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Global Perspectives of Nursing

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Hannah Withington

on 10 September 2013

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Transcript of Global Perspectives of Nursing

Global Perspectives of Nursing
Objectives
Look at person centred care and how patients needs are met through an inter-professional approach.
Person-Centred Care
Treating people as individuals, respecting them, their values and beliefs and developing mutual trust and understanding through the formation of therapeutic relationships between professionals, patients and their significant others.
Diversity
Recognizing and valuing difference in its broadest sense.
History
Look at the diverse roles nurses work in.
Look at how effective communication improves the quality of care delivered.
Discuss the Multidisciplinary Team.
In the 1920's New Zealand was the first known country to introduce a university programme for nurses.

(Chick 1987)
Today there are around 35 million nurses and midwives working around the globe.

(WHO 2007)
There is great diversity in the training and education of nurses around the world and many diverse roles to work in.

(WHO 2009)
'Encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings.'

(ICN 2002)
Nurses use clinical judgement in the provision of care to enable people to promote, improve, maintain or recover health or to die peacefully.

(RCN 2002)
Nursing
(DOH 2003, Hunt 2007)
Age
Ability
Culture
Ethnicity
Gender
Race
Religion
Sexual Orientation
ORBIS
ORBIS is a non-profit organisation fighting
blindness in developing countries, where 90 percent of the blind reside.

ORBIS has a Flying Eye Hospital which
makes it possible to provide ophthalmic training to communities throughout the world and to treat patients.
There are a variety of roles that nurses work in...

(Finke et al. 2008)
Nurses are responsible for:

Delivering care to patients in the operating, sub-sterile and recovery rooms.

Delivering care in the local hospitals.

Participate in training local health professionals in current ophthalmic surgical, pre/postoperative procedures, protocols and patient care.
Queen Alexandra's Royal Army Nursing Corps (QARANC)
deliver a high quality, adaptable and dedicated nursing care wherever the Army needs it.
Army Nurse
Postings vary from:

Ministry of Defence hospital units
Primary health care
Field hospitals
Close support medical regiments
General support medical regiments
Instructor posts (both military and academic courses)
Recruiting, management and staff (administrative).
Nurses could work in modern UK hospitals or in the more basic and challenging conditions of a field hospital.
Army nurses care for patients in physically and emotionally demanding situations.
Midwives are the main providers of care for childbearing women when their pregnancy is assessed to be low risk.
Midwifery
(Koblinsky 2006 & Cronie et al. 2012)
(Page 2003, Widmark et al. 1998)
Midwives also provide:
Parental education
Family planning (contraception)
Health information and education
Their role is to deliver a continuity of care for women throughout pregnancy, birth and the early weeks of family life.
Effective communication is the foundation of the nurse-patient relationship and is essential in the delivery of high quality care.
(Sheldon et al. 2006, Rosenstein & O’Daniel 2005)
Nurses are at the heart of communication as they assess, record and report on treatment and care.
They handle information confidentially, deal with complaints and report any concerns.
Without communication people are unable to relate to others, make their needs and concerns known or make sense of what is happening to them.
(DOH 2010a)
(DOH 2010a)
Effective communication improves the quality of care delivered as it:
Reduces the length of stay for a patient.
Creates a positive work environment.
Allows nurses to assess the unique needs of patients and then tailor their care to their individual, complex and varied needs.
Ensures each team member understands the plan of care, reducing delays and unnecessary mistakes.
(Rotter et al. 2010)
(Schmalenberg et al.2005)
(Shattell 2004, Williams 2006)
(Deering et al. 2011)
Relaxes patients, passes the time and helps them to forget their troubles.
(McCabe 2004)
Helps to establish rapport and trust, relieves anxiety and tension and conveys unspoken emotional messages.
(Sumners 1990, Astedt-Kurki 2001)
Enhances patient and family education, adherence to treatment and patient outcomes.
(Horton & Johnson 2010)
Decreases patient morbidity and mortality.
(Aiken et al. 2002)
Promotes patients' individuality, responsibility and participation in decision making opportunities.
(Boscart 2009)
Makes patients feel more comfortable to initiate social conversations with nurses and allows them to gain a better understanding of a patient's situation.
(Boscart 2009)
Communication
In nursing, the art of effective communication is to choose the best method that will have the highest impact on the person you are communicating to...
Face to Face
Sign Language
There are many ways in which the service has improved for patients as there is now access to:

Electronic records
Online referral system
GP's are informed of patients updates from their referrals via letters
Order prescriptions online
Translator Service
K2 - keeps an electronic log of patient's stay e.g. patient obs
Communication is an essential part in a midwives role to provide a safe service.

It is important to listen to the women and allow them to participate in decision making.

It is also important for a midwife to be sensitive to women's non-verbal communication.

An important aspect is establishing a relationship and building trust so the women feel cared for by the midwife.

Midwives significantly prefer to follow the women through their entire labour and birth.
Verbal
Non-verbal
Written
Pictorial Guide
Braille
Telephone
Video Link
Visual Aids
Translators
Communication has evolved...
Elective
(Butler et al. 2008, Lundgren & Dahlberg 2002, Halldorsdottir & Karlsdottir 2011)
Collaboration
Inter-professional collaboration is a range of professionals with varying skills that work together as a team to deliver care which focuses on a patient’s health and needs.

(Mitchell et al. 2008)
Benefits of Collaboration
Making use of various professionals' specialised knowledge provides effective patient care as the patient benefits from many forms of expertise.
Good patient care is achieved when multidisciplinary team members collaborate through the use of questions, reflection and reviews on each other.
Able to access other services to aid the patient as other professionals' opinions, perspectives and contributions to patient care are valued.
If all professionals are aware of all aspects of care the patient is receiving, each team member understands the plan of care, reducing delays and unnecessary mistakes.
Professionals flourish if there is a good team and patients feel more confident knowing the team work well together and are likely to be more cooperative with treatments.
Disadvantages of Collaboration
Ineffective communication within a multidisciplinary team can result in inadequate documentation and can obstruct information being relayed, this could compromise the safety of patients and hinder their outcomes.
If there is a lack of teamwork training, this could reduce the quality of care delivered and put patients' safety at risk.
Hierarchies within a team affects collaboration as if professionals do not voice their opinions this could hinder patients care.
If certain professionals do not enjoy their occupation, this can have an adverse effect on the rest of the team and could cause an increase in medical faults.
If the team leader is unapproachable and is unable to maintain cohesion between professionals it can lead to unproductive team meetings regarding patients' problems, progress and goals.
(Wong 2007)
(Benson 2010)
(Weller et al. 2011)
(Deering et al. 2011)
(Dean 2011)
Ensures the patient has a smooth journey from admission, to their care and being discharged through structured care plans.
(Rotter et al. 2010)
(Braaf et al. 2011)
(McQuillan 2009)
(Rice et al. 2010)
(Chang et al. 2009)
(Nagi et al. 2012)
If professionals do not understand each other's roles and responsibilities it can impede on consultations and referrals being effective.
(Murray-Davis et al. 2011)
Elective
Collaboration is important with midwives and they have contact with various other professionals to meet the needs of childbearing women.
Recommendations
Effective Collaboration
Different professionals came together quickly and efficiently for a woman who required an emergency caesarean.

Each team member knew their place and carried out their role to ensure the safety of the mother and baby in delivery.

Ineffective Collaboration
Patients can be missed through referrals not going through properly, human error and due to a heavy workload with lots of paperwork and writing.

This meant women were not being seen at the correct stages of their pregnancy for necessary appointments they required with different professionals.
Delivery of person-centred care is achieved by…
Is this down to effective professional integration?
Support patients', promoting their ability to make choices.
Make conference rooms available for collaborative meetings including the patient and their families.
Make the effort to go above and beyond their role, to gain trust and respect from patients.
Be a strong advocate for the patient and feel comfortable within the team to 'speak up' for the patient.
Keep patients informed and updated.
Meeting patients' needs effectively...
Provide emotional support and relief of fears and anxiety.
Deliver physical care, comfort and pain management.
Coordination of care and integration of services.
When patients' needs are met it can be down to professional integration as treating a patient requires collaboration between professionals, patients and relatives.
Different professionals need to work independently and then collaborate together in order to arrive at a joint goal for a patient.
Wanzer et al. 2004, Lee & Lau 2003, Auerbach et al. 2005, Verhaeghe et al. 2007, Binnie & Titchen 1999, Freitas et al. 2007, Stricker et al. 2009)
Patients' needs are met effectively when they are listened to so they receive the treatment they require. Their needs are then acted on with immediacy so that they are seen by the professionals they require effectively.
This improves patient outcomes and increases their satisfaction with the care they receive.
(Herdberg et al. 2008)
Summary
Having looked at the diverse roles in which nurses can work in and how communication and collaboration improves the service it has shown that the patient is always the main priority.
References
(McCance 2009, McCormack et al. 2008)
Teamwork training
Paperlite
Improve referral system
Improve
Communication
Make every interaction count with the patient.
(Duncan 2011, Holleran et al. 2012, Stichler 2011)
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12 weeks
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29 weeks
15 weeks
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Elective
Women and their unborn children are the centre to everything a midwife does.
They make sure to deliver person centred care via support, helping in decision making, delivering care and making interactions count so the women receive everything they require.
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