Introduction
Nursing represents an essential part of the medical care of any country because of the specific range of duties and responsibilities nurses have. Though the nursing position has traditionally been perceived as a complementary, secondary one, the growing awareness of the nursing role in patient care, medical operations and manipulations, keeping medical records and other fields of activity has replaced the conventional underestimation tendencies.
Nowadays the field of nursing is paid more and more attention to, with the proper regard of ethical and safety rules and codes that nurses have to observe, the range of their responsibilities as well as the patterns of coordinating their activities with other health team members. Constructing a complete and effective image of what a nurse should do, as well as defining strict standards for the activity completion, is seen as the way to improving such vital medical care fields as handling patients, acute patient care, nursing turnover, etc.
It goes without saying that the function of a nurse as any other professional healthcare executive, is to provide a high quality of healthcare. As it comes from the available research, professionalism in healthcare involves recognition of multidisciplinarity of healthcare in modern settings, seeing partners in patients, and recognizing the public legitimate power in healthcare. A healthcare professional should provide reflective care, and execute professional, clinical and educational leadership (Royal College of Physicians of London, 2005).
However, the question is challenged by the initial selection of criteria to which the candidate for a nursing position should fit in order to qualify for the job. White (2004) considers the most essential elements for the professional nurse as follows: self-awareness (the ability to understand one’s inner self, incentives and beliefs, attitudes and philosophy as it is the key to understanding others), self-concept (only people with a positive self-concept will be able to work as nurses because of their necessity to give confidence, hope and optimism to patients and their family members) and self-care (it encompasses several elements dealing with inner and outer wellness in equal terms).
Outer wellness reflected in the process of self-care includes the appealing appearance (tidy, groomed nurses always act as a reassuring factor and an association with the quality of healthcare) and absence of bad habits such as smoking or unhealthy nutrition (nurses are the representatives of healthcare, hence they should propagate it). Socio-cultural wellness is needed to face the needs of patients who represent various social and cultural groups; the nurse should be tolerant and understanding towards them, and cannot have any biases about their beliefs or lifestyles.
Psychological and intellectual wellness is also helpful skills in the process of working with diverse patients, while spirituality assists the nurse in the communication with patients needing support, reassurance and faith (White, 2004). As one can see, there are many characteristics of a nurse that no other profession requires in the whole complex, so a deeper insight into what nursing roles and responsibilities are, and what place a nurse occupies within a health care team, will enable to produce more practical and relevant conclusions on the nursing professionalism concept.
Ethical Nursing and Safety in Nursing Care
Ethics is the science of living well and achieving a level of more excellence in life standards (Husted & Husted, 2008). There is a set of ethical values that shape the image of an ethically correct individual. They include fidelity (objectivity, watchfulness, imagination), purpose (determination in one’s actions, wisdom to make correct decisions, prudence and integrity – unacceptability of treason or indecency), and pride, that is the pleasure from exercising those virtues (Husted & Husted, 2008).
However, it would be wrong to suppose that a nurse, like any other individual, may learn ethics naturally without any guidance. It is thought that ethics is formed in every human being by means of observing others and reflecting the conclusions about differences and similarities on one’s inner self. Hence, the nurse should study the patient’s desires, reasoning, life, purposes and agency to produce relevant conclusions for him- or herself.
Nurses should look into their inner self to strengthen his/her ethical principles by means of realizing their desire for self-awareness and self-development, realizing their purposes and leading a successful life as professionals, understanding their need for a true and objective understanding of the world, control their effort and time, do good and avoid harm, and devote themselves to what they value (Husted & Husted, 2008). There is no need to mention that the nursing values involve dedication to the patient needs and fulfillment of the nursing responsibilities on allocating resources necessary for the patient in adequate amount and at a high quality of service.
Surely, there are some challenges that nurses face nowadays in terms of workplace ethics. Bosek and Savage (2007) described one of them as the challenge to meet ethical obligations towards the patient being at the same time stewards of resources for them, thus being unsatisfied with the quality of provided services under limited circumstances. Some other challenges include the ability to work professionally in the conditions of constant nursing shortage, as well as under the growing diversity of the surrounding community, requiring a nurse to develop additional skills and qualities to manage the needs of specific groups of patients accordingly.
Deriving the practical conclusions from the theoretical aspects of nursing ethics explained above, one should note some points in the 2001 Code of Nursing Ethics produced by the American Nursing Association. It reveals the theoretical assumptions of ethics stating that a nurse should:
- Take care about the patient disregarding his/her socio-demographic profile
- Take a primary commitment to a patient, be it an individual, a family, a group or a community
- Promote and advocate the protection of safety and health
- Be accountable and responsible for conducting optimal healthcare services, as well as for delegation of any related tasks
- Conduct personal and professional growth, taking care of personal safety as well
- Collaborate with other healthcare professionals etc. (Bosek & Savage, 2007).
Not much has been changed in the code of ethics within nearly ten years, and nowadays nursing ethics is known to be much more appreciated than some decades ago. Tschudin (2010) notes that virtue ethics is at the forefront of scientific attention in the present period of time. She states that scholars and nurses have acquired a better understanding of the inherent character of ethics existing in work, relationships, care, institutional life etc. Nonetheless, there is also much to do in the aspect of studying and enhancing ethics at the nursing workplace. To achieve this, more international, transnational and intercultural studies are required by truly international teams. Only this way one can ensure the comprehensive and precise nature of research (Tschudin, 2010).
However, one has to note that ethical and legal environments are closely interconnected within the nursing institution; they interrelate in the daily nursing practice and shape the pattern of the nursing profession, responsibility and basis for decision-making:
“State nursing boards approve and monitor nursing professional education programs that lead to initial licensure by the standards and procedures defined in laws. Pursuing an increase in their regulatory legitimacy, nursing schools create structural change… Therefore, legal statements regulating ethics education have coercion power for leading the structural change of nursing schools in relation to teaching ethics…” (Park, 2009, p. 107).
There is an Occupational Health and Safety (OHS) Act in every jurisdiction of Australia that governs monitoring of workplaces regarding safety, eliminating the threats to health, and handling the situations critical for employee health (Funnell, Koutoukidis, & Lawrence, 2008). One of the specific safety rules for nurses is the no-lift policy pertaining to the physical handling of patients. Since there used to be many workplace injuries connected with the necessity of manual moving patients, the Australian Nursing Federation initiated the no-lift, no-injury program in 1994; it is aimed at reducing the risk for nurses to get occupational injuries, and for patients to acquire such injuries as bruising or skin tears resulting from improper moving or falls (Funnell, Koutoukidis, & Lawrence, 2008).
The program led to the establishment of a proper procedure in terms of automated lifting of patients, leaving the possibility of manual handling only in extreme, life-threatening situations. In addition to no-lift policies, the Australian code of nursing professional conduct and safety involves compulsory observance of body posture and mechanics regulations (helping release stress and relax the body), mandatory immunization of nurses (healthcare agencies initiate immunization to protect nurses from infectious diseases they can obtain from patients), and techniques to resist the workplace aggression connected with the specificity of work (Funnell, Koutoukidis, & Lawrence, 2008).
Nursing Responsibilities and Roles within a Healthcare Team
Several decades ago, the responsibilities of nurses were limited to sanitation measures, nutrition, hygiene and comfort of patients, prevention of cross-infection etc. This means that the nurses usually performed as housekeepers, dietitians and cleaners (Funnell, Koutoukidis, & Lawrence, 2008). However, further on the profession evolved into a health-centered concept encompassing a multitude of considerations and obligations (moral, medical, legal etc.) towards the patient, the community, the employing authority and the profession in general (Funnell, Koutoukidis, & Lawrence, 2008). Among the most important responsibilities of nurses, one should note the ethical responsibilities referring to the ambience of medicine and nursing, and legal responsibilities referring to provision of safe and effective nursing care, health of the community, leadership and continuous professional education (Husted & Husted, 2008).
Even in general terms, the range of nursing responsibilities is not limited to being a care provider, an advocate, a communicator, teacher and a leader; a nurse is also a team member (Roshdahl & Kowalski, 2007). According to the opinion of White (2004), there is a multidisciplinary team in which the nurse has t cooperate daily, so he/she has to know the specificity of suchlike interactions. The team consists of nurses, a physician, a dentist, a registered pharmacist (to define the appropriate drug treatment), the physician’s assistant, a registered dietitian, a social worker, a respiratory therapist, a physical therapist, an occupational therapist, a speech therapist, and a chaplain (taking care about the spiritual needs of patients).
Special attention should be paid to the role of interactions between the nurse and the social worker. The latter forms the readiness of the family to accept the change and move the patient to the clinic of primary health care (PHC). Hence, the social worker is much more aware of the community resources; nurses and social workers should interact and share ideas to increase their efficiency in operations (Funnell, Koutoukidis, & Lawrence, 2008).
Ways of Improving Nursing Handover
As it turns out in the modern period of time, the computer-based information systems are already widely used in medicine, but are lacking in nursing care. Hence, the study of Moeller-Jensen, Pedersen, and Simonsen (2006) how efficiently the patient handover, ward around and patient conference activities that are traditionally conducted by nurses can be coordinated for increased information exchange between nurses, and more accurate decision-making on treatment-related activities resulting from the introduction of Electronic Health Records (EHR) in hospitals.
The scholars note that the patient handover that traditionally occurs three times a day, lasts for about an hour and takes place at the beginning of the nursing shift, does not offer enough opportunities for nurses to communicate the information about patients. It results in the loss of time and effort for duplicating records, which could be avoided through the introduction of HER where the systematized information for nursing handover, ward around and patient conferences would be available (Moeller-Jensen, Pedersen, and Simonsen, 2006).
In addition, the informational perspective is now applied to assessing and improving patient handover. It may be traditionally seen as the provision of information to right people at the right moment. Hence, the communicative element of patient handover should also be taken as a central component for quality provision and improvement. Information technologies currently introduced in medical care are successfully used to improve medical care management, and handle the problem of over-abundance of information in the medical records, thus helping to solve the issues of communication in medical handover (Yee, Wong, & Turner, 2006).
Conclusion: Nursing Professionalism
As it comes from the present paper, there is a great set of demands and requirements to a genuine nursing professional. Besides the internal coherence, self-awareness and self-management, the nurse should be an embodiment of a healthy way of life and security that he or she propagates and promotes in the community. A professional nurse should comply with the code of ethics in nursing and medicine as well as with the set of legal regulations governing the procedures of providing healthcare.
It does not mean that nurses are only the tools for resource allocation for patients; they are also subject to numerous workplace safety rules such as no-lift policies, body mechanics and posture, anti-aggression issues etc. Nurses have a variety of workplace responsibilities that go far beyond ambulatory care for the patients; a truly professional nurse should be a manager, a leader, a professional and educational inspirer and scholar constantly working on the improvement of the nursing care quality in theory and reality.
References
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Funnell, R., Koutoukidis, G., & Lawrence, K. (2008). Tabbner’s Nursing Care: Theory and Practice. (5th ed.). Chatswood: Elsevier Australia.
Husted, J.H., & Husted, G.L. (2008). Ethical decision making in nursing and health care: the symphonological approach. (4th ed.). New York: Springer Publishing Company.
Moeller-Jensen, J., Pedersen, I.L., & Simonsen, J. (2006). “Measurement of the Clinical Usability of Configurable EHR”. In A. Hasman et al. (Eds.). Ubiquity: Technologies for Better Health in Aging Societies. Amsterdam: IQS Press.
Park, M. (2009). The Legal Basis of Nursing Ethics Education. Journal of Nursing Law. New York. Vol. 13, Iss. 4. pp. 106-114.
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White, L. (2004). Foundations of Nursing. Connecticut: Cengage Learning.
Yee, K.C., Wong, M.C., & Turner, P. (2006). Medical error management and the role of information technology – A new approach to investigating medical handover in acute care settings. In A. Hasman et al. (Eds.). Ubiquity: Technologies for Better Health in Aging Societies. Amsterdam: IQS Press.