Health Watch

Professional nursing and the role of a practising nurse

Mallika De Silva Former Principal of School of Nursing (Dept of Health)

In order to understand the concept of professional nursing it is important to know what makes a professional, what does a professional look like, act like and behave like, and how can the nurses become more professional in the practice of nursing.

A profession by definition according to ‘choose nursing. com’, is a chosen paid occupation that requires prolonged specialized education and training. This is specially true for professional nursing. There are a number of educational paths to becoming a professional nurse, which vary greatly worldwide, all involve extensive study of nursing theory and practice as well as training skills that takes place in a college or university.

Professionals therefore can be defined as individuals expected to display competent, skillful behaviours in alignment with their profession.

As a profession, nursing is a humanistic, socially essential service which is instrumental in providing quality care to all people. The aim of nursing community worldwide is to ensure quality care to their patients, to society and to each other while maintaining their credentials, competencies, standards and the code of professional conduct. Accordingly throughout the world nurses are known to be caring individuals as ‘caring’ is the most important role in nursing practice.

Professional conduct

The members of any profession agree to observe the highest standards of probity and professional conduct at all times. As a whole code of professional ethics provides explicit guidelines that reflect common understanding of the professional community regarding what is and what is not expected of its members. Hence the code of professional conduct for nurses in most of the countries published by their nursing and midwifery councils/ professional nurses associations provide guidelines and standards for the practice of nursing.

While each country or health facility a nurse practices in may have a slightly different laws or policies governing what professional duties of a nurse may perform, professional responsibility in nursing is universal and refers more to a code of conduct and a standard of practice than to specific functions that may or may not be performed by a nurse.

It is an ethical duty of a professional to treat every individual with dignity and respect. They see value of each person. The International Council of Nursing (ICN) code of ethics defined that “Inherent in nursing is respect for human rights including the right to life, to dignity and to be treated with respect. Nursing care is unrestricted by consideration of age, colour, creed, culture, disability or illness, gender, nationality, politics, race or social status.”

In fact, nurses must relate to all persons worthy of respect and endeavours in all their actions to preserve and demonstrate respect for the dignity and respect the rights of each individual. A code of ethics is the foundation of good nursing practice and a key tool in safeguarding the health and well being of the public. The code of professional conduct sets out ethical behaviours expected of nurses, and it encourages practising registered nurses to provide fair safe and ethical treatment for all patients/clients and it strictly enforces all patients are worth the dignity and rights of human beings and should not be discriminated for any reason.

The code gives guidance for decision-making, concerning ethical matters and responsibilities in nursing practice. The code not only educate nurses about their ethical responsibilities in nursing practice but also informs other healthcare professionals and members of public about the moral commitment expected of nurses. Always the functions of nursing demands caring nature and should be abided by the caring principles as indicated in the code of professional nursing ethics.

Life - long learning

A professional commits to life-long learning and has a continuing duty to maintain professional knowledge and skills at a level required to ensure that an employer or client receives the advantages of competent professional service based on up-to-date development in practice, legislation and technique. Although the nurses enter the field armed with the knowledge they need to excel at their duties, there is an expectation

all qualified nurses will continue to learn to maintain professional growth and commitment for the service. Some countries have made continuing education for nurses mandatory and require certain number of course credit hours to be attained in order to renew their professional licence at regular basis to continue practise as registered nurses.

Changes

As the world is in unrelenting constant process of change specially in science and technology, the field of medicine, nursing and health care is always changing and evolving. As a result nurses are moving towards an era of science based practice in nursing that incorporate the latest findings from the behavioural and biological science in to practice to assist people of varying cultural background to adopt healthy lifestyle.

Internationally the nursing profession believes that learning needs to be a continuous

process for nurses to respond to the demands of rapid changes in science and technology.

Generally percentage of nurses is geared towards continuing professional education by attending seminars and conventions. Some are enrolling to mastoral and doctoral classes.

All are goaled towards becoming competent nurses. This means nursing education is not one-phase process. It does not end after becoming a registered nurse. It is continuous. Unending. Ever changing. The nurses must be abreast with new technologies, new approaches, and new techniques. Hence individual nurses are responsible for their own

learning. Providers of continuing education must have a commitment to involve learners in the learning process.

The continuing education assists nurses in the continuous acquisition of current knowledge, the extension of professional responsibilities, the expansion of interpersonal skills and the improvement of problem-solving approaches to professional practice. As the role of the nurse in emergency preparedness is also crucially important, the continuing education programmes need to have a deliberate plan for responding to various types of emergencies and disasters (natural, accidental pandemic etc).

The process of training and learning need to be a continuous cycle that involves planning, organizing, training, exercising, evaluating and revisions.

Handling disaster situations

These programmes allow nurses and other healthcare professionals to become engaged in emergency planning and be members of response teams in order to respond quickly when a disaster strikes.

Nurses can play a key role in advance of a disaster by preparing individuals, families and communities, so that potential health hazards are mitigated when disaster strikes.

The overall goal of disaster nursing is to achieve the best possible level of health for the people and the community involved in the disaster. Of course nurses are often in frontline to facilitate communication and coordinate care among members of healthcare team, patients and there families during a disaster. With the continuous learning process nurses are expected to be adaptive as changes are always constant in healthcare settings. Continuing education should serve as a viable means of improving the professional competence of the nurses with the outcome of improved healthcare.

Nursing includes a range of specialities and definitions that vary from country to country. According to the International Council of Nursing; “Nursing encompasses autonomous and collaborative care of all ages, families, groups and communities sick or well and in all settings. Nursing includes the promotion of health, prevention of illness and the care of ill, disabled and dying people.

Advocacy, promotion of a stable environment, research, participation in shaping health policy and education are also key nursing roles.” Caring and nursing have always been thought synonymously. Several nursing theorists today believe that caring is essential to the well-being of people. Nursing theorist Jean Watson defined “caring as a science that encompasses arts and humanities.” Watson further states that the caring makes a difference to the patient's sense of well-being. Caring may occur without curing but curing cannot occur without caring (Watson 2003).

Caring behaviour

Caring behaviours are defined as: behaviours evidenced by nurses in caring for patients.

The top ten caring behaviours; derived from nursing literature are; attentive listening, comforting, honesty, patience, responsibility, providing information so the patient can make an informed decision, touch, sensitivity, respect, calling the patient by dignified

manner. (Tablers 1993).

As nurses deal with sick and injured people and their families on a daily basis the caring behaviours of the nurse make the patients/clients more comfortable. Nursing theorist Madeline Leninger believe that care is the essence of nursing, the central dominant and unifying focus of Nursing (Vance 2009). The nurses’ primary goal of caring is to respect patient's physical, psychological, cultural needs and it allows them to start the healing process. When the patient is seen as a whole and not just as their illness or their disease, then it makes them feel human.

To be continued

Biggest health risks:

High blood pressure, smoking and alcohol

Institute for Health Metrics and Evaluation (IHME), global study of health risks finds that high blood pressure caused 9.4m early deaths, while smoking was next biggest

People with high blood pressure are at the greatest risk of ill health and an early death, according to the Global Burden of Disease Study, with tobacco use as the second biggest danger, and alcohol use third. Among young people, aged between 15 and 49, a drinking habit is the most likely cause of disability and an early grave.

High blood pressure can be caused or made worse by diet, such as too much sodium in salt and salty foods, but some populations have a genetic predisposition, as in India. In Europe and North America, many middle-aged people are given pills to bring their blood pressure down because it is a big risk factor for stroke, one of the main causes of death in the world today.

The IHME study finds that in 2010, high blood pressure was to blame for 9.4 million early deaths and 7% of DALYs (disability-adjusted life years – a standardised measure of the amount of poor health a person suffers). This compared with 6.3 million people killed as a consequence of smoking or inhaling other people's smoke. Tobacco also caused 6.3% of global DALYs.

Alcohol caused 5 million deaths in 2010 and 5.5% of global DALYs. Drinking can cause liver cancer and cirrhosis, but also plays a part in other diseases, such as cancer of the oesophagus, and kills because intoxicated people often end up in violent incidents and accidents. The study shows that alcohol has become a big problem now in eastern Europe, where it is responsible for a quarter of all disease. It also takes a big toll across Latin America.

Poor diet and inactivity together are responsible for 12.5 million deaths and 10% of disability. The biggest nutritional issues are diets that are low in fruit and diets high in sodium. Indoor stoves burning wood, animal dung, charcoal and coal, which pollute the air in homes in sub-Saharan Africa and Asia, are a big risk for disease and early death. The study estimates that they caused 4 million deaths – double the estimate WHO made in 2009. They can cause lung cancer and disease, lower respiratory infections in children, cardiovascular disease and cataracts.

Radha Muthiah, executive director of the Global Alliance for Clean Cookstoves, which is trying to get clean and affordable alternatives into poor homes, said: “These results provide further momentum to our mission to ensure that cooking doesn't kill.” Malnutrition and not breastfeeding for long enough are the other two major risks in sub-Saharan Africa.

-Guardian.co.uk

Caption: A blood pressure test. Diet is a major factor but some people are genetically predisposed to it.

Chest compression, only CPR shows long-term benefit

People who suffer cardiac arrest - in which the heart stops beating - were less likely to die in subsequent years when bystanders performed cardiopulmonary resuscitation using chest compressions only, a new study found.

That builds on previous research that found no short-term survival differences in adult victims given compression-only CPR instead of the standard kind, which includes mouth-to-mouth resuscitation.

And it supports an American Heart Association recommendation that the simpler form of CPR is appropriate for bystanders, who may feel so intimidated by the prospect of combining chest compressions with rescue breathing that they give no aid at all.

This study shows “we were on the right track in 2008,” said Dr. Roger White of the Mayo Clinic, who was on the advisory group that wrote the AHA's statement.

The recommendations don't apply to CPR performed in the hospital, nor in the community by medical personnel or people who are proficient in rescue breathing. They also apply only to adult, not pediatric, victims.

Some 383,000 people in the U.S. suffer cardiac arrests every year, and only about 10 percent survive.

The study looked at data from two randomized trials that were published in the New England Journal of Medicine in 2010 and covered more than 3,200 adults whose cardiac arrests were likely due to heart problems rather than trauma, suffocating or drowning. Dispatchers instructed bystanders via phone to use either the standard or compression-only form of CPR.

The new study's authors, who were from Seattle, France and Sweden, were able to follow up on longer-term outcomes for 78 percent of those participants.

The one-year survival rate was about 12 percent for chest compression alone and about 10 percent for compression plus breathing, said Dr. Florence Dumas, an author of the study, in an email to Reuters Health.

After adjusting for different factors, mortality in the compression-only group was 9 percent lower than in the standard CPR group. The survival benefit persisted over five years, according to findings published in the journal Circulation.

That suggests “that potential short-term outcome differences do translate to meaningful long-term public health benefits,” said Dumas.

Health News

Fighting obesity

The World Health Organization (WHO) estimates that by 2015, more than 700 million adults will be obese. What’s even more frightening is that just 50 years ago, there were absolutely no statistics on obesity.

Today, obesity has reached epidemic proportions globally with at least 2.8 million people dying yearly as a result of being overweight or obese.

Although obesity was previously thought to be confined to western countries, this fat pandemic seems to be a growing problem in Sri Lanka. A study published on ‘obesity review 2010’ (Katulanda P et al) confirmed that there is a large percentage of Sri Lankan adults in the overweight, obese and centrally obese categories; 25.2%, 9.2% and 26.2%, respectively.

People who are overweight have a multitude of ailments and health consequences that increase the risk of premature death and serious chronic conditions that reduce the overall quality of life. The WHO attributes that ailments associated with obesity and being overweight range from coronary heart disease, hypertension, ischemic stroke, type 2 diabetes mellitus and also increases the risk of certain cancers of the breast, colon, prostate, endometrium, kidney and gall bladder.

Furthermore, obesity also makes one more susceptible to high blood pressure and cholesterol, triglycerides and insulin resistance. A pioneer in the scientific slimming domain, VLCC Health care LTD has led and supported numerous initiatives that work towards promoting a healthier lifestyle including organizing numerous health camps, workshops, mass counseling and other pro-active initiatives to try and curb obesity.

At VLCC, we are guided by the vision of transforming lives and making fitness, beauty and health accessible,” says its Managing Director Sandeep Ahuja “With concerted efforts, we will continue to increase awareness and educate on lifestyle changes, and together with our holistic weight management program these lifestyle diseases can be prevented.”