Nurses must provide high quality, compassionate and effective care
Across the globe, nursing is one of the most regulated and valued profession in any healthcare system. Nurses advocate for patients, promote health and well-being, they also participate in management and health care research. Nurses are expected to conduct their nursing duties professionally by providing patient with high quality, compassionate and effective care (NHS England 2016). The history of nurses in a contemporary society cannot be achieved without the fundamental interpersonal skills by nurses who can demonstrate these skills when called upon to perform holistic care in the society. The government policy drivers report relating to care and compassion should be applicable to good practice in caring for service users. These practices are very much regulated to maintain accountability and professionalism in the profession.
The history of nursing began in the mid-nineteenth century, nursing was not seen as skilled job and no qualification is required. However, the professional nursing began with Florence Nightingale, who took a bold decision to become a nurse despite the disapproval of her family. Nightingale came from a wealthy background, she had different view and using scientific principles to care for the environment in relation to health to advance the care of the sick (Thomas 2016). During the Crimean war (1845), Nightingale led a small group of nurses to the military hospital in Scutari. They found wounded soldiers in an overcrowded accommodation, some were sleeping on the floor with no blankets, food or medicine. Their bodies were covered in lice, maggots and all medical care was given during the day. (Ellis and Hartley 2012 cited in Cherry and Jacob 2018).
At the barrack the surgeons and physicians at first refused Nightingale’s support but when they were in desperate need due to outbreak of dysentery, scurvy and starvation they asked for assistance. Nightingale used her money and the time relief fund to quickly purchase medical items, linens and food and within days she delegated jobs such as cleaning, social services and recreational area to her team, the soldiers and their wives. She also comforted the wounded soldiers, check on them at night which led her to be known as “the lady of the Lamp”. On her returned to England, she campaigned for cleaner hospitals and the money raised from her campaign, she used to establish the first nursing training school at St Thomas’ Hospital London during her service she promoted competent care as a basic human right (Nies and McEew 2015 cited in Cherry and Jacob 2018).
Nightingale played a major role in changing nursing, she was known for her contributions to improve sanitation in public health. She also used data analysis to advocate health conditions of British soldier’s, applied holistic approach for care delivery and was able to show the drop-in death rate which was due to improved sanitation, this led to the recognition of her contribution as a research nurse and her theory of environmental cleanliness is still relevant in today’s practice. Ellis and Hartley (2012 cited in Cherry and Jacob 2018).
Nightingale’s theory led to other theories in nursing such as Henderson theory (1964), Roper-Logan-Tierney’s theory (1980), Orem theory (1971), Benner theory (1982) etc. Theories are clinical backbone to support nursing practice. According to Parsons 1949, cited in Smith 2015 a theory is an idea that analyse experience, aim to explain and describe a subject and project an outcome. The purpose of nursing theory is to provide high standard of care, it helps nurses to explain nursing care and guide on how to give care competently and effectively. Benner used Dreyfus model as the base of her theory novice to expert which has five level of nursing experience-novice, advance beginner, competent, proficient and expert. Her theory suggested that through formal education and lots of clinical experience nurses can develop their skills and understand how to give competent care to their patient. Benner’s stages of clinical competence enable nurses to be proficient as they progress in nursing practice (Benner 2001).
It is important for nurses to have the best skills to deal with daily situations so that they can continue to give high quality care and build a therapeutic relationship with patient. To extend compassionate and effective care, nurses must acquaint themselves with fundamental interpersonal skills such as communication, Active listening, critical thinking, patience and compassion these skills play a vital role in assisting through various situations. Communication- is an essential skill in human interaction used to establish, improve and convey information between two or more people it can be verbal, non-verbal, written or electronic. Webb (2011) stated that communication is an important tool use to deliver a high standard of care, which enable patient to voice out their needs, engage in the care, help to build a therapeutic relationship and to comply with their treatment. A nurse must also have good documentation skills because it is classed as evidence in the court of law and if it is not documented it did not happen. Nursing and Midwifery Council (NMC) (2015), suggested that nurses should keep clear and accurate record which is relevant to their practice.
Nurses cannot deliver holistic care to the patients due to Poor communication this can impact on patient care leading to misdiagnosis, medication errors, waste of resources or even death. For example, the case of Baby P who had several contacts with healthcare professionals and other agencies i.e. police and they fail to protect him. According to Care Quality commission (2009) publication they identified lack of communication amongst health professionals and other agencies resulting to his death. For example: when he was discharged from the hospital, there was no official discussion to escalate concerns despite being on the child protection register they failed to protect Baby P.
Active listening requires giving full attention to the patient, it also develops trust, gather meaningful information and facilitate good quality care. Patients are sometimes anxious and uncertain about their experience in using healthcare system. As a nurse having compassion, empathy, being attentive and a thoughtful communication can enable patients to address their anxieties while ensuring that their needs and hopes are met, this will make patient feel valued and respected. (Kraszewski and McEwen 2010).
Compassion can be realised in practice by developing relationships, interpersonal skills and knowing the person that is sick. According to Matiti and Trorey 2008 cited in Dewar 2013, patients perceive good care as being able to express emotions such as vulnerability, being treated as an individual, their needs recognise, treated with respect and dignity also given them opportunity and choice to be involve in their care and making decision.
There are different policies that influence the nursing profession such as Francis Report, Lord Willis report, Every Child Matters etc. Policies in practice are essential for nurses to deliver effective care in connection with the inspection framework of Care Quality Commission (CQC). The necessity to strengthen compassionate practice has been a priority in nursing. Francis report examined the failings of care at Mid Staffordshire NHS Foundation trust, poor care led to several preventable tragedies, lack of compassionate care that is patient-centered such as keeping patients and equipment clean, call bell left unanswered, no transparency even when things needs reporting, and failings of the system/organisation. The report was the main driver of 6Cs of nursing. In 2012, the chief nursing officer of England Jane Cumming launched a strategy for nurses, midwives known as the 6Cs (Care, Compassion, Communication, courage, competent and commitment). The strategy was designed to restore public faith following failings at the mid Staffordshire and enable care staff to always place compassion and care as their central roles. It would also aid positive patient experience, strengthen leadership and ensure that staff with the right skills are in the right place. (Regan and Shillitoe 2017).
Compassion in practice is an important quality for a nurse, the ability to show kindness will make the patient feel respected and valued. Compassion have been highlighted as the appropriate system to give effective care which enhance the effect of illness, injury thereby reducing their length of stay in the hospital. For nurses to deliver good medical service they must put patient first and protect them from harm, maintain diversity and cultural differences, listen and respond effectively, empower and advocate for their patients. However, we ought to understand that nurses with higher potential to empathise with others relating to illness and distress could become compassion fatigue or stress and their organisation should have a structure in place to support those staff to avoid or reduce work stress (Lowerson 2015).
In today’s nursing, professionalism and accountability in practice is a key concern for registered nurses to give compassionate and effective care. Professional accountability means that every registered practitioner is accountable for their action by their regulatory body. According to Royal College of Nursing 2018, accountability is a legal requirement which all health practitioners need to be aware in practice. Professional accountable is a continuous process that always covers the nurses’ action even when they work outside their main job e.g. locum. The NMC set standards for nurses’ education, conduct, training and performance the aim is to protect the public by maintaining a register for qualified nurses’ midwives and health visitors. Nurses also need to always maintain professionalism. According to NMC (2018), professionalism is described by the independent evidence-based decision making by individuals from an occupation who share similar qualities and career. Professional accountability ensures regular safety and offer person-centered care that support patients to achieve good status of health and well-being.
Nurses must adhere to the NMC code of professionalism and accountability. They have a duty of care to protect patients in their care, they are accountable to NMC, their employer, the individual and public (Sage Pub 2018).
In conclusion, Nurses plays a vital role in our society, we have the responsibility for providing health care services and we must do so within the confines of the law that guides the profession and refer to them when making an informed decision which must be relevant to the laid down guidelines. It is also important to note that nursing requires us to possess high level of integrity besides being aware of standards of good practice.
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