Factors Impacting on Nursing Care Quality

Factors Impacting on Nursing Care Quality Introduction Nurses play an indispensable front-line role in patient care within the NHS. However, issues such as role ambiguity, management concerns, training deficiencies, and a limited evidence-base raise serious questions about the quality of health care nurses dispense. This essay considers some of these issues. Role Ambiguity Although nurses offer a wide variety of patient care services, there is considerable ambiguity about specific work responsibilities in some areas of nursing (Goll-McGee, 1999; Rask Hallberg, 2000; Hinsby et al, 2004; Dickens et al, 2005; Needham et al, 05; Sekula, 2005). Forensic psychiatric care is a good example. In a comprehensive survey of nurse’s views about their job responsibilities, Rask and Hallberg (2000) found significant differences between licensed mental health nurses and registered nurses in the emphasis attached to key nursing roles, such as assessment, medical tasks (e.g. giving medication), and actions relating to patients ‘daily living activities’. Nurses often feel uncertain about whether they can undertake certain tasks autonomously without incurring the wrath of doctors. For example, much has been written about nurse-initiated thrombolysis for cardiac patients (Rawles, 1994; Smallwood, 2000; Smallwood et al, 2004; Kelly, 2004). Patients pres enting at an A E unit with cardiac symptoms may benefit from nurse-administered thrombolysis prior to formal medical screening. This would include performing an electrocardiogram and administering a thrombolytic agent via a standard protocol. Although nurse-induced thrombolysis may significantly reduce door-to-needle times, until recently there was no precise definition of this role in nursing literature. Nurses are often unsure precisely what roles they are expected to perform to deal with problems like teenage pregnancy and STD transmission (Campbell, 2004). This situation is confounded by the fact that sexual health needs vary considerably across specific patient groups (e.g. HIV incidence is significantly high and access to health access seemingly more limited amongst African/immigrant communities) (DOH, 2001, 2002; 2005a, 2005b; also see Erwin et al, 2002). The net effect of this haziness is that nurses may not always be entire certain of their role at critical moments, or may feel too stressed out, in situations where immediate patient care is paramount. Workload, Time Management Training Issues The issue of work-related stress (Ewers et al, 2002) is directly implicated in workload time management. It is no secret that nursing staff in the UK can be overworked at times (Kilfedder et al, 2001; Hinsby Baker, 2004; Hughes Umeh, 2005). A major reason for this is the severe time constraints created by the multiplicity of tasks nurses are required to perform. The Nursing Stress Scale (Plant et al, 1992; Tyler Cushway, 1995), a standard measure of work stress experienced by nurses incorporates workload as one of several separate and distinct sources of stress, highlighting the importance of this factor in nursing care. The workload problem was emphasised in a recent article about school nursing (Martell, 2005). School nurses are heavily under resourced but yet face an arduous workload, more so for those working in the pubic sector. Staff shortages and a multiplicity of responsibilities means that not enough time is spent on health promotion and in the classroom. More than half o f school nurses report feeling ‘emotionally drained’, and work excess hours on a daily basis, several times a week. The level of stress seems to vary considerable across different nursing fields. A recent study found that registered nurses report higher levels of stress compared with psychiatric nurses especially in the absence of social support (Hughes Umeh, 2005). Then there is the issue of training. Nurses in the UK receive extensive training before being employed to work on the ‘frontline’ (Campbell, 2004). However, questions have been raised about the adequacy of existing nursing education in various aspects of patient care. For example, although it has been suggested that nurses can play a crucial role in evaluating and caring for victims of sexual assault, nurses in the UK currently receive no formal training in this area (Dinsdale, 2005). Another area of training deficiency is in HIV prevention. Although the Nursing and Midwifery Council (NMC) appr oves specific training courses for nurses in this area, universities and colleges are not compelled to offer them, â€Å"Pre-registration training for nurses does not include mandatory education relating to sexual health services. Nurses working in sexual health gain post-basic education in an ad-hoc manner through working in the specialty, and by undertaking specialist post-registration courses (Campbell, 2004, p.169). Nurses often receive limited (if any) training in the care of specific patient groups. For example, few nurses have special knowledge of the health care needs of ethnic minorities communities (DOH, 2000b; Andalo, 2004). Those who by chance spend some time working in such communities may gain some of the necessary expertise, but otherwise most nurses may be uninformed in this area. School nursing is another area in which training needs are not being met (Harrison, 2004; Martell, 2005). Martell (2005) reports that school nurses often have limited access to essential training for their role. Research Evidence-based practice As with other branches of health care there is increasing emphasis in nursing care on evidence-based practice (Lewis Latney, 2003; Thompson et al, 2004; Ring et al, 2005). Feasible evidence-based practice requires an adequate evidence base (Lewis Latney, 2003). However scientific literature in certain areas of nursing care is often patchy, delaying the development of appropriate ‘best practice’ statements that will ensure consistency in the quality of care nurses dispense across all sectors of the NHS and private sector (Hoskins, 2000; Serrant-Green, 2004). The importance of evidence-based ‘best practice’ guidelines cannot be overstated. The Nursing and Midwifery Practice Development Unit (NMPDU) emphasises their importance in achieving consistent care delivery across nursing sectors. Unfortunately, even where best-practice guidelines have been widely developed for nursing care, as is the case with NHS Scotland, implementation is often slow and inconsisten t (Ring et al, 2005). Nurses rarely refer to an evidence base when making decisions about patient care (Thompson et al, 2004). For example, midwifes often fail to offer antenatal HIV testing to women for ethnic minority backgrounds, to avoid appearing discriminatory (Gibb et al, 1998), even though such testing is a standard recommendation of the National Institute for Clinical Excellence (NICE), DOH, and Nurse Agencies National Minimum Standards (DOH, 1994, 2000a). Guideline execution can be hampered by many factors including resource deficiencies, lack of training, resistance to change, lack of emphasis or prioritisation, absence of local nurse ‘leaders’ who can champion best-practice ideology, and resistance to change. Fulbrook (2003) notes that nursing knowledge and care often derives from more experiential and in-depth one-to-one interactions with patients, rather than formal scientific doctrine. Thus, it is questionable whether existing best practice statements, wh ich are rooted in positivist literature, are indeed appropriate for nursing care. Conclusion The quality of nursing care patients receive may often be compromised by workload issues, training deficiencies, a paucity of an adequate research evidence base, inconsistent implementation of clinical guidelines, and poorly defined job responsibilities. It appears these problems are rather more pressing in the public compared with private sector. A recent study of the work-related perceptions of nurses working in non-NHS facilities found that nurses in this sector reported greater levels of support, cohesion, job clarity and physical comfort (Dickens et al, 2005). However, they also indicated greater work pressure. There appears to be significant variation across various nursing specialties in the importance attached to key aspects of nursing care, such as patient assessment. Furthermore, certain nursing domains, for example school nursing, suffer from severe staff shortages, a multiplicity of responsibilities, and significant training issues. Overall, nursing care in the UK appears to lack the support it needs to meet expectations. References Andalo, D. (2004) How to sell. Nursing Standard, 18, pp.14-17. Campbell, P. (2004) The role of nurses in sexual and reproductive health. Journal of Family Planning and Reproductive Health Care, 30, pp.169-170. Department of Health (1994) Guidelines for Offering Voluntary named HIV Anti- Body Testing to Women receiving Antenatal Care. London, Department of Health. Department of Health (2000a) Nurse Agencies National Minimum Standards: Nurse Agencies Regulations.London, Department of Health. Department of Health (2000b) Black and ethnic nurses midwives and health visitors leading change a report of the Mary Seacole leadership award the first five years. London, Department of Health. Department of Health (2001) The National Strategy for Sexual Health and HIV. London, Department of Health. Department of Health (2002) The National Strategy for Sexual Health and HIV: Implementation Action Plan. London, Department of Health. Department of Health (2005a) Integrating the National Strategy for Sexual Health and HIV with Primary Medical Care Contracting. London, Department of Health. Department of Health (2005b) HIV and AIDS in African Communities: A Framework for Better Prevention and Care. London, Department of Health. Dickens, G., Sugarman, P. Rogers, G. (2005) Nurses’ perceptions of the working environment: a UK independent sector study. Journal of Psychiatric Mental Health Nursing. 12, pp.297-302. Dinsdale, P. (2005) Pioneering nurse-led assault service. Nursing Standard, 19, p.9. Erwin, J., Morgan, M., Britten, N., Gray, K. Peters, B. (2002) Pathways to HIV testing and care by black African and white patients in London, Sexually TransmittedInfections, 78, 37-39. Ewers, P., Bradshaw, T., McGovern, J. Ewers, B. (2002) Does training in psychosocial interventions reduce burnout rates in forensic nurses? Journal of Advanced Nursing, 37, pp.470-476. Fulbrook, P. (2003) Developing best practice in critical acre nursing: knowledge, evidence and practice. Nursing Critical Care, 8, pp.96-102.Gibb, D.M., MacDonagh, S.E., Gupta, R., Tookey, P.A., Peckham, C.S. Ades, A.E.(1998) Factors affecting uptake of antenatal HIV testing in London: results of a multicentre study. British Medical Journal, 316, pp.259-261. Goll-McGee, B. (1999) The role of the clinical forensic nurse in critical acre. Critical Care in Nursing Quarterly. 22, pp.8-18. Gray-Toft, P. Anderson, J.G. (1981) The nursing stress scale: development ofan instrument. Journal of Behavioural Assessment. 3, pp.11-23. Hinsby, K. Baker, M. (2004) Patient and nurse accounts of violent incidents in a medium secure unit. Journal of Psychiatric and Mental Health Nursing. 11, pp.341-347. Hughes, H. Umeh, K. (2005) Work stress differentials between psychiatric and general nurses. British Journal of Nursing. 14, pp.802-808. Kilfedder, C.J., Power, K.G. Wells, T.J. (2001) Burnout in psychiatric nursing. Journal of Advanced Nursing. 34, pp.383-396. Harrison, S. (2004) School nurses pivotal to achieving health targets. Nursing Standard, 19, p.7.

Peer-Reviewed Article: Heart Disease Essay -- Article Review

There are many reasons I have used health care services at different times in my lifetime from birth to the present time. I have utilized pregnancy healthcare services. I have used health care services for preventive care such as a yearly Pap smear or health physicals. My friends, family and my co-workers may use health care services for the same reasons as mine, especially if they are of the same gender. The peer-reviewed article that I chose was about heart disease. Heart disease needs particular attention from health care administrators, since â€Å"Chronic heart failure (CHF) is a progressive syndrome that results in a poor quality of life for the patient and places an economic burden on the health care system†. (Ramani, Uber, & Mehra, 2010). There is no one test to diagnose heart failure. Hypertension increases the risk of heart failure 2 to 3 fold. (He, et al, 2001) The American College of Cardiology (ACC) has identified 4 stages of heart failure. (Hunt, Abraham, Chin et al, 2009). Screening patients for heart failure is sometimes controversial. Health care administrators...

Outline the Ways in Which Rubbish Can Be Said to Have Value in a Consumer Society

Since the latter part of the nineteenth century, contemporary UK society has been steadily changing. Where once we tended to define ourselves by our employment and the status in society that position may have given us, we now define ourselves much more by the goods we buy and choose to surround ourselves with (Hinchcliffe 2009). What we wear, the house we live in, the food we choose to buy and the experiences we create for ourselves all are thought to say more about us personally and as a society and have led to the creation of the term ‘consumer society’(Hinchliffe 2009). The rise in disposable income and the ability to acquire easy credit has enabled the vast majority of the UK population to buy goods more readily than at any time ever before and to fill our homes with an array of consumables. However this increase in affluence has generated a massive rise in consumer goods being manufactured and purchased and consequently is creating huge amounts of waste in return. Outdated and broken goods, massive amounts of packaging and waste created during manufacture are proving increasingly difficult to dispose of. The resources being depleted in order to create and transport goods are also having devastating consequences on the earth and the environment and are not sustainable (Brown 2009). This essay will look at some of the ways in which we can revalue this rubbish in our ever changing and evolving society. When we purchase goods today there are many factors that can eventually transform the item into what we would commonly term as ‘rubbish’, something of no value whatsoever to its owner. Goods are made increasingly cheaply and in quantity to allow for low selling prices and are not necessarily built to last. The cost of repair can be more than replacing the item itself with very few specialist repair services being offered on the high street nowadays. Ever changing fashions and trends altering every season can lead to everything from shoes to furniture being thrown away and replaced in order for one to stay ‘in trend’ in our modern consumer society (Brown 2009). One theory of how rubbish can be redefined and given new value is put forward by Michael Thomson (Brown 2009). His theory suggests that items can move from being valued into the category of rubbish and out again into something of value. Items can be ‘Transient’, in other words, not built to last and consisting of most of the consumer goods such as mobile phones and clothing we can purchase in our shops today. Their value will decrease with use and they will often be replaced as fashion and trend dictates and newer and more desired items come on to the market. Other items can be called ‘Durables’. These items are often more expensive to buy and gain value over time such as good jewellery, paintings and rarer items people may wish to invest in or collect. His third category is one of ‘Zero value’ such as completely broken items and worn out clothes (Brown 2009). Economic reasons can be one of the ways in which new value can be placed on an object. The rise in charity shops, car boot sales and online auctions enables some of the ‘Transient’ items to be given new value. One person’s rubbish may be of value to another (Brown 2009). The changing economic climate since the recent credit crunch and more unemployment may mean that people with more time and less money may find uses for the worn out clothes and other ‘Zero value’ items by repairing or recycling in some innovative way(‘Reflections on Material Lives’,2009). Transient goods can become out-dated over time until they apparently become almost worthless. Some of these goods may then become popular or appealing in some other way. For instance a new trend in retro items such as the current interest in ‘shabby chic’ goods gives the items a fashionable appeal. Old and outdated consumer goods can become of interest to collectors and as interest increases so does the value. If these goods are no longer being produced, demand will outweigh supply and thus increase their price and therefore their value (Brown 2009). Aesthetic revaluation is another example of how new value can be given to rubbish. Some contemporary artists such as Tracey Emin and Chris Jordan (Brown 2009) have created works containing junk and other waste such as plastic cups, circuit boards, empty bottles and cigarette ends. By making a statement about our wastefulness in our consumer society in their works, they are bringing new value to rubbish by transforming it into valuable objects of art (Brown 2009). Environmental concern is another aspect that is prompting the revaluation of rubbish. In 2008, the waste generated more quickly than could be disposed of, was said to be 40% greater than the earth’s available yearly resources (Brown 2009). The earth’s resources and its capacity for absorbing the waste we generate has become environmentally unsustainable. Disposing and recycling of rubbish is now huge international business and although there is great economic value in this for the companies involved the need to find ways to sustain the environment is also a major factor in this process (Brown 2009). Transporting rubbish around the world where it is recycled more cheaply and remanufactured into a usable commodity to be shipped back, highlights the new value of some of our rubbish. Waste plastics, paper, card and glass are now just some of the products collected, recycled and sold for profit. Previously they may have been simply landfilled at not only monetary cost, so of ‘negative value’, but as we are now discovering, great cost to our planet (Brown 2009). Revaluing rubbish can therefore come about in many ways. In an ever growing consumer society we are beginning to become more fully aware of not only the amount of rubbish we are generating, but the understanding that by revaluing this waste we are helping to sustain the planet. Where once we would have thrown it into the bin without thought, we now know the ‘value’ of our waste. The increasing demands to cease using plastic carriers in favour of supermarket ‘bags for life’; the prevalence of car park bottle bins and clothing banks; the household recycling bins are all constant reminders to us of the value of our rubbish. Economic value can be added to out dated goods due to new trends and fashions and as items become of interest to collectors. The less there may be of something and the more the demand is for it; the more likely the value will be raised creating further interest and higher prices. Taking junk and turning it into art also revalue’s rubbish. Many artists are seeing the possibilities of pointing out to us our wastefulness and by using rubbish in their art they are turning it into something of artistic merit and often considerable monetary value (Brown 2009). Moreover, even design students today are being taught to utilise used items and create something new and useful or aesthetically appealing from them. (Reflections on Material Lives’, 2009). Whether selling our old possessions on online auctions for profit or donating to the charity shop, we are giving new value to what we no longer feel has worth. Rubbish is becoming more and more valuable as our consumption as a society grows ; â€Å"at a time when we’re both short of materials globally as well as short of energy globally, we’re now looking to waste as a real resource† ( Reflections on Material Lives,2009).

David Humes Views On Natural Religion - 2294 Words

In Dialogues Concerning Natural Religion, David Hume challenges the existence of God by presenting three different arguments from the perspectives of three philosophers. First is that of the fideist, Demea, who presents the weakest argument. The reader is quickly aware that this perspective is the least believable according to Hume. Although Hume quickly dismisses the idea of faith as a basis for the existence of God, he uses faith as a wedge in the attempt to break apart the argument of for intelligent design presented by the second character Cleanthes. A majority of the Dialogues is dedicated to this cause, as the strongest argument is from the perspective of intelligent design. The third character, Philo, is the skeptic wielding the pickaxe, and believed to be the voice of Hume, has the most difficult time dismantling this concept. By the end of the dialogue, it is unclear as to the true position that Hume is taking concerning natural theology. It is my understanding that H ume would accept the existence of God through the perspective of natural theology, if it were not deterred by the misuse of a Deity through organized religion as a means to control the masses. Because of this misuse, it is understandable why Hume remained a skeptic (at least publically) for the duration of his life (Craig 486-512). As we begin the Dialogues, Demea is complimenting Cleanthes on the education of his young student, Pamphilus. I find the compliment disingenuous. I believe it servesShow MoreRelatedHumes Ethics1047 Words   |  5 PagesHume’s Ethics Contents 1. Introduction 2. Hume’s ethics as an emotive theory of ethics 3. Conclusion 4. Bibliography David Hume is an outstanding Scottish philosopher of the 18th century whose views has a significant impact on the following generations of thinkers throughout the world. His sceptical arguments concerning induction, causation and especially religion, including his famous thesis that human knowledge arises only from sense experience and not from rational judgments, shaped theRead MoreEssay on An Analysis of Humes Dialogues Concerning Natural Religion4493 Words   |  18 PagesAn Analysis of Humes Dialogues Concerning Natural Religion ABSTRACT: Humes Dialogues Concerning Natural Religion (1779) may be read in the way Cleanthes (and Philo as well) reads Nature, as analogous to human artifice and contrivance. The Dialogues and Nature then are both texts, with an intelligent author or Author, and analogies may be started from these five facts of Humes text: the independence of Humes characters; the non-straightforwardness of the characters discourse; the way theRead MoreBy Definition Miracles Do Not Occur Essay1398 Words   |  6 PagesBy Definition Miracles Do Not Occur Even in this modern age, belief in the miraculous is widespread and is a feature of many world religions, including the Christian faith where miracles have played a significant role. It is important attempt to define what a miracle is, as this in itself is a source for debate. Today the term ‘miracle’ in many different ways and the idea is open to many interpretations. A miracle can be defined in a number of ways, firstly asRead MoreWilliam Paley And David Hume1260 Words   |  6 PagesAristotle. 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This is an important field of study, as with greater knowledge of the character of physical law, one finds more and more (rather than less) accounts of miracles being touted as exceptions to natural laws. Hume’s ideas on the matter are extremely illuminatingRead MoreDavid Hume Essay1210 Words   |  5 PagesDavid Hume Hume, David, 1711-76, Scottish philosopher and historian. Hume carried the empiricism of John Locke and George Berkeley to the logical extreme of radical skepticism. He repudiated the possibility of certain knowledge, finding in the mind nothing but a series of sensations, and held that cause-and-effect in the natural world derives solely from the conjunction ofRead MoreDavid Humes Theory of Ethics Essay1675 Words   |  7 PagesDavid Hume is considered to be one of the big three British empiricists, along with Hobbes and Locke, and lived near the end of the Enlightenment. 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Under fire from an agnostic skeptic and a rationalist, the empiricist view on skepticism and religionRead MoreComparing David Hume and Immanuel Kant Essay1356 Words   |  6 PagesComparing David Hume and Immanuel Kant David Hume and Immanuel Kant each made a significant break from other theorists in putting forward a morality that doesn’t require a higher being or god, for a man to recognize his moral duty. Although Hume and Kant shared some basic principals they differed on their view of morality. In comparing the different views on human will and the maxims established to determine moral worth by David Hume and Immanuel Kant, I find their theories on morality have someRead MoreImmanuel Kant And Kant On Morality1097 Words   |  5 Pagesanother, Immanuel Kant and David Hume. Immanuel Kant had many theories throughout his philosophical time. Here are some of his ethical works, Groundwork of the Metaphysics of Morals (1785), the Critique of Practical Reason (1788), and the Metaphysics of Morals (1797), which contains both â€Å"the Doctrine of Right† and â€Å"the Doctrine of Virtue.† He also had some other works of importance to his moral philosophy including the Critique of the Power of Judgment (1790), Religion within the Boundaries of Mere