisting with feeding, brushing teeth, bed baths, assisting with toilet needs etc. This is the use of beneficence, acting in a way that is beneficial for the patient. Although the fundamentals of care are set out to promote care and have a benefit for the health, it can also have a negative impact on the patient. It is taking away the patients independence, patients are made to feel as though they are incapable of doing daily tasks that they carried out prior to coming into hospital. An example of this is on a cardiac ward; after having a heart attack and even though you are now stable and mobile, you cannot leave your bed area and therefore are made to go to toilet into a disposable bedpan, when in reality they could have gone to the toilet. One study found that 12% of patients aged 70 and over had noticed a decline in their ability to carry out essential tasks independently such as bathing dressing, using the toilet, eating and moving around, between their arrival to hospital and discharge (K.E.Covinsky et al, 2003). It also makes patients very reliant on nurses, they then feel that they can’t carry out tasks without a nurse and because they are so used to nurses assisting them with their care, they become more dependent and less mobile. In terms of mobility, being bed bound for weeks on end in hospital can cause muscles to break down in the body. Evidence has proven how longer stays in hospital can lead to worse health outcomes. Older patients can lose mobility rapidly when not kept active. Monitors recent review had shown how for healthy older adults, 10 days of bed rest can lead to 14% reduction in leg and hip muscle strength. With a further 12% reduction in aerobic capacity (Monitor, 2015 cited on National Audit Office p.14). This expresses how nurses should encourage patients to walk around on regular intervals if they are able and it is safe to do so to decrease the chances of having muscle loss and to ensure that they are able to go back to their own homes rather than to other care facilities.

The NMC Code (2015) second category for nurses to adhere to is “Practice effectively”. One of the points expressed is to “communicate clearly”. Communication amongst all nursing is one of the most important roles that a nurse has. Communication is usually taken for granted and is dismissed to the point where people believe that it is not important. But, in a nursing role, a nurse has to be able to communicate efficiently and effectively with both patients and other members of staff. There are two forms of communication; verbal and non-verbal. (S.Kraszewski & A. McEwen, 2010) Verbal communication is the use of speech or written information in order to express opinions and beliefs or simply for a conversation. The way in which we speak with tone of voice and with pitch is all based around the individual patients. If a patient were to be slightly deaf, then a nurse would understandably be using a higher volume of speech and also using a slow pace to give the patient time to understand what it is that they are actually saying. However, if the patient were to be of a well hearing health then a nurse would use a mediocre tone of voice and perhaps use a faster pace as the patient will understand more clearly. Verbal communication is the most common form. However, non-verbal communication also pays an important role. Non-verbal communication is the use of body language, eye contact and facial expression. This is useful in situations where the use of speech isn’t always appropriate. For example, in cases where a patient has been given a short time frame to live, a nurse may have broken the news and have used a healthy silence to allow the patient to digest the information that has been given. But, maintaining an open body stance and having soft eyes in this situation, allows the patient to recognise that they are there to talk to and ask questions when they feel they can (Nursing times, 2018). Albeit, there are many strengths and weaknesses to both forms of communication. Verbal communication can ensure that a point has gotten across to the patients and that they understand fully everything that has been explained to them. It also allows for a nurse to gain consent, they are able to discuss with a patient the procedure of their care and the patient is then able to decline or consent. This also brings out a sense of autonomy in the patients as they feel in control of their health care; they have a say as to what goes on, such as when they wish to wash, whether they want to go ahead with extensive surgery, to even when they wish to get out of bed. Effective communication also makes a patient feel valued. It shows how you are willing to listen and attempt to understand how they are feeling. This will build a report with a patient which makes them more trusting and they take on board what you have to say. Verbal communication can also have weaknesses. These can include language barriers. Visual and hearing impairments are a form of language barriers. The loss of hearing makes it difficult to understand what a person is saying. You would need to be able to speak sign language and studies have shown how only a minority of health professionals can communicate using sign language. It was reported in 2013 that 46% of reported deaf respondents have communicated with health professionals with the use of pen and paper. Having to write things down in order to have a conversation. 23% have reported they currently communicate using spoken English and the use of lip reading; stating that they would prefer not to. (Research into the health of death people, 2013). This research is only based on the presence of 553 deaf people within the UK. This can suggest how it is not a true representative of the whole deaf community worldwide. 553 deaf people is a small amount compared to the thousands that are present in the UK. This is stating that it only gives a slight insight into the difficulties faced by deaf people within the NHS; it cannot be said that all deaf people feel this certain way. Also, the study was carried out 6 years ago, therefore, it is slightly out of date. There is a possibility that there has been an increased awareness into the struggles that the deaf community face and changes could have been made over recent years to improve the experience these people face during health visits. It is important for a nurse to be aware of all these barriers when in their role.

Team work is also necessary when working within a nursing role. Teams have all different levels of experience and knowledge within the NHS and this has to be recognised and understood to enable the delivery of care to be most effective. The main function of a team during healthcare is to provide a good quality of care. The Harding committee (DHSS 1981, cited in S.Kraszewski & A. McEwen, 2010. pg.76-77) stated that a team has to have four certain key elements in order to function. These are; an overall common objective that is to be accepted by all staff within the team, an understanding of their personal roles, skills and how they function- taking into consideration about their own responsibilities and lastly having mutual respect for all other team members and their role. If a team was able to express and act upon these key elements, then the care delivered would be of a high standard. Even though, the definition is outdated coming from 1981, it is extremely relevant in modern day nursing as the principles of a team remains the same and the emphasis on teamworking is still at a high. However, the Harding committee failed to acknowledge the strength that communication has within a team. Under ‘practice effectively’ of the NMC code (2015) it states “work-co-operatively” and one sub-point says that a nurse must maintain effective communication with colleagues which links with another sub-point of sharing information to identify and reduce risk. Having effective communication whilst in a team can enhance the quality of care given.

The third category of the NMC code (2015) is to “Preserve Safety”. This is essential in nursing care both for the nurse themselves and for patients. This means that nurses have to recognise and notice their capabilities, to work within their own skill set and competence to prevent any harm. It is encouraging that nurses ask for help from suitably qualified staff, this not only increases the quality of care, but also improves and develops the skill sets of the nurse.  It also states how nurses should “always offer help if an emergency arises in your practice setting or anywhere else”. This form of commitment can be shown to the profession itself. If a shift was over and an emergency arises a nurse would not just clock off and leave, they would step in and help to resolve the situation and provide their services when needed. Nurses have a commitment to personal excellence. This is carrying out frequent evaluations of one’s self to further develop the professional care that is being given. It allows for nurses to critically evaluate themselves to make changes or improvements, writing up reflections in order to say what has been done well and what they would do differently. This is showing commitment to the job, making changes to improve and develop further to enhance not only yourself but the patient’s well-being. Commitment to the job can also be shown towards colleagues. Complimenting colleagues on what they have done well and help assist them on what they are still learning. Show care and compassion to other employers as well as patients. (J.R.Ellis&C.L.Hartley, 2004)

4 Promote Professionalism and trust

Confidentiality

Care

Courage

Empathy

RCN 8 principles

Reference List

• M.Waite (2012) Paperback Oxford English Dictionary, Seventh edition. Oxford University Press. Oxford.
• D.Hicks (2011) Dignity: The essential role it plays in resolving conflict. Yale University Press. London.
• K.E.Covinsky et al (2003) ‘Loss of independence in activities of daily living in older adults hospitalised with medical illnesses’, Journal of the American Geriatric Society, 51 (4), April 2003.
• M.L.Lobo cited in J.B.George. pg.43 (2002) Nursing Theories the base for Professional Nursing Practice, fifth edition.Pearson Education LTD. New Jersey.
• S.Kraszewski & A. McEwen (2010) Communication skills for adult nurses. Open University Press. Berkshire, England.
• Nursing Times (2018) Available [online]  https://www.nursingtimes.net/clinical-archive/assessment-skills/communication-skills-3-non-verbal-communication/7022784.article  Accessed [20/12/2018]
• NMC Code (2015) Available [online] https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf  Accessed [12/12/2018]
• Communication in health and social care (2010) Available [online] https://resources.collins.co.uk/free/BTECHSCunit1.pdf  Accessed [18/12/2018]
• Royal College of Nursing (2016) Available [online] https://rcni.com/hosted-content/rcn/first-steps/why-communication-important  accessed [28/12/2018]
• Six Degrees (2018) Available [online] https://www.six-degrees.com/the-psychology-of-first-impressions/ Accessed [01/01/2019]
• Research into the health of deaf people (2013) Available [online] https://signhealth.org.uk/wp-content/uploads/2014/03/SignHealth-Deaf-Health-Survey-Report.pdf  Accessed [01/01/2019]
• Monitor (2015) cited on National Audit Office p.14 (2016) Available [online] https://www.nao.org.uk/wp-content/uploads/2015/12/Discharging-older-patients-from-hospital.pdf  Accessed [02/01/2019]