Category: Job

What is a nurse? If someone were asked to describe the role of a nurse there could be many different answers. To a lot of people, a nurse will be viewed as someone who is there to support their patients, to be a friendly face and to give patients and family reassurance when needed. When asked what a nurse’s role entails, a few examples could be: giving medications, checking observations, completing paperwork and giving feedback to other members of a multidisciplinary team. A nurses’ role is very diverse, there are so many types of nursing and different people have different experiences with them. Because of this, nursing is hard to define. The Royal College of Nursing (RCN) came up with the following definition for nursing:

“The use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death.” (RCN, 2004)

Nursing is a lot more complex than it used to be. Historically, it was a job taken on by poor women who were neither trained, nor skilled. During the 19th century anyone could call themselves a nurse, without the need for any formal training. In 1919 The Nurses Registration act was passed, meaning that nurses had to receive standardised training and be added to a register. This was thanks to the work of nurses such as, Florence Nightingale, Ethel Fenwick and Dame Sarah Swift who championed the need for the training and registration of nurses. Thanks to this act and the work done by these prominent figures, nursing is now seen as a highly skilled profession. Nurses now have more skills than ever and are encouraged to take on further roles and responsibilities. Nurses also have the opportunity to become more qualified, taking on roles such as advanced and specialised practitioners, these roles, for example, can involve prescribing medications without the need of a doctor. Although time has moved on and nursing has advanced significantly, nursing is still a predominately female career choice. In 2017, only 10.8% of registered nurses were male. This has barely changed over the last ten years. Since 2006, there has only been a 0.1% rise in male Registered Nurses. (RCN, 2017)

In the 1990s, the education of nurses began to change. Instead of training in schools and colleges attached to hospitals, training for degrees in nursing, at universities, began. This scheme was called Project 2000. As people were living longer and technologies in medicine were advancing, it was decided that nurses would need the knowledge and education to reflect the advanced treatments they were administering. These days there is a lot more emphasis on theory than there used to be, so a student nurse’s time is spent, roughly, 50% in the classroom and 50% on the job, in a placement. (Patterson, C. 2012)

There have been many changes that have impacted on the role of nurses over the years. One of the most significant changes that impacted on the role of nurses was political, the founding of the NHS in 1948 and The NHS Act 1946. When the NHS first came about there was a severe shortage of nurses to the amount of beds in hospitals. The number of student nurses continued to grow over the years, but the role was changing. With new government policies, the public were now to be more responsible for their own health and wellbeing, with more choices. Nurses were also now more accountable for their actions and held more responsibilities than before. (Rivett, G. 2020) The political changes that take place can also have an impact on economical and sociological circumstances. For example, when the financial crisis happened in 2008, the government had to make budget cuts and reduce funding for public health. The financial strain had an impact on nursing with staffing and supply shortages, certain treatments having to be prioritised, the rising life expectancy of the public and health foundations having to budget more effectively. The rising life expectancy of the public is also classed as a social change that is having an impact. Because people are living longer there is more pressure on the NHS including its nurses. The costs for treating the elderly are rising. Technologies are also having to advance, and nurses are having to update their knowledge frequently because of this. (NHS, 2020)

As mentioned earlier, Nurses must be registered. The register is held and kept up to date by The Nursing and Midwifery Council (NMC). To register, nurses need to meet certain requirements. These include having the appropriate qualification, being of good health and character and use of English language skills. (NMC, 2019a) After three years, a nurse is required to revalidate their registration and evidence that they have met all the requirements to do this. It involves several different elements, which include, continuing professional development, reflective accounts and a certain number of practice hours. This is then all confirmed before revalidation. (NMC, 2019b) Apart from holding the register, the NMC are responsible for several other things. The NMC sets all the professional standards, education and skills that are required to become and continue to practise as a nurse. Through the NMC Code, they set the standards, behaviours, expectations and continuing development that are required to be upheld by nurses. Aside from the register, the NMC also deal with concerns about nurses who may not be doing their jobs effectively. The concerns that they investigate can include ill health, misconduct and criminal behaviours, amongst other things. They thoroughly investigate any allegations made and make sure that the nurse meets the NMC standards and is fit for practice. If a nurse is found to have not met the standards, they could be removed from the register for a certain amount of time or if very serious, permanently. (NMC, 2020) Above all, the NMC has a commitment to keeping the general public safe, through the work that they do.

The NMC Code, as mentioned previously, is the professional standards set that must be adhered to by registered nurses in the UK. Employers and educators should support their staff and students to uphold the Code. There are four themes that The Code is based around, prioritise people, practice effectively, preserve safety and promote professionalism and trust. These themes are then broken down into 25 sections, in the form of statements that indicate what good practice looks like, to make up the code. The code is not only about the standards of the NMC, but also those that are expected by the public. It can be used as a tool by the public to provide feedback on the care that they have received. Not adhering to the code can cause implications in relation to a nurses role.

I choose to join the Air Force as a nurse because I am passionate about providing unique patient care to individuals in the military. The thought of caring for the heroes who fight for not only our nation but the entire world makes me feel accomplished and contented. In particular, becoming a nurse in the Air force not only allows me to focus on the delivery of patient care but will provide me with an opportunity and tools needed to develop my career and thus continue training and growing as I become a respected leader in my field. Moreover, it is evident that the Air Force provides numerous opportunities for skills and career advancement and the incredible benefits are evident.

Now that I am certified in critical care and I have achieved a high level of clinical expertise, I have realized that there is more to do. Although I can coast in this place of professional and mastery satisfaction for a while, but that is not how I roll, I mean the health care landscape changes frequently, so elevating my professionalism and marketability is critical in my case. Therefore, as a critical care nurse with confidence and experience, I want to earn a master’s degree that will provide even vast opportunities for me to advance. I believe that I can accomplish even more for patients by becoming a nurse leader. Consequently, I would love to be a progressive nurse leader who nurtures other nurses towards mastery and skills, and this is where my passion now lies.

The health professions play a crucial role in the military and have a huge impact on the overall well-being of American service men and women. As health expert I am extremely excited about getting an opportunity to take part in this noble cause of providing unique patient care by offering good health and safety. Moreover, the health facility department often provide training in the field of nursing and valuable leadership skills that lasts a lifetime. I believe that an experience with the military will teach me to be open, direct, and honest as well as confident in my interactions with both patients and other medical professionals.

The Air Force perceives nurses as integral to the top-rate healthcare they provide to men and their families in the Air Force. Nurses are treated as essential members of the healthcare team. They provide personal care in the state-of-the art medical facilities or aeromedical evacuation in the entire world. With comprehensive training in my field, I have vast knowledge in nursing and provision of unique patient care. In Particular, I possess a unique combination of skills and experiences that make me stand out from the crowd. For instance, from this interview you can tell that my communication skills are solid and remarkable, a fundamental element for a career in nursing. I can also ascertain that nursing is a stressful job where traumatic situations are common and thus emotional stability, empathy, and attentiveness to details are critical skills required to successfully provide adequate personal care to injured patients in the military. I am confident that my competencies, in patient care, deployment, and leadership will play a vital role in accomplishing the responsibilities assigned to me as an Air Force nurse practitioner.

Spending the better part of a day or night working in a hospital can already burn me a hundred of fats and calories. However, am not fit enough, walking and running around to cater for patients’ needs can prove difficult. To make sure I stay in the top shape, I have established a personal fitness routine whereby I engage in it early in the morning before work and in the evening after work. For instance, I do planks which target my inner and core muscles, hamstring muscles, and glutes. I also do squats and unilateral exercises and shoulder shrugs. The planks are important for improving posture, better balance, and improved general fitness that is critical for physical demands of nursing. Doing squats helps prevent knee and hip injuries while lifting and assisting patients, essential for improving the strength of hamstrings. I am well conversant with the Air Force fitness routine undertaken by service men and women in the military. In particular, the fitness program is categorized into four areas; aerobics, push-ups, crunches, and body composition. The scores in each area are determined by gender, body measurements, age, and amount of elapsed or repetition time. I believe that upon joining the military as a nurse, I will align my fitness program with that of the air force to ensure that I meet the requirements of the program.

Nursing has helped people come a long way. Many new diseases have been discovered over the years. Nurses and scientists have also found new medications to treat these diseases. It has done wonders for many people. Nursing is significant to keep people vibrant and healthy.

History of a Nurse

Nursing has a great deal of history to it. Nursing began in Rome around 300 A.D. Later on the first six hundred Spanish hospitals were built. Citizens also helped injured soldiers in the Crimean and Civil War. Nursing began in a couple of ways. One way it began was doctors traveled to peoples homes to care for them. Another way was they built one hospital in each town. There were also early nursing schools where they could learn more about the nursing field. Nursing has come a long way since then.

Interesting People

There are many interesting people who helped strengthen the nursing field. One woman who helped strengthen the nursing field was Mary Seacole. She voluntarily cared for the harmed soldiers during the Crimean War. While there she would dress the soldiers’ wounds. Mary and her mother would help people with yellow fever and other diseases. She also performed an autopsy on a dead child to figure out the cause of death. Mary is also known for making herbal remedies to cure her patients. Another woman who strengthened the nursing field was Florence Nightengale. She led 38 nurses overseas to the Crimean war. There she was displeased by how dirty the hospital was so she cleaned it. While there she also bathed, clothed, and fed her patients. She also tried to get parliament to extend a census to collect data on sickness and disability but they disagreed with her and turned it down. Last is a gentleman named Walt Whitman. He enlisted to be a nurse during the war. He tried to help over 100,000 soldiers back to health. He also attempted to help his sick brother get stronger. They all contributed so much to nursing.

Responsibilities

Nurses have many responsibilities throughout their day. Some responsibilities are on a computer. One of them is to keep detailed records. Another one is to keep detailed records. Thet should also schedule follow-ups for their patients. They also need to make sure they send the right prescription to the right pharmacy. Other responsibilities are in the office. One of them is to make sure they make the right diagnosis. Another one is to make sure the patients are not allergic to any of the medications. They also need to be able to combine information to make the right diagnosis. They need to make sure they pay attention to details because one detail could separate one illness from another. They should let patients know what self-management is needed for their sickness. Nursing takes many important responsibilities.

Working Conditions

The working conditions are very precise. The typical day for a nurse can be easy or hard. One reason is they never know what kind of traumas or illnesses will walk in the doors. Another is their almost always up on their toes walking around. The schedule of a nurse is not very flexible. They have the option of working days, evenings, or nights. They can also either work eight, ten, twelve, or twenty-four hour days. They usually can get overtime if they ask for it. Nurses also do not get a great deal of time off. They get ten days off for working one year, fifteen days off for working five years, and twenty days for working fifteen years. The schedule for nurses can be very strict.

Degree or Training

There are many years of schooling and training needed to become a nurse. They need to go to school for one to two years to become a registered nurse. They need to go one and a half to four years to get a graduate degree. Nurses also need to go to school for four years to get your bachelor’s degree and your doctor’s degree. They need to take many classes such as anatomy, psychology, chemistry, biology, and statistics. The names of the degrees you can earn are bachelors, graduate, master, and doctor.

Highschool Preparation

There are many classes people can take to prepare for your nursing career. Some more advanced classes you can take are AP courses, CPR, first aid, and take the TEAS. Some less advanced classes you can take are math and science. They can also get active in their community by gaining customer service and volunteering. There are also things you can plan before starting your career. One way people can plan is by looking up nursing programs. Another way is by creating a financial plan. People could also plan by practicing their interviewing skills. Those are just some of the many classes you can take and skills you can learn.

Wages

Wages for a nurse can be remarkably high. The lowest wage in Ohio is thirty-nine dollars an hour. The lowest wage in the United States is thirty-eight dollars an hour. The maximum wage in Ohio is sixty-three dollars an hour. The maximum wage in the United States is seventy-two dollars an hour. Nurses wages can advance depending on their experience. They can also go back to school and get a better degree so they can get paid more. Nurses wages can change in many different ways.

Schools to Attend

There are many great schools students can join for nursing. One school students can go to is the University of Michigan. It has a variety of programs you can choose from. Some of its classes provide you with knowledge in skill-building and testing. It offers you a two, three, and four-year plan. Another school students can go to is Vanderbilt University. It has advanced options for you. It is also a school that is just focused on nursing. Students can also go to Delta State University. They provide doctoral nursing education. Delta State also teaches leadership skills. They also teach students how to evaluate the information they are given. They also allow students to get a degree or do better. Many schools can be great for progressing in your career.

There are many things people can and cannot expect every day. New discoveries are made each day. These discoveries are leading to big things like treating diseases. Nursing has helped people in a variety of ways and will hopefully continue to do so.

The skill of Needle Thorococentesis (NT) has been a core paramedic skill for many years (Reichman, 2018), used to halt the development of a Tension Pneumothorax (TP). TPs occur in 1 in 250 of major trauma patients, equating to 0.4%, and lead to rapid death if not treated timely and effectively (Leech et al, 2016). TP develops when air enters the pleural cavity without escaping, causing the lung to collapse as air pressure within the thoracic cavity prevents it from inflating: this leads to a ventilation and perfusion (V/Q) mismatch and ultimately cardiac arrest if not rapidly treated [Skinner et al, 2013]. NT describes the process of inserting a cannula though the chest wall into the pleural cavity providing a catheter whereby excess air can escape, reducing intra-pleural pressure and allowing the lung to re-inflate (Gregory and Mursell, 2010). This essay will critically evaluate the skill of NT and make recommendations for future paramedic practice.

The Royal College of Surgeons of Edinburgh (RCSE) (2017) state that NT should be performed in any patient whom a clinician suspects has a TP but also recognises the difficulty in making a TP diagnosis (Leech et al, 2016). Joint Royal Colleges Ambulance Liaison Committee (JRCALC) (2019) guidelines for thoracic trauma advise clinicians to assess for TP within the primary survey of a patient who has suffered thoracic trauma, with symptoms including: poor or no chest movement on the affected side; reduced or absent air entry; distended neck veins; tachycardia and hypotension; tracheal displacement in late stages; and acknowledge that some patients will present only with rapidly deteriorating respiratory distress (JRCALC, 2019). Treatment of TP by NT also forms part of the ‘Hypovolaemia, Oxygenation, Tension Pneumothorax’ (HOT) principles advocated by Lockey et al (2013) in traumatic cardiac arrest, advising NT as a priority reversible cause.

The thorax contains vital organs and structures therefore it is important for a paramedic to be aware of underlying anatomy and correctly identify landmarks for NT (Wernick et al, 2015); although a study of 51 clinicians did find that 85.2% failed to identify the correct landmarks (Kenny et al, 2016). Current paramedic guidelines advocate 2nd intercostal space, mid-clavicular line (ICS2/MCL) as the primary site of choice for NT, with further attempts in the 5th intercostal space, mid-axilla line (ICS5/MAL) (JRCALC, 2019), also advocated by the RCS (Leech et al, 2016). Caroline and Pilbery (2014) assert the ICS2/MCL is easy to access and has less chance of displacement as patients are generally treated and conveyed in the supine position. The Resuscitation Council (UK) (2015) guidelines state both landmarks can be used and offer no guidance on which the preferred site should be (Deakin et al, 2015). Recent research has offered evidence that ICS5/MAL has a higher chance of success due to a lower mean chest wall thickness (CWT) (Mays, 2016). Laan, et al (2015) concluded that alternative placement sites 4th intercostal space, anterior-axilla line (ICS4/AAL) and ICS5/MAL both had a lower mean CWT of

NT has many documented complications associated with the practice (Wernick, B. et al, 2015). Current guidance advocates using a standard 14g catheter of 4.5cm length for NT (Powers et al, 2015). The Journal of Visualised Experiments (2019) and RCSE (2017) agree with using a large-bore cannula, however the length of the cannula has been shown to influence the success rate of treatment (Blavais, 2010). A study of adult trauma patients demonstrated an average CWT of 3.50cm on the right and 3.51cm on the left at the point of the ICS2/MCL (Zengerink, I. et al, 2008). The study goes onto point out that up to 35.4% of the population studied had a CWT of >4.5cm therefore the 4.5cm cannula length would be unable to penetrate the chest wall and therefore be ineffective at relieving a TP. Harcke, T. et al (2007) agree that a standard length cannula would be ineffective at treating a large percentage of trauma patients indicating a larger mean CWT: they advise that a specialised angiocatheter of 8cm should be used, however their study on male military personnel may not be representative of the population of trauma patients likely to be encountered by civilian paramedics. Schroeder, E. et al (2013) conducted a study of civilian trauma patients and agree with Harke, T. et al (2007) that a standard catheter is inadequate. Aho, J. et al (2016) report success rates of up to 100% using an 8cm catheter but do acknowledge an increase in iatrogenic injury. A meta-analysis performed by Clemency et al (2015) also concludes that a longer catheter of at least 6.44cm is necessary and recommend educating paramedics that not all patients will require the full catheter length to reduce injury.

The National Health Service (NHS) report that obesity affects approximately 1 in 4 adults in the UK (NHS, 2019) and obesity has been shown to be a significant factor in failed NT attempts (Ozen et al, 2016). Carter et al (2013) state a longer needle must be available for use on obese patients and suggest use could be determined by the clinician’s assessment of the individual patient. This is further supported by Powers et al. (2014) who suggest a tool could be developed to estimate appropriate catheter size as CWT directly correlates with weight. It could however be argued that weight is difficult to accurately estimate in the prehospital setting (Leib and Gluckman, 2004), and Britten, S. et al, (1996) disagree with this approach, recommending that should a first NT with a standard cannula fail, it should only then be followed by NT using a longer cannula.

It was noted in several studies that women have a larger mean CWT than men and therefore a standard catheter would fail in a larger percentage of female patients than male (Zengerink, I. et al, 2008), (Laan, D. et al, 2015), (Akoglu et al, 2013) so it could be argued that female patients could be indicated for longer catheters, but Schroeder, E. et al (2013) found no link between sex and CWT. Interestingly, Ozen (2016) reported a higher success rate in ICS2/MCL than ICS5/MAL in female patients, contradicting Laan et al’s (2016) conclusion that ICS5/MAL provided a better chance of success.

Current guidelines offer only one suggested catheter size and length for all patients with no definitive guidance on paediatric NT (Terboven et al, 2019). The Broweslow tape, a tool used to determine equipment sizing and dosages in paediatric trauma emergencies, does not offer guidance on needle size for NT (DeRoss and Vane, 2004). Mandt, M. et al (2019) found a 14g 4.5cm catheter would penetrate the chest wall at ICS2/MCL of all paediatrics

NT can be further complicated by the catheter blocking with blood and/or tissue during insertion (Wernick et al, 2015). Gregory and Mursell (2010) also recognise these common complications, with Escott et al (2014) acknowledging that it is difficult to ascertain if the catheter is blocked or if the TP was initially misdiagnosed. Beckett et al (2011) noted an increase in catheters kinking and thus becoming occluded when placed in a midaxillary line. The National Institute for Health and Care Excellence (NICE) (2015) and Resuscitation Council (UK) (Deakin et al, 2015) highlight the importance of regular reassessment in a patient who has undergone NT for early recognition of these complications as a successfully treated TP may redevelop and require further NT.

It is widely accepted that NT is not intended as a definitive treatment for TP and should only be used as an interim measure while provision is made to insert tube chest drains (Jones and Hollingsworth, 2002). NT is associated with a high failure rate (Kaserer et al, 2017); and Jenkins and Sudheer (2000) advise immediate ST or tube thoracostomy (TT) should NT fail in the first instance. NICE (2015) recommend ST or TT instead of NT if a qualified clinician is available as ST and TT are regarded as more stable than NT. Escott et al (2014) puts forward a case that a paramedic’s skillset could be broadened to include ST for patients in traumatic cardiac arrest with the correct training and a clear set of guidelines. Rottenstreich et al (2015) also identified a need to develop more advanced techniques in the prehospital management of TP but did cite the shorter procedural time and lower risk of infection as potential benefits of NT. Shorter pre-hospital times have shown to be associated with better trauma patient outcome, often referred to as the ‘Golden Hour’ (Swaroop, 2013) but Weichenthal et al (2015) found no significant correlation between survival rates and transport time in patients who had undergone NT. Braude et al (2014) further concluded that neither ST or TT was required for patients travelling by air, and TP could be successfully managed by NT in these cases.

At ICS2/MCL, nerves and arteries run inferior to the 2nd rib and insertion of a needle here can damage these structures (Heng et al, 2004). Several cases of iatrogenic injury have been documented as a result of NT, with the primary cause attributed to dangerous anatomic location (Netto et al, 2007). Zahoor (2015) and Lyndsay (2016) also recount cases of poor NT placement leading to injury. Rawlins et al (2003) and Riwoe and Poncia (2011) further document instances of significant haemorrhage post NT in ICS2/MCL, while Yacovone, Kartan and Bautista (2010) specifies elderly patients as high risk for iatrogenic injury. There is concern that implementation of longer catheters could see an increase in damage to the lung, heart, subclavian and great vessels (Zengerink, 2008).

The Health and Care Professions Council (HCPC) (2014) state registrant paramedics must be competent and safe in practice, emphasising the need for continued up-to-date learning and development. It has been demonstrated that there is a lack of awareness of appropriate site for NT, with many clinicians being unable to correctly identify the landmarks prehospitally (Ferrie, Collum and McGovern, 2005). Equipment has been developed to improve accuracy with anatomic location however it has not yet been trialled in the emergency setting (Shah, Kothera and Dheer, 2019). Blavais et al (2010) ascertained that up to 26% of patients undergoing NT by paramedics had been misdiagnosed with TP, with Kaserer et al (2017) reporting similar findings, indicating a requirement for more extensive training on TP recognition. Warner et al (2008) states many patients who have undergone prehospital NT go on to have TT in hospital, and highlights how unnecessary NT would lead to unnecessary TT, possibly increasing patient morbidity. Such educational programs have been shown to positively influence successful treatment of TP (Cantwell et al, 2014). NT is currently often taught and practiced on simulation mannequin chests leading to unrealistic experiences of identifying landmarks (Boyle et al, 2012) which could account for incorrect placement found by Kenney et al (2016). A progressive training format from mannequin to cadaver simulation was shown to increase clinician’s confidence with placement (Studer et al, 2013), while Kenny et al (2016) found clinicians’ confidence did not correlate with their competence in NT. It is, however, overwhelmingly concluded that NT remains a safe and necessary skill when performed correctly by paramedics (Warner et al, 2008), (Leech et al, 2017), (JRCALC, 2019).

In conclusion, NT remains a necessary, life-saving skill as part of paramedic practice. Further education is required to ensure robust knowledge of patient assessment and indications to improve clinicians’ competence and confidence, thereby reducing error in diagnosis and treatment. Extensive research should be conducted on the introduction of longer catheters with a view to reducing failure rates: cost-effectiveness and complications should be considered. Finally, training in ST and TT could be viewed as a natural progression of paramedic skill, however the author recommends establishing consistent success with NT primarily. This could be achieved by broadening guidance on NT anatomical placement and encouraging critical assessment prior to decision making by paramedics.

Over the last decade, Advance Practice roles have gained a tremendous amount of popularity. The role of a Nurse Practitioner first gained its popularity back in 1965, when a public health nurse named Loretta Ford, a pediatrician, would establish the first NP certification program. It was then; primary care physicians would slowly start to move outward from a general practice type of setting to a more acute care complex setting. Over time, physicians alone could not keep up with the demands of their patients. By the 1970s, more structuralized NP programs would be federally funded, meaning better formalized and structured programs that could focus on how to deliver primary care to patients appropriately. To further help standardize this, the American Journal of Nursing writes “the Consensus Model for APRN regulation: Licensure, Accreditation, Certification, and Education was produced in 2008” (Ralston, Collier, & Fairman, 2015, p. 56) and by 2015 most schools had adopted this type of model. A more adaptive model would allow for a more collaborative effort, and the Affordable Care Act would help include provisions to the practice. It is no surprise that nationally there is a nursing shortage, but there is a growing shortage with Physicians and a increased need for help in acute and non-acute settings. Physicians continue to fall short of meeting the demands of their patients, which is why Advance Practitioners have been sought after in inpatient and outpatient settings. Since the inception of this role, APN’s can contribute to a service model that allows for better health services to meet the needs of high quality and cost-effective medicine.

Advancing myself in this profession, I was very aware that I wanted my focus to be in Adult Gerontology. It wasn’t until 2011 that the Consensus Model would merge adult-gerontology into primary care and acute care. It was then recognized by the National Organization of Nurse Practitioner Faculties that it got its identified of its core competencies and would then be validated as a focus of this specialty among others such as Pediatric and Women’s Health. What exactly makes Adult Gerontology different from other specialties? This particular specialty focuses on patients from age thirteen to the advanced age of an adult. Practitioners in general, no matter what interest you choose to focus on, primarily work closely with Physicians in acute and non-acute settings. Often, this can cover anywhere from a primary care offices, in patient hospitals, long term care, palliative, and private practices. The role of the NP in practice can include diagnosing, managing acute and chronic disease, history intake, ordering and interpreting diagnostic tests, prescribing pharmacologic agents and therapies, ongoing teaching, and educate patients. Adult Gerontology role specifically provides care to young adults to older adults, with a focus on delivering more stabilization of patients in critical conditions, preventing further complications, restoring maximum health, and can include patients in need palliative care. Patients who are characterized as physically unstable, dependent, or are highly vulnerable to complications require ongoing monitoring and coordination by the Practitioner. Nurse Practitioners can further help meet the needs of patients by practicing autonomously with other providers within the group they work within if need be. Utilization of this can be crucial especially because of NP’s play a vital role in primary care workforces. With such rapid growth in healthcare alone, NP’s are handy when used as a licensed provider, whether working independently or in adjunction with a primary care physician. As chronic illnesses and multimorbidity continue to rise with the advanced age, the demand for advanced providers will continue to be needed.

With the overall population aging, chronic diseases and the overall complexity of chronic physical and mental illnesses, healthcare demands will only continue to rise. Nurses in the advanced practice role can continue to add value to the healthcare demands by strengthening healthcare, and this over time will lead to an expansion of this role and the autonomy it will share. Having better autonomy will be evident by having higher patient safety ratings and better clinical outcomes for their patients. A randomized trial concluded that ‘NPs achieved consistently better results than their physician colleagues on measures of patient follow-up, consultation time, satisfaction, and the provision of screening, assessment, and counseling” (Stokowshi, 2010, p. 4). Overall, most patients when asked preferred to see a nurse practitioner as opposed to a physician due to more personalized and compassionate care, and excellent communication regarding their treatment.

As we look further into the Nurse Practitioner role, education and teaching is also another critical component that is provided by the practitioner. Even though teaching a patient about their illness is vital, patients need to be proactive in their own healthcare too. Before the patient can fully become an active participant, the practitioner must fully understand how the patient comprehends and understands what exactly is being educated to them. Millions of people living in America are considered to be illiterate, while it most can also not read or write, further complicating what is understood. Knowing this, having a better understanding of a patients socioeconomic background, language and culture, and a full assessment of a patients understanding can lead to better health adherence and outcomes. Incorporating education into the plan of care once you have a better understanding of how your patient learns, education and teaching effectiveness will be achieved. Providing excellent tools and resources for your patients, whether the material is printed, making sure layman’s terms are used, or return demonstration can allow for better guidance when providing health information. Nurse Practitioners are unique to this because they will always play a role in health promotion, education, and advocacy.

Another primary role of the practitioner is autonomy. The autonomy an NP shares is not only with his or her patients but a collaborative agreement they share with a Physician. The amount of independence a nurse practitioner carries also varies by state. Currently, twenty-one states grant nurse practitioners full practice authority, which allows for diagnosing, managing primary illness, ordering and interpretation of tests, prescribing medications, and managing treatment of patients. This autonomy is significant because the ‘US Department of Health and Human Services reported that approximately 20 million Americans have gained health care coverage as result of the ACA’ (DiLascio, 2018, p. 7). While more Americans may have better health coverage and have better insurance, there remains a shortage among primary care physicians. Also, there is a significant shortage in rural areas, so even though more Americans are covered there still lacks the availability of providers to provide the care. Nurse Practitioners may be the solution to this problem by providing valuable services to areas where there is such a significant shortage by practicing independently or in conjunction with a primary care group.

Overall, Nurse Practitioners no matter what specialty you decide to choose will play an essential role in patient-centered care. There will be a continued critical need for Nurse Practitioners as we face challenges in the again population and rising healthcare costs. The combination of medical skills and nursing care that an NP can provide will strengthen the needs of not only primary care settings but community care settings. Health promotion and disease prevention will always be a priority to ensure a better quality of care. Making the transition in this role from Nurse to Nurse Practitioner can be stressful and taking some adjustment to your new position. Having a full understanding of your role is imperative as you go from novice to expert.

References

1. DiLascio, T. M. (2018, June 1). Nursing Autonomy: Overview. Points of View: Nursing Autonomy, 5-8. Retrieved from https://eds-b-ebscohost-com.southuniversity.libproxy.edmc.edu/eds/pdfviewer/pdfviewer?vid=6&sid=eefab261-5a43-4306-9aad-9ef9a17d2d10%40sessionmgr101
2. Ralston, B., Collier, T. H., & Fairman, J. (2015). The NP: Celebrating 50 years . American Journal of Nursing, 115, 54-57. http://dx.doi.org/http://dx.doi.org/10.1097/01.NAJ.0000471941.77288.a4
3. Stokowshi, L. A. (2010, June 29). The Nurse Practitioner Will See You Now. Medscape Nurses, 1-5. Retrieved from https://www.medscape.com/viewarticle/723986_1

The Importance of Caring: My Journey Into Nursing

Nursing is more than treating an illness; rather it is focused on delivering quality patient care that is individualized to the needs of each patient. The purpose of this paper is to describe my personal philosophies of nursing along with the philosophy of a nursing theorist and a comparison. This paper also discusses my experiences in my journey of nursing along with my ideas on improving healthcare in the future.

Philosophy

Personal

Throughout my journey of becoming a nurse, I have started to develop my personal philosophy of nursing. My philosophy views nursing as a way of healing others, caring for others, respecting others, and treating others the way you would want to be treated. I believe that we learn from our mistakes. Each mistake is a learning experience that helps me become a better nurse. In my opinion, nursing is both an art and a science. To me, the art of nursing involves both the patient and the family. A collaborative approach helps the patient to recover faster. I believe nursing is about knowing how to connect with those around us through caring and compassion. Nursing is also a science. As nurses, we are taught the theories and scientific knowledge in order to understand a patient’s disease process and medication needs which aid us in individualized nursing care. There is so much that I have already encountered as a nursing student and still have a whole lot more to learn. But one thing that has always stayed with me is my ability to heal and respect everyone. I always walk into my patient’s room with a smile. A smile makes a big difference. My philosophy views nursing as a way of healing through trust and empathy. I am able to view the patient as a whole and not just as a set of signs and symptoms or as a disease. I don’t just give medications and leave. I talk with the patient and help them in all possible ways I can. As nurses, we heal by using therapeutic touch, active listening, being present in the moment, and instilling hope. I believe that I have learned just a bit and there is a lot more to learn. Each day and each patient is a new learning experience for me. As I continue my journey to becoming a nurse I will continue to learn new knowledge and grow from my experiences. These values and beliefs are what is built on my personal philosophy of nursing.

Theorist

Patricia Benner is a nursing theorist, a nursing educator, and an author. She was born on August 31, 1942. She is best known for her book From Novice To Expert: Excellence and Power in Clinical Nursing Practice (1984). She is the first nursing theorist to develop a model for the stages of clinical competence. Her nursing theory proposes that expert nurses develop skills and understanding of patient care through a proper educational background as well as a multitude of experiences (Petiprin, 2016). Dr. Benner’s theory was basically focused on how nurses acquire nursing knowledge and not how to be a nurse. The theory consists of five phases which build on each other as the nurse refines and expands learned theories and develops clinical expertise through gained experiences. Dr. Benner used the Dreyfus Model of Skill Acquisition as the foundation of her work. The Dreyfus model describes how individuals progress through various levels in their acquisition of skills and subsume ideas with regard to how individuals learn (Pẽna,2010). The Dreyfus brothers- Stuart and Hubert believed that learning was experimental (learning through experiences) as well as situation-based, and that a student had to pass through five very distinct stages in learning; novice to expert. Dr. Benner found nursing to be similar to this, where improved practice depended on experience and science, and developing those skills was a long and progressive process(Petiprin, 2016). She found out that when nurses were involved in various situations, they learned from the situations and they developed “skills of involvement” with patients and family. The five stages of clinical competence according to Dr. Benner include the following:

1. Novice: This would be a nursing student in his/her first year of clinical education. According to Dr. Benner, novices have a very limited ability to predict what might happen in a particular patient situation (Benner,2001). A novice nurse has an incomplete understanding, approaches tasks mechanically, and needs supervision to complete them.
2. Advanced Beginner: This would be the newly graduated nurses in their first jobs. They have had more experiences that enable them to recognize recurrent, meaningful components of a situation (Benner,2001). Advanced beginners have a working understanding and tend to see actions as a series of steps. They can complete simpler tasks without supervision.
3. Competent: These nurses have a good working and background understanding, see actions at least partly in context, and are able to complete work independently to a standard that is acceptable, though it may lack refinement (Petiprin,2016). These nurses lack the speed and flexibility of proficient nurses but have some mastery.
4. Proficient: At this level, the nurse has a deep understanding, sees actions holistically, and can achieve a high standard routinely (Benner,2001).
5. Expert: These nurses are able to recognize demands and resources in situations and attain their goals. They know what needs to be done. They have an authoritative or deep holistic understanding, deal with routine matters intuitively, and are able to go beyond existing interpretations (Benner, 2001). They are able to achieve excellence with ease.

This is Patricia Benner’s nursing theory and I believe that each step builds from the previous one as we gain knowledge from experience. According to Dr. Benner, beginner nurses focus on tasks and follow a “to-do” list, whereas expert nurses focus on the bigger picture even when performing tasks and are able to notice subtle changes in a patient(Petiprin,2016).

Comparison

According to Dr. Benner’s theory, I believe that I am in the novice stage beginning to advance into the advanced beginner stage. As a nursing student, I know the theory; of signs and symptoms of certain diseases, but I am just learning on applying them to real-life symptoms. I agree with Dr. Benner on how expert nurses develop skills and understand patient care over time and experience. Like I said before, I believe that we all learn from mistakes. Just like that, Dr. Benner says that we learn from our experiences. It takes years to become an expert nurse, but with hard work and experience, I hope that one day I will also become an expert nurse.

Reflection

Perceptions

Before I came into the nursing program, I had many different views of nursing. I have heard opinions of what nurses are and what they do from many people. Everyone has different opinions and in my opinion, many people don’t know what a nurse actually does. I was told that nurses just bathe patients, feed them and pass medications. I was told that nurses have no value and that nurses are just like servants. They listen to doctors’ orders and have no say in anything. These are things that I have heard and I still hear from random people. But I actually knew that people are expressing their opinion because of their lack of knowledge. Over the last two years, I have understood that nurses are much more than pill slingers. Nurses play a significant role in patient care. I never knew the importance of a nurse when it comes to patient care. They are critical thinkers. Nurses use their critical thinking skills to prioritize and make key decisions that can save lives (Nurse Journal, 2019). They are with the patient throughout the continuum of life. Nurses are teachers, advocates, caregivers, critical thinkers, and innovators. Nursing is an honorable profession and nurses are the heart and soul of the healthcare system (Weinstein,2020), but still, among many, nurses are looked upon with disdain.

Goals

My mom is a nurse and she has influenced me in becoming a nurse. I always wanted to help the sick and needy and felt nursing was my thing. She has always been a support. After nursing school, I plan on going straight into an RN-BSN program and later doing a master’s. I hope that one day I become a Nurse Practitioner.

Incident

Situation

As a nursing student, an incident that occurred in my clinical rotation was a medication overdose error. The doctor prescribed 975mg of Acetaminophen every 4 hours. That would add up to 5850mg per day. The maximum recommended daily dose of acetaminophen for a healthy adult is 4,000 milligrams (Farrell,2020). That was truly a prescriber error. I was getting ready to administer 10 AM medications when my clinical instructor and I noticed this mistake. We stopped and reported this error to the patient’s in-charge nurse. The nurse then took a look at it and called the doctor. The doctor then changed the prescription to 625mg every 4 hours. Because the medication was acetaminophen nothing acute occurred. But if this was left unnoticed, it could have led to serious kidney damage, irreversible liver damage, and death.

Analysis

In the liver, most acetaminophen is metabolized through the glucuronidation and sulfation hepatic pathways; the remaining drug in the liver is metabolized by the cytochrome P450 system into a toxic metabolite (Smith, 2007). This metabolite then couples with hepatic glutathione to produce a nontoxic metabolite (Smith, 2007). When a patient overdoses on acetaminophen, the glucuronidation and sulfation pathways become saturated and more acetaminophen in the liver is metabolized by the cytochrome P450 system (Smith, 2007). This depletes glutathione stores and lets the toxic metabolite accumulate, causing hepatic injury (Smith, 2007).

The root cause of this error was basically due to the prescriber’s error. The prescription was taken off correctly as written, by the nurse, but the nurse should have noticed the error. At the same time, the pharmacy should have not allowed it to be dispensed. Also, as per hospital policy every day during the night shift a 24-hour chart check should have been done by the nurse. She had checked everything but had not noticed the error and it was not corrected. Therefore, in this incident, the doctor, nurse, and pharmacy are at fault. Like I said before since the medication was Acetaminophen, no acute problems were reported, but if this was left unnoticed it would have led to severe liver damage, eventually leading to death.

Prevention

Never events are serious medical errors or adverse events that should never happen to a patient (McKeon&Cardell, 2011). As nurses, we are often the last “gatekeeper” in the administration process to prevent medication errors (Maryniak, 2016). It is important to take the time needed to ensure patient safety and minimize distractions throughout the process (Maryniak, 2016). This incident could have been avoided by the nurse if she took the time to check the medication order and was able to recognize the overdose error. She should have clarified with the doctor about the prescription. Nurses who don’t follow the five rights (right drug, right patient, right dose, right timing, right route) of medication administration can contribute to medication errors (Chu, 2016). In addition, they must complete accurate documentation once the patient receives the medication. Failure to record the medication administered increases the risk that the patient will receive another dose (Chu,2016). Deficits in pharmacologic knowledge, miscalculations, distractions, increased workloads, and fatigue are common reasons why the five rights aren’t always followed (Chu,2016). Certain ways in which we can prevent a medication error in the future is by going over the rights of medication administration. If the nurse took a close look at the medication administration rights three times she would have noticed the timings and the dosage. Also, a medication review can be done which includes comparing the medication record and the patient record at the beginning of a nurse’s shift and determining the rationale for each ordered medication. Nurses must improve their pharmacologic knowledge and keep up-to-date about new drugs. Pharmacologic continuing education updates nurses about the safe use of new drugs, including appropriate indications and dosages, proper administration, drug actions, contraindications to use, drug-drug interactions, potential adverse drug reactions, patient monitoring, patient teaching, and documentation (Chu,2016). Medication errors should be reported. This helps identify failures in medication processes and may help to prevent further incidents.

I believe the only way to prevent this incident is to be more careful and follow all the instructions. No matter what, the nurse should check the 5 rights of medication administration. Also, the nurses make medication errors when they are interrupted when preparing medications. I believe if they have a quiet space to prepare the medications, many errors can be prevented. Adequate communication is an important factor in nursing. We could have prevented this incident if the nurse approached the doctor with doubt, or if the pharmacy had not dispensed the medication. Medication errors are preventable events. Safe medication practices, adequate resources, a work environment free from interruptions, and a nonpunitive approach to error reporting should be encouraged.

I would like to conclude this paper by saying that nurses make a big difference. Safe and effective care should be given to each patient and we should try our best to prevent life-threatening errors. It’s just a matter of time.

When I think of nursing as a career, I cannot help but think that the laws, practices, and procedures all started with someone’s theories and thoughts. Obviously, people such as Florence Nightingale come to mind, however, there is one more person in particular that really stood out to me, Isabel Hampton Robb, an American nurse theorist, advocate for higher nursing education, and the founder of several nursing associations. Through her standards of teachings and writings, she paved the path for millions of future nurses to understand our duties, expectations, and rights. Because of her genius theories and ideas, they are all practices that students like myself still are implemented in nursing programs worldwide today.

On August 26, 1859, in Welland, Ontario a leader was born. After graduating high school she had a short career as a high school teacher which came to an end in 1881 once she enrolled in Bellevue Training School for Nurses in New York, becoming her first step towards her future role model and leadership position. After graduating from nursing school she was employed at several hospitals throughout the world including hospitals in Rome, Germany, and France and by 1889 she became the first Superintendent of Nurses and Principal of the Training School at Johns Hopkins Hospital (Chinn, 2018). It was here that she became known for having strict admission criteria, entry times for applicants, and a tough grading system for nursing students. In 1894 she gave up her position at John Hopkins Hospital and followed her heart and the love of her life whom she married and moved to Cleveland Ohio with. Isabell Hampton Robb has had many accomplishments and contributions to nursing throughout her life, including founding the Journal Club and creating an Alumnae Association. In summary of an article I read written on the ANA Enterprise website, the Journal Club became the Alumnae Magazine and then was later changed to the American Journal of Nursing, and the Alumnae Association was eventually called the Nurses Association Alumnae of the Us and Canada. The magazine and association merged and became the American Nurses Association.

Isabell Hampton Robb realized that the nursing education system was extremely unorganized, had low standards upon admission and the curriculum was not as formal as it should be. This lead her to propagate new teaching material that would forever influence the way nursing schools were run. She wrote several textbooks including Nursing Ethics and Educational Standards for Nurses that would serve as a basis for nursing practice from the 1900s until today. Isabell Hampton Robb set standards for nursing students that are still applicable today. Upon glancing over one book, in particular, History of Professional Nursing in the United States, a few things really intrigued me, beginning with the expectations of a student nurse that Isabell Hampton Robb deemed necessary. I felt like this was extremely relatable to me because I am a nursing student. The expectations summarized in this book are all standards that I think the AHC nursing education staff strongly implement, particularly the learning tool of constant repetition being the only way one can learn and become familiar enough with the information. Through repetition, one can gain confidence and over time become more precise and accurate. This standard of nursing education reminds me so much of the everyday repetition and intensity that I am taught as a student. Even though each class I am taking is a different type of study, they are all somehow related and seem to repeat the same standards and education. History of Professional Nursing through the United States also summarizes specifications taught by Isabell Hampton Robb. The high expectations begin with education, implementation of a strict uniform, and having a soft-spoken yet commanding voice is just the tip of the iceberg when it comes to the expectations Isabell Hampton Robb had for nursing students. Many people might say that the strictness of nursing school is extensive or that Isabell Hampton Robb’s ideas of what makes up a great nurse are extreme, but I disagree. Everything I was reading had me so intrigued and inspired. She was so intelligent and in touch with what it took to become a nurse that she even went to the extreme to talk about how tired a nursing student should be, yet assuring the reader it was okay because being tired was secondary to her education.

Professional practice

What is professional practice?

Professional practice assures that the standard of treatment of the nurses and midwives is upheld; their work is continually displayed and reviewed, concentrating on nursing and midwifery history, legislation, governance, administration, and administrative and legislative practices (Youtube, 2019). Professional practice is in embracing the maximum scope of the profession for patients and nurses.

Describe professional nursing practice.

Nursing is a discipline with its own code of ethics, its own ethical points of view, and its own role in the health care system. This ensures that nurses are completely accountable for their jobs. Nursing is in essence a specific job that not everybody would perform. But this video it reflects that Nickie’s unprofessional attitude regarding patient care puts a question mark on the professional practice of the nurses.

Privacy and confidentiality in the health field

Which laws governed registered nursing health professionals with regard to privacy and confidentiality?

The National Law provides a mechanism for privacy that requires the Ahpra and the National Boards to preserve the secrecy and the privacy of protected information,’ meaning information that enters the awareness of an individual within or via the national law of that country. In fact, statutory law demands that the Privacy Act 1988 as amended by the National Law Framework for 2018, be revised, be complied with by us (SA Health, 2020).

How is privacy and confidentiality part of professional nursing practice?

The nurses maintain privacy and confidentiality through below different ways

• Create a clear framework for medical safety and data
• Ensure that the Protection Policy protects partners
• Test for safe device protection of all classified details
• IT management strategy application in best practice

How it is important in nursing due to the below reasons

• Patients may be worried about their HIV-associated stigma and prejudice and medical conditions
• Patients would like to learn who has access to knowledge concerning them
• When patients feel relaxed, appreciated, and healthy, they are far more willing to receive treatment and offer complete and truthful accounts of their symptoms
• Community faith and interest in public care overall would be strengthened by a health program with clear privacy protections (Ashm, 2020).

Patient rights

Outline the purpose of the Australian Charter of Health Care Rights and discuss why those rights are important for the patient/consumer and for health professionals in the clinical setting

The Australian Healthcare Rights Charter outlines the obligations of the Australian healthcare sector to doctors, patients, and other persons. This freedom is vital if healthcare is to be of a good standard and secure whenever and wherever it is received. It is important for the patient due to the good and quality care they received during the illness and for doctors so that they provide the best care services to the patients in an ethical manner according to the policies.

What is the importance of health care rights when it is related to professional practice?

Professional behavior is one of the main factors in the progress of your profession. Healthcare includes multiple intimate experiences with a variety of people. Health etiquette is more than just an effective way to create relationships that are respectful with patients, peers, and superiors. The level of contact with patients and guests must be established in a medical environment (Russell, et al., 2014). They are in daily interact with men, who judge them on the grounds of their interactions, their vocabulary, and their presence.

Nursing and Midwifery Board of Australia Code of Conduct

Outline the purpose of the Nursing and Midwifery Board of Australia Code of Conduct For Nurses and its importance in clinical practices

The Nurses Code of conduct defines rules, ethical standards, and functional requirements for all nurses in Australia, in all work conditions. It outlines the basic concepts of ethical conduct and specifically identifies the actions of healthcare workers ‘ staff and society at large. NMC exists to protect the public. They achieve so by ensuring that those in Britain, with a nursing associate in Australia, only those that fulfill our qualifications are qualified to work as nurses with midwives. They take action if questions regarding the suitability of a patient, midwife, or nursing partner emerge.

How can health professionals make sure that they are providing professional nursing practice working within the nurses’ “code of conduct”

Nurses follow the principles and code of conduct like beneficence, accountability, responsibility, nonmaleficence, fidelity, autonomy, and veracity during performing their duties. For example, in the video, it is clearly indicated that the nurse would not follow the code of conduct during the services, and her casual approach did not indicate professional nursing practice. So it is important for nurses to dedicatedly provide their services to the patients and follow all the codes of conduct mentioned above during their duties is a sign of professional nursing practice (Kalb, et al., 2015). The nurses should her honesty and ethics during critical times and understand the patient’s condition and effectively communicate with the doctors and families during the services are indicators of a professional nursing attitude.

References

1. Ashm (2020) Privacy and confidentiality.[Online].Available at: https://hivlegal.ashm.org.au/privacy-and-confidentiality/ (Accessed on: 17th march 2020)
2. Kalb, K.A., O’Conner-Von, S.K., Brockway, C., Rierson, C.L. and Sendelbach, S., (2015) Evidence-based teaching practice in nursing education: Faculty perspectives and practices. Nursing education perspectives, 36(4), pp.212-219.
3. Russell, E., Chan, R.J., Marsh, N. and New, K., (2014) A point prevalence study of cancer nursing practices for managing intravascular devices in an Australian tertiary cancer center. European Journal of Oncology Nursing, 18(3), pp.231-235.
4. SA Health (2020) Professional practice.[Online].Available at: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/about+us/department+of+health/system+performance+division/nursing+and+midwifery+office/nursing+and+midwifery+professional+practice (Accessed on: 17th March 2020)
5. Youtube (2019) Crossing professional boundaries as a registered nurse in Australia.[Online].Available at: https://www.youtube.com/watch?v=x-bOgRUJv4g&feature=youtu.be (Accessed on: 17th March 2020)

In this assignment, I will be analyzing and expanding on the skills and tendencies of what it is to be an entrepreneur and how my entrepreneurial skills have developed throughout the course of this module. Entrepreneurship is not an inborn skill; it is a product of the environment. Withstanding that, I will be highlighting the fact that I have never attempted or successfully used any entrepreneurial assets before taking this module. I want to use this assignment as a descriptive walkthrough of the development of my skills and how I put them to use in the real world during and after taking this module. I’m going to express my findings and analysis carried out on my personal abilities, skills, and experience to develop my newly found entrepreneurial skills, as well as an analysis of the lessons learned from this module. Furthermore, the identification of my strengths and weaknesses will be analyzed along with how I address these and what actions I took in doing so. Finally, a reflection on the skills, experience, and information, gained from carrying out this assignment will be explained.

“Entrepreneur is defined as a person who starts a business and is willing to risk a loss to make money” (Merriam-Webster.com). The word ‘entrepreneur’ is derived from the French word ‘entre’, meaning ‘between’, and ‘prendre’, meaning ‘take’. The word was originally used to describe people who ‘take on a risk’ between buyers and sellers, or who ‘undertake’ a task such as starting a new venture. There are numerous definitions of entrepreneurship. These all stem from the perspective that entrepreneurship has been explored. The three main categories came from: the economic approach, the trait approach, and the social identity approach.

The role of entrepreneurs today is not just for self-fulfillment but for causative to frugality and helping resolve many of the difficulties in society. There are specific types of characteristics that one must develop when wanting to be an entrepreneur. For example, there is a need for independence, achievement, internal locus of control, innovation, and proactivity. When pursuing the role of an entrepreneur all these characteristics don’t have to be fulfilled, but I do agree it would help you develop a variety of different, useful skills. The two main roles of entrepreneurs are: first, taking the risk of developing new products or services, and second, successfully bringing new products and services into the marketplace.

I learned a fair amount of new skills during this module. One skill I developed further throughout the course of this is originality and creativity. I have creativity seeping out of my pores, hence the university degree I’m taking, which is English and creative writing. So, by no means, am I at fault for this trait. These are useful traits for entrepreneurs because the fondness for ideas and brainstorming is a part of the tendency to be creative and original. A specific love for testing boundaries and an ability to communicate boldly and directly give the entrepreneur a means to be original and creative.

Another viable skill that I really feel will help me in my future is team management skill. A known quote by George S. Patton is the best example of the difficulty in team management. The quote is as follows: “If everyone in a group is thinking alike, then someone is not thinking anything”. This skill seems almost significant in the development of being an entrepreneur. Whether you work in a team with many people or only a few, having good team management skills helps the process a lot more. As stated in the quote above, a team must have a variety of different people to have different assets and ideas within the team. Communication is also viable when working with other people. Ignorance towards other people and their ideas cause conflict within the group. Making sure you listen and acknowledge one another’s ideas, whether you agree with them or not, is highly important within the deed of communication.

Most entrepreneurs think that their concepts are very innovative when they start their businesses. Withstanding that, whether or not they truly are, it will command the long-term achievement or failure of their business. The main barrier to innovation is the refusal to acknowledge that your idea has already been put out there and has possibly been done better by someone else. But, standing the grain of your ideas in contradiction of your opponent’s shows deep and true innovation.

Goal setting is a powerful process for thinking about your ideal future, and for motivating yourself to turn your vision of this future into reality. The process of setting goals helps you choose where you want to go in life and what you want out of it. By knowing precisely what you want to achieve, you know where you can concentrate your efforts. You’ll also quickly spot the distractions that can so easily lead you astray.

By setting sharp and clearly defined goals, you can measure and take pride in the achievement of those goals, and you’ll see a forward process in what may be previously have seemed a long pointless grind. You will also raise your self-confidence as you recognize your own ability and competence in achieving the goals that you’ve set. For me, clearly defining my goals and achieving them was an area that needed to be greatly improved. A useful way of making goals more powerfully prioritized is to use the SMART mnemonic. While there are plenty of variants, SMART usually stands for: specific, measurable, attainable, relevant, and time-bound.

When writing a personal development plan, there are specific things you could include to make sure you get the full use out of it. For example, you should set yourself some goals, realistic or not, and then you must prioritize them. Setting deadlines for when you want to achieve said goals is an effective way to correctly prioritize them. Personally, using a SMART personal development plan would have greatly improved my whole entrepreneurial development significantly and would have overall made my ideas and plans more organized.

One weakness I found myself having was my incompetent presentation skills. It is not something I thought would be valuable when developing my entrepreneurial skills, as showing off good communication skills and personal attributes makes a good entrepreneur. Whether I have to present something to a group I’m working in or to a class of people, I find it hard to fully pitch any ideas I may have. I focused mainly on the fact I’m such a creative person and that no ideas are bad ideas. With that being said, I also focused on the fact that there are always going to be several people who don’t agree with some ideas I may come up with, and that’s a hurdle you just have to get over yourself.

To conclude, many people have entrepreneurial skills within themselves, but may not even know them. The assets can be worked on and grown into something bolder. With the help of this module, I can explore more of these traits deeper and can apply them to my use in the real world. Things like presentation skills and teamwork have really helped me grow and will come into use in the future.

Vocal health is of paramount importance to singers, as the voice is their instrument and needs to be kept in excellent condition for it to perform effectively. When vocal illness is present, it can impact not just the voice, but can lead to other physical and emotional health problems. One of the major issues is who and where to go for help and advice.

Many singers, along with other professionals such as teachers, doctors, and public speakers, suffer from problems arising from issues with their vocal folds: laryngitis, vocal nodules, and polyps, as well as paralysis of the vocal cord. These are two bands of muscle tissue located in the larynx that vibrate, producing sound waves through the nose, mouth, and throat; this produces the tone, volume, and pitch of the voice. An article written by Sataloff looks in detail at the challenges involved with vocal fold scarring, and he stresses that “the best treatment is prevention” (2015: 467). He also suggests that singing teachers have “a basic understanding of vocal fold healing in order to help guide and counsel students” (2015: 467). Of equal importance are the resonators, the throat, mouth, nasopharynx, nose, and sinuses, to add color and depth to the voice; when there is not enough air and sound able to bounce around the vocal tract, singers can encounter many further vocal problems.

For example, a bad cold causes congestion of the vocal tract and the nasal cavity, which means that the vibrations are unable to bounce around the nose, and this changes how the voice sounds. Another common problem for singers is having a deviated septum; this occurs either naturally or after a trauma to the nose and causes the cartilage in the front of the septum or the bone at the back to be crooked. This can make breathing difficult because of increased nasal congestion and be the cause of recurrent sinus infections, headaches, and postnasal drip. Surgery called septoplasty can be carried out to straighten the septum, but it is difficult to ascertain whether the operation will improve the problem.

I have been singing since I was ten, classical since twelve, and opera since sixteen. I started to realize around the age of sixteen (when my voice was stabilizing and I was beginning a more vocally strenuous repertoire), that something was wrong with my voice. I felt constantly blocked up, as though I had a constant cold. My throat would dry up extremely easily, and I would feel uneasy singing above an FG. As a tenor, this was rather daunting. Eventually, an ENT specialist told me that I had a deviated septum, but that an operation might not actually help at all. Now in my third year of university and I have still not received the help that I need. It’s become imminently clear to me that there is not enough support for singers and their general welfare. I intend to meet with another leading ENT specialist in London soon to try to get to the bottom of my own health problems, but I would like to discuss the effect that illness can have on the performer mentally.

I know that singers, and all musicians for that matter, are already anxious enough before a big performance, exam, or gig, without having to worry about external factors. I find myself in a near-constant state of anxiety whenever I perform, fretting about my throat being dry every five seconds, being too blocked up, and whether that means I will not be able to reach the big Bb or C at the end of my piece. It is fair to say that the mental damage that the illness brings forward is equal, if not more, stress-inducing for the singer than the physical factors. To put it simply, there is an enormous lack of both medical and mental health support for singers at all levels of education. For us, our first line of defense is our singing teacher. If we think something is wrong, we go to them, which is not always the answer, as they may not all be vocal experts. It’s vitally important that singers get the attention they need early on in their musical education, otherwise, we are subject to the risk of damaging our voices permanently without even knowing anything is wrong.

Trollinger talks about a relatively new area called ‘performing arts medicine’, which is a field “composed not only medical doctors, but also specialists in music performance and mental health” (2016: 3). Trollinger believes this to be of the utmost importance for those involved with performing, as it encompasses performance anxiety, hearing loss and physiological problems relating to singing. Another article written by Latham includes an in-depth survey carried out in 75 postgraduate schools and colleges looking at how much education is provided on vocal health and who provides it. She concluded that although a high number provided “some instruction in vocal health and vocal physiology to their graduate singing students” (2016), under half used any medical professionals, and there was a real need for more collaboration with these professionals and for vocal health to be a compulsory module at university. LaPine discusses the importance of vocal health and awareness for singers and other professionals who rely on their voice and stresses the need for a multidisciplinary approach, including “physicians who are trained to manage laryngeal function, certified voice teachers and coaches who are knowledgeable about voice production and voice use” (2008: 29), along with speech-language pathologists and psychologists.

I attend a performing arts university, but I’ve found very few resources available in the library on vocal health. In conducting my own research, I have discovered that there is much work being carried out around vocal health which will hopefully lead to better understanding and awareness for the performer and the teacher. I have also discovered websites such as The British Voice Association and BAPAM, which provide specialist health support to performing arts students and professionals.

In conclusion, vocal health is vital for singers, and vocal illness can impact not just the voice, but also a person’s overall physical health and emotional well-being. There are services and help available, but I believe that this subject should be an integral part of the university department and possibly incorporated within a compulsory module.