Clinical Skills for Nursing Practice

Tina Moore, Sheila Cunningham, Tina Moore, Sheila Cunningham

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781315528755
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing Skills

Employing an evidence-based approach, this comprehensive textbook introduces the core clinical skills and competencies a newly-qualified nurse is required to have for professional practice. It is divided into five broad sections looking at:

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• Care and compassion and communication, including personal care and pain assessment

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• Essential skills, including observations, monitoring and emergency management

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• Organisational aspects of care, including moving and handling, and wound care

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• Safety and protection, including medicine management and infection control

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• Nutrition and fluid balance, including hydration and nutrition.

Designed to allow readers to develop and enhance their clinical skills with one key textbook, each chapter contains learning outcomes, recommendations for practice, case studies, activities, 'clinical significance' highlights and step-by-step guides to important procedures.

This invaluable clinical skills textbook is an essential reference for pre-registration nursing students of all fields of nursing.

Chapter 1

The professional role of the nurse

Kathy Wilson and Nora Cooper

My aunt’s basic human rights as a person, never mind her special needs and rights as a person with severe disabilities, were totally disregarded and neglected. I am certain that she was in great distress and felt totally alone and abandoned (Mrs H’s niece).

(Health Service Ombudsman, 2011, p. 23)

Key concepts

Care, compassion

Professional role

Beliefs and values

Culture

Leadership

Raising concerns

Duty of candour

Fitness to practice

Learning outcomes

By the end of this chapter you will be able to:

■Discuss some of the key historical influences that have shaped nursing over the years

■Explore the underpinning beliefs and values of the nurse

■Identify relevant professional standards and regulations

■Debate key policy drivers that influence the professional role of the nurse

■Reflect on the knowledge and skills required by the nurse in contributing effectively to the transformation of services and care delivery models.

Introduction

The statement that opened this chapter may cause emotions of shock and outrage but this is unfortunately one of many similar statements that have been reported by the media over the past few years, reflecting serious incidences of poor practice. While care delivery involves a large number of multi-professional staff across a range of levels, often it is nurses who have been singled out as culprits in many of these cases.

Discussions about professionalism and why compassion appears to have disappeared from nursing values have been widely and thoroughly debated with a number of key policies published just prior to and following the investigation and publication of the final Francis Report in January 2013 (Francis, 2013; Keogh, 2013). This report detailed the serious failings at the Mid Staffordshire NHS Foundation Trust, highlighting poor leadership, in particular, as one of the main reasons for these organisational failures. The Francis Report details 290 recommendations for improvements in care, culture and education. Twenty-nine of these recommendations specifically focused on nursing. This report and the subsequent dissection and analysis by the media, professionals and policy-makers are considered a watershed moment for nursing.

This negates the fact that over the past 15 years, nursing has gained increasing recognition as a profession, with the inception of an all-graduate education and the development of advanced practice, together with an increase in the autonomous roles of the nurse.

Ensuring pride in our profession and giving patients the very best care with compassion are key aims for the nursing workforce and this was specifically expressed by the Chief Nursing Office for England in 2012. The publication Compassion in Practice outlined a vision and strategy for nursing, midwifery and care staff (Commissioning Board Chief Nursing Officer and DH Chief Nursing Advisor, 2012).

To be a professional is to be engaged in activities that are guided by a body of knowledge and evidence. The registered nurse must understand what it means to deliver professional practice within this constantly changing environment (Murphy et al., 2009). Nurses need to feel confident and proud of their profession and strive further to make positive contributions to multi-disciplinary care in an ever-changing and politically-driven healthcare arena. In this chapter a number of views of nursing will be represented and the public perception of professionals, i.e. the social and historical context of professional practice will also be discussed.

It is important that student nurses aiming to be admitted to the register have an understanding of why all nurses are bound by a professional code of conduct and what constitutes the hallmarks of professional behaviour as dictated by the Nursing and Midwifery Council (NMC, 2015a). In addition to practising in accordance with the Code and as a reflective practitioner, nurses also need to consider their own values, beliefs and actions in terms of how these translate into ‘professionalism’.

The aim of this chapter is to explore the professional role of the nurse. Being able to articulate the essential duties of the nurse will aid critical reflection which is crucial to the delivery of safe, competent and compassionate care, which should lead to an enhanced patient/service user experience, promote the uniqueness of nursing within an inter-professional team and support a strong professional identity for nurses. The remaining chapters in this book will help facilitate the integration of theory and practice and enable the student nurse to develop a thorough understanding of the evidence base that supports practice and builds on the knowledge and skills required by all nurses in the delivery of high quality care.

The nurse of today

The role of the nurse is constantly changing in every field of practice as services evolve and patient/service user needs alter as a result of the changing sociocultural environments we live in: developments in science and technology; new models of service delivery; flexible pathways to registration; health inequalities and an ageing population with co-morbidities are some of the factors that impact on the role of the registered nurse practitioner.

Activity 1.1

It is useful to reflect on your reasons for becoming a nurse and if your values have remained the same. Consider the following questions fully and seek opportunities to discuss your thoughts with colleagues.

■Why did you decide to become a nurse?

■What did you think you would do as a nurse? If you are already qualified, try to remember how it felt to be starting out in your nursing career.

■What is it that you value most about being a nurse?

One of the most common reasons cited at interview by prospective nursing students for wanting to be a nurse is helping people, perhaps as a result of having witnessed sick relatives being cared for in a hospital or community setting. It is noted that those who enter the profession later in life, sometimes after a number of years in other jobs, voice concerns about wanting to do something worthwhile. Anecdotally, it would appear that few candidates have stated that they want to be part of a distinct professional group (perhaps like medicine) or indeed fully recognise the autonomous role undertaken by many practising nurses. With the introduction of an all-graduate profession, it will be interesting to note if these views change with more candidates considering the excellent opportunities to combine an academic and clinical career with the increase in availability of Post-Graduate programmes, with initial registration as well as post-registration pathways to Masters and Doctorate programmes.

When one considers why nurses remain in the profession, it is more complicated as there are many reasons why people continue in an occupation that is often stressful and demanding. Some may see nursing as a job which pays the bills and provides job security but many remain highly committed and enjoy their roles, and, despite very negative and sometimes shocking reports, they remain proud of their profession and continue to strive to deliver a high standard of care. Nurses in Society, a report commissioned by the Chief Nursing Officer on behalf of the Department of Health (DoH, 2008), interviewed a number of senior practising nurses and identified five aspects they valued most about nursing:

1Making a difference to patients’ lives

2Close contact with people

3Delivering excellent care

4Working in a team and being a role model

5Continuous development.

The increased number of career opportunities that nursing offers nowadays (nurse consultant, advanced nurse practitioner, nurse researcher, nurse educator) together with a high level of respect for nursing within the multi-disciplinary team appeals to many who are keen to progress in their careers. An occupation that brings relative security, job satisfaction and career progression is an attractive career option. This needs to be promoted more fully to ensure that this essential workforce is maintained. While the professionalisation of nursing has developed over the years, the image of the nurse has not always been portrayed in this light. It seems that the role of the nurse remains largely misunderstood by the wider public.

A professional image is influenced by the views of the society it serves and nursing is no exception. The social context has shaped nurses’ attitudes, public attitudes and in many ways, the direction of nursing practice. Hoeve et al. (2013) refer to the work of Bridges in 1990 which identified 34 different nursing stereotypes, many of which are unflattering and inaccurate and unfortunately still seem to influence public perception today. They advocate that nurses should stand up for themselves more, increase their visibility and use their professionalism to enhance understanding about what nurses actually do. Much of the negativity still stems from the fact that nursing has always been a largely female occupation. However, a Nursing and Midwifery Council (NMC) report states that there are now 65,755 male nurses, representing over 10 per cent of the nursing workforce (NMC, 2010). An understanding of the history of nursing will enable a better understanding of the development of the profession and how the past has shaped the present.

Historical perspective

Throughout history, nursing has existed formally or informally in the form of caring for the sick. Historically care has been seen as a feminine practice, almost exclusively performed by women and often viewed as low-level and low-profit work.

Charles Dickens, in his 1843 novel, Martin Chuzzlewit, depicts the poor state of nursing care in his representation of the drunken character Sairy Gamp, whom he claimed was based on a nurse he knew. At the other extreme, nurses were often also described as members of religious orders in the Middle Ages.

In the mid-1800s in Europe, changes in the way nurses were trained were evident with the establishment of the Deaconess Institute at Kaiserswerth in Germany. A training programme for deaconesses had been set up in Kaiserswerth, and Florence Nightingale, who is widely viewed as the ‘pioneer nurse’ and founder of modern-day nursing, undertook her nurse training there in 1850 over a period of three years. In the mid-nineteenth century, the attitude remained that training was not required for nursing or for any other profession undertaken by women. Florence Nightingale challenged those who supported this sexist view of nursing and proposed that the ‘new nurse’ was to be trained and to have thoroughly mastered her subject just as a man masters his: ‘an uneducated man who practices physics is justly called a quack, perhaps an imposter but why are uneducated nurses not called quacks and imposters?’ (Seymour, 1932, p. 92), The general opinion at the time was that anyone could be a nurse, all that was required was instinct. Some of these beliefs have been perpetuated ...