Category: Nursing

Explanation of the Concept

The specific concept involves the insertion and maintenance of nasogastric tubes for patients with gastrointestinal diseases. A Nasogastric (NG) tube is a flexible, hollow tube passed from the nasopharynx into the stomach (Cooper & Gosnell, 2022). The tube removes toxic substances, fluids, and gas from the stomach, diagnosing gastrointestinal problems, obtaining secretions, or administering nutrients and fluids into the stomach. In addition, an NG tube can be used to prevent abdominal distention and vomiting, thereby allowing the digestive tract to heal and rest. Some of the commonly known NG tubes that physicians use depending on the suitability of the patient are jejunal, button tubes, and percutaneous endoscopic gastrostomy.

Depending on the function of the NG tube, the procedure can be referred to as tube feeding if it is used for delivering liquid nutrition. Therefore, NG tubes have become part of care procedures in alleviating intestinal obstruction and supporting nutritional support. The procedure can be used for any patient population requiring nutritional or decompression support (Kids health information: Nasogastric tubes, n.d.). The tube can also be used during the X-rays process when adding contrast to the stomach to assist in differentiating structures for better views. An NG tube can be used for persons irrespective of age (Cooper & Gosnell, 2022). In addition, the tube can be used among children experiencing difficulties in swallowing, inflammation, digestive problems, and medical conditions. The NG tube placement serves different purposes and can be used for gastric gavage, gastric lavage, and gastric decompression.

Gastric Gavage

Gastric gavage refers to supplying nutritional substances via a feeding tube directly to the stomach. The process entails attaching an NG tube to a feeding pump or feeding the patient by allowing the nutrients or fluids to flow using a syringe or gravity. Ensure the patient feeds through the NG tube to keep their head elevated at 30 degrees to avoid gastric reflux or aspiration. Start tube feeding slowly and increase gradually or dilute and strengthen gradually to avert dumping syndrome associated with too rapid infusion of concentrated feedings. Damping syndrome has similar symptoms to shock and is very distressing to the patient when it occurs. The feeding can be supplemented with additional water, which the health caregiver gives through the tube.

Water is given during feeding to assist in meeting the fluid requirements of the patients, assist in dilution of the tube feedings, and maintain the tubes patent. However, before anything is introduced into an NG tube, it is essential to verify tube placement to prevent contents from entering the lungs. X-ray is used as absolute means of verification for NG tube placement (Nasogastric intubation, 2022). Another means of testing the placement involves aspirating gastric contents either by observing the aspirated contents for consistency and color of the fluid or testing the aspirated gastric juices for pH. The pH of normal gastric juice contents is less than 4. The caregiver continuously monitors residual feedings in the stomach of the patients receiving nutrients. Any increase is reported as a sign of a problem like aspiration or gastric reflux.

Gastric Lavage

The NG tube is used primarily for delivering nutrients or fluids during nursing assessment for gastrointestinal disease. In this process, a feeding pump is attached to allow a steady flow of the fluids by gravity. When administering, patients must sit with their heads raised 30 degrees to prevent gastric reflux or aspiration. The use of gastric lavage allows for the stopping of gastrointestinal bleeding, and it is done in case of poisoning. Through this process, the stomach is provided with room temperature solutions, after which it is suctioned out. Precaution is taken not to use iced solutions to avoid causing hypothermia, increased bleeding, and impaired platelet production. The solution used is administered until there is an improvement in results, and every time the solution is removed from the stomach, it has to be measured, evaluated, and documented.

Gastric Decompression

Gastric decompression is done mainly to remove the fluids and air building up during slowed gastrointestinal motility. The method can be used after surgery to prevent vomiting, nausea, and distention development. During decompression, the NG tube is coupled to an intermittent gastric suction device, and with the help of the nurse measure, the content is routine. Lavin and Salem sump tubes are the most common tubes applied for decompression. When administering the NG tube, patients present numerous issues, and maintaining their comfort is often challenging (Nasogastric tube (NG tube), n.d.). The tube irritates nasal mucosa and can result in trauma. To lessen this discomfort involves securing the tube on the nose and gown to restrict unwanted movement. Excessive secretions around the nostrils and nares are also removed, and the tube is lubricated with water-soluble that prevents the crusting of secretions.

Patient Problems/Nursing Diagnoses

1. Risk for aspiration related to the insertion of NG tube, which is secondary to dysphagia.
2. Deficient knowledge is mainly related to home management and care of NG tube management which is secondary to stroke. It is evidenced by inadequate understanding regarding the condition, limited ability to manage NG tubes appropriately, and the existence of severe complications which are preventable (Ignatavicius et al., 2020).
3. The risk for imbalanced nutrition associated with feeding through the NG tube is secondary to gastrectomy.
4. Risk for fluid volume deficiency related to feeding through NG tube secondary to critical Crohns disease.
5. Risk for infection related to the insertion of NG tube and feeding secondary to gastrointestinal cancer.

Nursing Assessments

1. Verify the NG tube, suction method, and irrigation instructions given by the doctor. This maintains precision in carrying out the doctors instructions.
2. Examine the NG tube drainage to assess the quality, including the samples quantity, color, composition, and odor. Test the drainage using a hematology kit to find out if theres any blood in it. Gastric discharge typically appears to be a pale yellow to light green tint due to bile presence. Bloody leakage following gastric surgery is possible and should be constantly monitored. (Ignatavicius et al., 2020) Drainage that resembles coffee grounds could be a sign of internal hemorrhage.
3. Inspect vacuum cleaners to verify whether the correct settings have been made for the suction type, the suction range, and the presence of drainage movement through the tube. The action protects the integrity of the doctors instructions by ensuring their precise execution (Ackley et al., 2020). In addition, it verifies the presence and strength of suction. Inadequate suction may result from a loose connection or some form of obstruction in the tube.
4. Check the NG tube positioning because it can be accidentally pushed into the trachea if the patient moves or through manipulation.
5. Examine if the patient is experiencing pain, nausea, or fullness in their stomach. Lack of ease could indicate a clogged NG tube or improperly functioning NG suction.
6. Using auscultation, check the patients abdomen for distention and the absence of bowel sounds. Distention in the abdomen could be caused by gas buildup or internal hemorrhage. If there are rumblings in the stomach again, peristalsis has resumed.
7. Determine the clients level of mobility and evaluate their breathing. Peristalsis can be restored and drainage facilitated by turning from side to side in bed and ambulating if allowed (Ignatavicius et al., 2020). In addition, NG tube may dissuade patients from engaging in deep breathing and coughing, which helps maintain a healthy respiratory exchange.
8. Check the clients mouth and nose for any signs of infection. Cleaning and lubricating the nostrils with a water-soluble lubricant and changing the tape as needed can help reduce irritation from the NG tube. In addition, oral hygiene should be practiced every two hours to keep the oral mucosa supple and comfortable.
9. Continuously monitor and assess the well-being of your NG tube patient. An NG tube may be taped to the patients nose and attached to their robe to facilitate patient mobility. Nursing assistance is always a push away if a client has a call bell within easy reach. When an NG tube becomes obstructed or kinked, its ability to deliver oxygen is compromised (Ackley et al., 2020). The semi-Fowlers position helps with drainage and reduces the potential for aspiration.
10. Ensure that supplies are always adequate and that equipment is serviced as per manufacturer specifications and agency guidelines. The availability of resources ensures the proper functioning of machinery and the effective removal of stomach contents from patients.
11. Fill out an intake/output chart with NG irrigation and drainage measurements as required by the agency. Create a chart detailing the draining process and the clients reaction. Intake includes irrigation, and output from the NG tube is monitored every 8 hours. When there is a lot of runoff, the trash can must be emptied more often. Therefore, the documentation of the clients reaction to NG drainage is reliable.
12. Check the NG tube and suction equipment at least every two hours. Irrigate as prescribed by the physician to promote safe system functioning. Any change in the clients condition or drainage demands increased monitoring and physician notification.

Specific, Realistic and Measurable Goals

Deficient Knowledge

1. The patient will acquire more knowledge about managing an NG tube.
2. The patient will be able to identify symptoms of severe complications at an early stage to prevent worsening.
3. The patient will gain awareness of the benefit and learn how to control the disadvantages associated with NG tube feeding.

Risk for Aspiration

The patient will be protected from the risk by healthcare staff who have adequate knowledge of its management by identifying the problem at an early stage.

Imbalanced Nutrition

1. The patient will display no malnutrition signs.
2. The patient will exhibit a slow weight gain or keep a stable weight in accordance with specific standards established to normalize laboratory values.

Deficient Fluid Volume

The patient will maintain a stable fluid volume and an appropriate balance between the output and input of fluids.

Infection

The patient will be knowledgeable concerning limiting and controlling the risk of infection associated with NG tube feeding.

Nursing Interventions

1. Ensure patients have the appropriate food in the NG tubing, especially those affected by stroke. Components of NG dietary food are often in a liquid form. The patients condition determines the specific food or medication to be given and the frequency (Gulanick & Myers, 2022). Care providers can receive guidance from a doctor or dietitian on what kinds of food to serve patients. The patient and their loved ones can select ready-made liquid formulations and prepare the food themselves. Food should be heated to a temperature the patient finds comfortable before being served.
2. Teach the patient and any close relatives how to use the NG tube correctly.
3. Provide patient and family members with information about NG tube care and management.
4. Check that the NG tube is in the right place to prevent any problems. Remind them that the NG tube must not be removed or reinserted unless instructed by the attending physician.
5. It is important to inquire about the hospitals handling of patients at high risk of aspiration from other facilities where they were treated.
6. Create an alternative or contingency plan to treat all individuals with emergency needs appropriately.
7. Inform the doctor if there is any displacement of the NG tube
8. Record the quantity and features of the patients stomach discharge because persistent bleeding is indicative of complications
9. Check for skin breakdown, tachycardia, hypoglycemia, and a relatively high gravity in the patients urine as indicators of a fluid-volume deficit.
10. Ensure proper medication administration via the NG tube and appropriate preparation is done.
11. Inform family members about the risk for infection and strategies to avoid such factors
12. Examine urine production hourly and weigh the patient frequently to monitor any gain or losses per fluid volume retention strategies.

References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier

Cooper, K., & Gosnell, K. (2022). Foundations of nursing. Elsevier Health Sciences.

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medicalsurgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier

Kids health information: Nasogastric tubes. (n.d.). The Royal childrens hospital: The royal childrens hospital. Web.

Nasogastric intubation: Background, indications, contraindications. (2022). Diseases & Conditions  Medscape reference.

Nasogastric tube (NG tube). (n.d.). MedlinePlus  Health Information from the National Library of Medicine. Web.

Nasogastric tube. (n.d.). Nemours kids health  the Webs most visited site about childrens health.

The necessity for continuing nursing education (CNE) has been well established and documented, with available scholarship demonstrating an association between mandatory CNE and the actualization of professional competence among nurses (Smith, 2003). Indeed, CNE is not only seen as the cornerstone to the professional development of nurses within healthcare settings (McCarthy & Evans, 2003) but also as a necessary component that allows nursing professionals to perform competently (Tilley, 2008). The present paper elucidates the pros and cons of CNE, particularly concerning its impact on nursing competency.

A foremost advantage of CNE is that it enables nurses to keep up with the shifting technological and patient care trends which are brought into the limelight by new medical breakthroughs, threats of emerging or evolving diseases, as well as developing health care innovations (Smith, 2003). It would be almost impossible for nurses to deal with emerging threats of disease or innovations in medical and health care technology, for example, if they fail to develop their competencies through CNE. Another advantage related to impact on competency is that CNE provides the capacity for nurses to improve patient outcomes through continuous exposure to journal articles, webinars, videos, or clinical trials. A third advantage is that CNE provides nurses with the capacity to demonstrate professionalism by keeping up with emerging evidence-based practices as reported in journals and other modes of education (Tilley, 2008). Available literature also demonstrates that CNE fosters networking among nurses who attend seminars or read journal articles, which in turn elevates their competency levels through the sharing of experience and knowledge (McCarthy & Evans, 2003).

In disadvantages, it is documented that the high costs involved in CNE may not equate to the competency skills achieved, particularly upon the realization that some CNE programs and resources are commercially-oriented and hence leave a minimal footprint in terms of their impact on competency. It is also argued that some nurses fail to benefit from CNE as most of the programs require a substantial allocation of time. Such allocation may not be possible due to other underlying factors such as the shortage of nurses. As such, most of the nurses enroll in the programs to get the certificate at the expense of competency development (Ousey & Roberts, 2013).

The position taken by the group is that CNE should be mandatory for all nurses as it assists them to develop various levels of skills and competencies if well administered. As already discussed in the pros section, CNE enhances the competency of nurses in health care settings by assisting them to develop the skills necessary to respond to emerging medical and technological shifts being witnessed in contemporary times (Smith, 2003), and also by elevating their professional status in the provision of current and ultimately safe and effective patient care (Tilley, 2008). CNE must be made mandatory as nurses are expected to base their profession on ever-evolving evidence-based practices which can only be identified, practiced, and internalized through reading current journal articles, attending seminars, and enrolling in professional improvement courses. Furthermore, it is generally believed that CNE could significantly assist nurses in key competency areas of assessment and intervention, communication, critical thinking, human caring relationships, management, and leadership (Tilley, 2008).

This paper has discussed the benefits and drawbacks of CNE, as well as taken a position that CNE should be made mandatory for all nurses because it assists them to develop various competencies. However, care should be taken to ensure that CNE translates into real benefits for nurses in terms of impact on competency.

References

McCarthy, A., & Evans, D.S. (2003). A study on the impact of continuing education for nurses and midwives who completed post-registration courses. Web.

Ousey, K., & Roberts, D. (2013). Improving access to CPD for nurses: The uptake of online provision. British Journal of Community Nursing, 18(2), 78-83.

Smith, J. (2003). Exploring the value of continuing education mandates. Web.

Tilley, D.D.S. (2008). Competency in nursing: A concept analysis. Journal of Continuing Education in Nursing, 39(2), 58-64.

Introduction

Ignoring residents is a common form of neglect in most nursing homes. Although it is not violent, nursing home neglect is commonly regarded as abuse. The Omnibus Budget Reconciliation Act of 1987, a federal statute that addresses patient rights and nursing facility reforms, defines nursing home neglect as abuse. Neglect can occur in many ways, including when a nurse is absent when necessary and when a patients basic needs, such as clothes or food, are not clean. Neglect is becoming an epidemic as an aging population moves into care facilities such as nursing homes and assisted living facilities. More than sixty percent of the elderly outside nursing homes and 24.3% in nursing homes experience at least one case of neglect or physical abuse (Nursing home abuse statistics, n.d). Research findings in the nursing field show an increasing neglect rate due to various reasons, such as insufficient staffing and poor training. When employees are overworked or under stress, their ability to provide patients with the individualized care they require may suffer, leading to poor-quality delivery. Nursing home neglect has been prevalent throughout the years and has increased since I have been in the nursing field.

Nursing Homes Neglect

Neglecting residents in nursing homes is a type of abuse that has increased over the years. Nursing home neglect occurs when patients do not receive the necessary care, which can harm their physical and mental well-being (Nursing home neglect and abuse, 2018). As a result, all of ones basic needs, such as nutrition, housing, clothing, cleanliness, and medical attention, must be met. When patients lack these needs, their mental and emotional well-being may suffer, leading to devastating consequences, including physical and emotional agony (Nursing home neglect, 2018). Patients who receive subpar care are more likely to experience complications and poor outcomes than those who do not. One possible explanation is that they lack the cognitive abilities to articulate and defend those demands and interests. Therefore, nurses are responsible for ensuring they offer the best possible high-quality care. Besides taking care of their patients, nurses can advocate for the rights of their patients, such as advising the leadership to add more staff when the need arises.

The best nursing homes and assisted living facilities to provide their patients with exceptional care. They meet all of their residents needs, including opportunities for meaningful relationships, regular exercise, nutritious meals, and downtime. On the other hand, some nursing homes do not provide adequate care and force their residents to live in unhealthy conditions such as high temperatures, filth, and an abundance of viruses. Such lack of dedication by professionals demonstrates the highest levels of neglect, which should not be tolerated in any healthcare institution.

Residents will receive better care if their concerns are acknowledged and addressed. Any interruption or factor affecting nurses performance, therefore, impacts the quality of care and patient concerns are unmet (Nursing homes neglect on the rise, 2019). For example, nursing home workers are often perceived as too slow to respond to patients needs. This can manifest in various ways, such as staff taking too long to respond to call buttons and leaving patients waiting in uncomfortable positions such as beds and wheelchairs for extended periods. The absence of a nurse may result in the poor mental health of the patient, especially in cases when the patient needs the most attention. The hospital dining hall is frequently the only place patients left alone can spend time between meals. This environment is filled with people who can call for help if the patient needs immediate attention. Additionally, interactions are possible in the dining hall, where the patient can meet and converse with other patients.

Neglected nursing home patients frequently suffer serious injuries or even death. For example, due to this neglect, a 74-year-old resident of a nursing facility in Oxnard, California, died (Nursing home neglect, 2018). The family claimed that the nursing home failed to provide adequate care, such as adequate nutrition, moving the patient frequently enough to prevent bed sores, and keeping the patient clean. The family seems to have noticed the neglect initially but kept quiet, which led to the death of their loved one. The case shows that if a family member is worried about moving into a nursing home, they must understand they are not alone and that they have support. Some homes may take advantage of their vulnerable residents by providing insufficient services. Nursing home patients and families have the right to complain about the facility (Nursing home neglect, n.d). This way, they can protect their patients from the severe consequences of neglect in nursing homes. Overall, nursing home neglect, which occurs when residents do not receive the care they require from personnel, is another common way the elderly are abused.

Causes of Nursing Neglect

Many nursing home residents are neglected because insufficient staff members care for them. When abuse occurs in nursing homes, it is usually the fault of managers and owners who prioritize profits over the interests of residents (Nursing home neglect, n.d). Instead of reinvesting profits in the nursing homes infrastructure, residents, and staff, the owners may keep them for themselves. On the other hand, employees may try to justify their poor performance by claiming they were sleepy, unprepared, or did not care. Either way, families who suspect their loved one is being abused in a nursing home must carefully consider their options and act quickly (Nursing home neglect, n.d). Being aware of the signs of possible abuse in nursing homes is one way to protect the elderly and loved ones in nursing homes.

Inadequate resources, such as personnel, training, and background checks, are widely blamed for nursing home abuse and neglect. A lack of personnel reduces the quality of care provided to most patients (Nursing home neglect, n.d). When there are not enough of them to go around, overworked employees are less efficient and more likely to make mistakes. Nursing home residents are at risk if nursing homes do not conduct thorough background checks on all new employees (Nursing home neglect, n.d). Failure to conduct extensive background checks presents the elderly and the sick to unprofessional nurses who do not understand their responsibilities. Finally, if new employees in a nursing home are not properly trained, they may neglect their duties (Nursing home neglect, n.d). The abuse was reported, but it was recently discovered that nursing home staff in Wisconsin lacked professional training. Overall, there is enough evidence that would prove that the common causes of nursing home neglect relate to the many ways caregivers do not provide proper care.

Types of Neglect

Neglect manifests in various ways in nursing homes and leads to negative consequences. Physical neglect, neglect of social and emotional needs, and disregard for basic needs are all common forms of neglect in nursing homes (Nursing home neglect, n.d). Medical neglect occurs when a nursing home employee fails to provide necessary care to a resident. The lawyers for a 72-year-old woman who claims she was abused and developed bedsores in a nursing home say their client never sought medical attention at a hospital during her stay. This case shows that the nursing home failed to provide adequate medical care and services to its residents. Restricting meaningful social interaction between nurses and patients increases the chances of not meeting nursing home patients social and emotional needs. Participating in group activities can help seniors improve their mood and cognitive function. Locking or isolating a nursing home resident is therefore considered abusive and neglectful treatment. Overall, several pieces of evidence suggest that nursing home staff may be complicit in neglect in more than one way.

Conclusion

Consistent reports of elder neglect in nursing homes have been found to harm the lives of those who live there. More severe nursing home neglect cases have resulted in catastrophic injuries or even death. Nursing home neglect can occur from caregivers not providing quality care to patients, and this neglect is also considered abuse. Neglecting the needs of those living in nursing homes can have serious psychological and physiological consequences. Neglect mostly occurs because of understaffing in nursing homes, leading to burnout and poor quality of health delivered. Individuals receiving nursing home care are vulnerable to the impacts of any form of neglect. In nursing homes, common abuse causes include insufficient staffing levels, training for new caregivers, and insufficient applicant screening. Neglect in a nursing home can have a wide range of negative consequences.

References

Nursing home neglect. (n.d). Nursing Home Abuse Justice.

Nursing homes neglect is on the rise. (2019). Krause and Kinsman Law Firm.

Nursing home abuse statistics. (n.d). Nursing Home Abuse Justice.

Nursing home neglect. (2018). Standards of Care.

Nursing home neglect and abuse. (2019). Ferrara Law Firm.

Professionalism and professional values lie at the core of the nursing practice ever since Florence Nightingale realized in the nineteenth century that nursing should not be just scientific comprehension and technical proficiency, but a profession established on explicit human values (Rassin, 2008).

Professionalism and professional values not only guide and lead nurses in taking particular positions as they interact with clients and the community, but act as standards that assist them to rationalize their attitudes and actions so that they may always feel moral, ethically and legally in the right (Begley, 2010). This paper illuminates some basic tenets of professionalism and professional values in nursing practice.

Professionalism implies the conduct, objectives or qualities that typify or identify a profession or professional individual (Begley, 2010). Nurses are not only required to conform to the technical and ethical standards of the nursing practice but are also encouraged to be autonomous and self-regulating within the scope of practice (Rassin, 2008).

Nurses are also expected to get involved in community service, share healthcare information in their communities, and show willingness to serve others (LaSala & Nelson, 2005). Additionally, nurses are expected to participate in professional organizations to support and advance the profession, not to mention that members are personally held accountable for continuing education and competency (Rassin, 2008).

Professional values act as guiding principles or standards of conduct for nurses as they interact with the community and clients. The moral standards of nursing practice require nurses to conform to the rules of right conduct, such as ensuring clients receive sufficient information on which to base consent for care and related treatment, holding in confidence personal information of clients and using judgment in sharing this information, and sharing with the community the responsibility for initiating and supporting concerted effort to meet the health and social needs of the public (Shaw & Degazon, 2008).

In regard to patients with psychosocial disorders, nurses have a moral responsibility to assist this vulnerable group of the population and improve their quality of life. It is also the moral responsibility of nurses to promote an environment in which the human rights of this vulnerable group of the population, along with their values, traditions and religious orientation, are respected (Begley, 2010).

Ethical standards in nursing represent basic convictions of what is right, good or desirable to do in the pursuit of assisting clients and the community to improve the quality of life. Consequently, a nurse is not only expected to promote health and prevent disease but also to restore health and alleviate human and community suffering (Rassin, 2008).

A nurse is also expected to show unreserved respect for human rights, including the right to life, and must be at the forefront in the preservation of life and prevention of pain and suffering among community members and clients suffering from psychosocial disorders. Additionally, nurses should demonstrate dignity and respect to the community and clients, and expect social recognition from society and clients in return. Other dispositional values include tolerance, courtesy, approachability, diligence, empathy, kindness, genuineness and patience (Begley, 2010).

On the legal front, nurses must not only practice in accordance with national and local policies and technical principles, but must practice in accordance with applicable legislation. To be on the right side of the law, nurses must have the right capability and skill to recognize and act upon any violation of law relating to their nursing practice or code of practice (Begley, 2010).

Reference List

Begley, A.M. (2010). On being a good nurse: Reflections on the past and preparing for the future. International Journal of Nursing Practice, 16(6), 525-532.

LaSala, K.B., & Nelson, J. (2005). What contributes to professionalism? MEDSURG Nursing, 14(1), 63-67.

Rassin, M. (2008). Nurses professional and personal values. Nursing Ethics, 15(5), 614-630.

Shaw, H.K., & Degazon, C. (2008). Integrating the core professional values of nursing: A profession, not just a career. Journal of Cultural Diversity, 15(1), 44-50.

What is Schizophrenia?

People with schizophrenia tend to hear funny voices that do not even exist. Schizophrenia is, therefore a chronic and disabling brain condition that affects many people (Birchwood, Spencer, & McGovern, 2000, p. 93). The affected patients believe strongly that other people are manipulating or controlling their minds. Sometimes they think that other individuals are planning to attack them. Some people with the condition will appear normal until they express their thoughts (Birchwood et al., 2000, p. 94). This condition makes it impossible for many patients to deal with their problems. Such people cannot have successful careers. This disorder affects many individuals, communities, and families.

Statistics

According to the World Health Organization (WHO), schizophrenia affects about 1 percent of the human population. The disease affected both women and men. Schizophrenia will occur in 10 percent of individuals whose relatives have been diagnosed with the disorder. Researchers believe that some genes contribute to the risk of schizophrenia (Birchwood, 2000, p. 93). The risk is also higher for identical twins of persons with the disorder (Birchwood, 2000, p. 93). New studies are being conducted in order to understand the prevalence of this disease.

Signs and Symptoms

Medical practitioners have divided the symptoms of schizophrenia into three unique categories. These categories include cognitive, positive, and negative symptoms. To begin with, positive symptoms are usually unusual and psychotic in nature. According to Mitra (2008, p. 35), the affected persons tend to lose touch with reality. These symptoms depend on the kind of medication availed to the targeted patient. Some hallucinations include things that the individual sees, smells, feels, or hears (Mitra, 2008, p. 34). The individuals might also portray some dysfunctional ways of interacting with other people. Movement disorders are also common among the affected individuals.

Some negative signs usually affect the normal behaviors of the targeted individual. For example, the affected patient might be unable to complete different activities. The affected individual will lack pleasure in different things. Some patients will be unable to interact with others. The affected persons should get the best support from their guardians and relatives. Cognitive symptoms are usually hard to detect. For instance, some patients will have difficulties whenever completing different chores (Mitra, 2008). Some patients will be unable to make accurate decisions.

Types of Schizophrenia

There are several types of this condition. Mitra (2008) identifies two subtypes of schizophrenia. The first one is the paranoid subtype. This type is characterized by auditory hallucinations. Most of the individuals affected by this type will portray such symptoms until their 40s. A proper management strategy will make it easier for individuals to have good lives. The second type is called disorganized schizophrenia. This type of schizophrenia is associated with disorganized thought processes (Birchwood, 2000, p. 94). The affected people might be emotionally disoriented or unstable. They will also be able to complete small tasks such as bathing and dressing. The people might also be unwilling to communicate with others. Medical professionals should consider most of these symptoms to offer the best support (Mitra, 2008).

Risk Factors

Some factors determine the development and progression of schizophrenia (Mitra, 2008, p. 36). To begin with, the condition develops from 16 to 40 years of age. The risk also declines with old age. Many men will develop the diseases between 15 and 24 years. The disease will occur in women between 24 and 34 years of age. Intelligent people are also prone to schizophrenia in comparison with other individuals (Meiner, 2010, p. 28). Some socioeconomic aspects also promote the development of this condition. It is notable that divorced and unmarried individuals will have higher chances of getting the disease. Poverty, famine, and loneliness can also increase the risks of getting the disease. Studies have also indicated that left-handed people have higher chances of developing this disease. Some behavioral problems and disorders can also increase the risk of schizophrenia (Mitra, 2008, p. 36). Individuals with epilepsy have higher chances of developing this disease.

Diagnostic Criteria

The Diagnostic and Statistical Manual of Mental Disorders (DSM) IV-TR is used for monitoring the development of schizophrenia. According to the model, doctors should examine the presence of specific symptoms for a period of 1-6 months. The model focuses on the presence of active (or positive) symptoms such as hallucinations and delusions. Doctors should also monitor some negative symptoms such as lack of motivation, catatonic behavior, and disorganized speech (Mitra, 2008, p. 34). In the case of a pervasive development disorder, an additional diagnosis is undertaken. Doctors should therefore monitor the presence of hallucinations and delusions (Mitra, 2008, p. 35).

Interventions: Pharmacological and Non-pharmacological

It is agreeable that the leading causes of schizophrenia are not known. However, some pharmacological interventions are used to eliminate most of the symptoms associated with schizophrenia. Some antipsychotic medications have been widely used to treat the disease. Some of these medications include Haloperidol, Chlorpromazine, Fluphenazine, and Perphernazine (Mitra, 2008, p. 33). Clozaril is also used to treat different symptoms such as hallucinations. Most of these drugs produce a wide range of side effects. The common side effects of most of these antipsychotics include blurred vision, skin rashes, drowsiness, and rapid heartbeat (Mitra, 2008, p. 37). According to Mitra (2008 p. 37), continued use of these drugs will result in a condition called Tardive Dyskinesia. These drugs are necessary because schizophrenia requires long-term management.

Some non-pharmacological methods can make it easier for many people to achieve their goals. Some of these therapies will reduce the period of hospitalization. Some illness management skills (IMSs) will ensure more people achieve their potentials. An integrated approach will combine therapy and medicine. Guardians should ensure every schizophrenic patient does not take any addictive drug. Rehabilitation is another powerful practice that can support the needs of many people. The strategy includes training and continued counseling. Cognitive behavioral therapy is effective because it re-patterns the behaviors of the affected individuals (Meiner, 2010). Societies should form self-help groups to support every person with the disease. The approach will eventually produce the best outcomes.

Other Considerations in the Management of Schizophrenia

Nursing should always be an evidence-based practice aimed at producing the best health outcomes (Fawcett, 2003, p. 45). Schizophrenia is one of the chronic conditions affecting mankind. That being the case, nurses should use different theories and evidence-based practices in order to support their patients (Meiner, 2010). To begin with, self help groups and family interventions can support the needs of many schizophrenic individuals. The individuals will learn how to live with the disease and focus on their goals.

According to Martha Rogers, nurses should focus on the unitary human being (Fawcett, 2003, p. 49). Medical practitioners should use the best health outcomes even when there is a presence of a disease (Fawcett, 2003, p. 48). Nurses should undertake more studies in order to address the needs of many schizophrenic patients. Nurses should also identify the clinical problems associated with schizophrenia (Fawcett, 2003, p. 48). This knowledge will also encourage more nurses to identify new practices in order to assist the targeted patients.

The Use of Evidence-Based Practices

An evidence-based practice focuses on the key issues associated with different medical problems. Nurses will examine the best treatment methods that can be used to deal with schizophrenia. This approach will ensure more nurses support the targeted patients. They will also examine the cultural backgrounds of different patients in order to re-pattern their associations with the surrounding environment (Fawcett, 2003, p. 45). Such nurses will also treat the practice as a science and art (Fawcett, 2003, p. 48). They will also develop new philosophies that can address the health needs of many schizophrenic people.

Medical practitioners should begin by understanding the types and symptoms exhibited by different patients. The practitioners will also identify the right therapies and medications that can produce the best outcomes. They will also use various training sessions and strategies to support the needs of the targeted patients. These practices will ensure more schizophrenic patients manage their lives. The above nursing skills will ensure more patients manage their families. Family education and continued behavioral therapies will ensure the targeted individuals achieve their goals. Nurses should mentor different families in order to support their patients. Such families should also get the best services and support for their patients (Meiner, 2010, p. 47). These evidence-based practices will ensure more societies support every person with schizophrenia.

Reference List

Birchwood, M., Spencer, E., & McGovern, D. (2000). Schizophrenia: Early Warning Signs. Advances in Psychiatric Treatment, 6(1), 93-101.

Fawcett, J. (2003). The Nurse Theorists: 21^st Century Updates  Martha E. Rogers. Nursing Science Quarterly, 16(1), 44-51.

Meiner, S. (2010). Gerontology Nursing. Maryland Heights, MO: Mosby.

Mitra, J. (2008). Management of Negative Symptoms in Schizophrenia: Looking Positively. Delhi Psychiatry, 11(1), 32-38.

Introduction

Nurses are important professionals in the health care system. They outline the point of contact between a patient and the system. Similarly, they identify problems, assess health situations, and offer solutions for health issues that may, or may not, need a doctors intervention (Haigh, 2013). Because of their critical role in the health sector, and the sensitive nature of their work, nurses often have to take an oath to affirm their commitment to their work (Haigh, 2013).

This is an old practice in the nursing profession, which applies today. Indeed, since many people believe that the profession is very important to human existence, they demand a lot of dedication and commitment from the stakeholders. Therefore, nurses have to assure people of their commitment to help them when they need their services (Finkelman and Kenner, 2010).

Throughout the world, nurses have used the Nightingale pledge to affirm their commitment to the practice (Haigh, 2013). However, this is an old pledge, and many people are pessimistic about its relevance to modern nursing practices. For example, some experts say some of its clauses and concepts are ambiguous and irrelevant to modern nursing (Finkelman and Kenner, 2010).

Others believe that the pledge is still relevant to the profession because the same issues that affected nurses, in the early 1900s, also affect them today (Finkelman and Kenner, 2010). The latter group believes that the nursing profession needs to keep the original components of the pledge because they symbolize a nurses commitment to the practice (Finkelman and Kenner, 2010).

The above controversy has created new problems for people who want to change the pledge to suit the modern nursing context, but still keep its originality. This issue has created two new problems for professional nurses. First, nurses need to assure the public that they are still committed to their practice by associating with the original words of the Nightingale pledge.

Secondly, they need to assure the public that they can meet modern nursing challenges by subscribing to a new set of ethical rules, which address modern nursing challenges. It is crucial to solve this issue to avoid integrity issues because the failure to do so may significantly affect the reputation of nurses. Based on this need, this paper investigates whether nurses should continue using the Nightingale pledge, or not. To do so, this paper explores different issues about the pledge, including its historical relevance, ethical limitations, functions, and ethical benefits.

Historical Relevance of the Pledge

Lystra Gretter developed the Nightingale pledge to commemorate the work of Florence Nightingale. She introduced the pledge as a tool for nurses to reaffirm their commitment to the profession (Finkelman and Kenner, 2010). Based on this need, new graduates in the practice often recite it as a modified version of the Hippocratic Oath. By doing so, nurses affirm their commitment to ethical practice. Similarly, as shown in this report, reciting the oath is akin to adhering to ethical values. Relative to this assertion, Selanders and Crane (2012) say the pledge has symbolically cemented the commitment by nurses to do their duties diligently.

Function and Purpose of the Pledge

Florence said,

Good nurses are often distressed because they cannot impress the doctor with the real danger of their patients and provoked because the patient will look either, so much better, or so much worse, than they are when the doctor is there (Haigh, 2013, p. 2).

Observers believe that this distress is justifiable, but it comes from a point of weakness where nurses do not have the power to explain their views to the doctors. The Nightingale pledge gives them this power. For example, Florence empowered the nurses by discussing their registration and examination requirements. In detail, she opposed nurse registration because she saw it as a technical intervention, as opposed to the moral development of the practice (Haigh, 2013).

Through the same concern, she believed that many doctors would have undue influence over nurses by controlling medical training facilities (Haigh, 2013). Based on these concerns, Florence believed that the law should empower nurses. Partly, this is the reason she introduced a code of conduct for nurses.

Unlike the registration of nurses, Florence did not oppose nursing examinations. However, she had some reservations about it because she said it was a tool for the upper classes to dominate over lower classes (Haigh, 2013). Similarly, the inability of such exams to measure character and morality concerned her. Based on this concern, Florence believed that nursing experts were better examiners. Moreover, since examinations failed to judge character and morality, the Nightingale pledge sought to do so.

Arguments in Favor

The Nightingale pledge, although shrouded in controversy, is relevant to modern nursing practices because it created a focus on patients requirements. For example, it introduced important welfare issues, such as the need for nurses to ensure their patients are clean and rested (Selanders and Crane, 2012). The pledge also created the link between clinical requirements and access to education. This link suffices through Florences assessment of nursing examination and registration requirements.

Overall, it is difficult to deny the commitment that the Nightingale pledge introduced to the practice. The New York Times also shares these sentiments and says, Perhaps the greatest good that has resulted from her noble life is the creation of a force which has led thousands of women to devote themselves to systematic care of the sick and wounded (Haigh, 2013, p. 21). Since patients welfare is still relevant today, as it was in the past, proponents say nurses should continue using the Nightingale pledge.

Arguments Against

Some people criticize the Nightingale pledge for the beliefs of its main sponsor, Florence Nightingale (Selanders and Crane, 2012). For example, they say the pledge is impractical to modern medicine because modern medicine would not exist without registering nurses, yet Florence did not understand this need in the first place (Haigh, 2013).

Similarly, in a modern world that strives to bridge social and economic divisions, they say the theory focuses too much on social divisions to align with modern societal practices. Another criticism, which they based on Florences character, was her bullish behaviors. She often opposed doctors who tried to overstep their mandate. In fact, people who have investigated this issue, in detail, say, her views of other health workers have created divisions between nurses and doctors (Haigh, 2013).

This quality prompted many of them to argue that Florences bullish tendencies live through the Nightingale pledge because it bullies and manipulates nurses to agree with her principles, regardless of their personal beliefs. Partly, they associate this issue with hostilities and power struggles between nurses and doctors (a divide that has taken several decades to end) (Haigh, 2013).

Ethical Benefits and Limitations of the Pledge

Understanding the ethical boundaries of any profession is a difficult process. This is why many professional bodies introduce ethical codes of conduct to guide the behaviors of their members. Before Florence came into the nursing profession, there was no ethical code of conduct to guide health workers. However, after nurses adopted the Nightingale pledge, the practice got an ethical framework. This section of the report explores the benefits and limitations of this pledge.

Benefits

As shown in this paper, the Nightingale pledge is an ethics statement. In this regard, it has an important ethical benefit. Particularly, it reaffirms a nurses commitment to refrain from participating in unprofessional activities (deleterious or mischievous activities) (Dahnke, 2013). Using the same impetus, the pledge creates a strong zeal to offer quality health services.

Based on this ethical commitment, some scholars have revised the pledge to portray the nursing role as a pivotal aspect of human welfare advancement (Dahnke, 2013). For example, in 1935, Gretter (a nursing scholar) used the ethical foundation of the Nightingale pledge to expand the role of nurses to make them missionaries of health (Shelly and Miller, 2009).

Limitations

The greatest limitation of the Nightingale pledge is human fallibility (Dahnke, 2013). This ethical limitation does not only characterize the nursing practice, but other professions as well. Indeed, nurses are human beings and human beings are prone to making errors. Therefore, although they want to work diligently, they are still bound to make some technical and moral misjudgments. Particularly, this is true because an excerpt in the Nightingale pledge requires nurses to support physicians, always.

This clause is contentious because it implies that all nurses should support physicians even when they make mistakes. The same ethical dilemma exists through a different clause in the pledge, which requires nurses to pledge to God. The belief in God embodies religious beliefs and such beliefs vary across different societies. Therefore, there is an unclear line between religion and practice (Shelly and Miller, 2009).

Lastly, environmental factors, such as changes in technology and organizational structures, also limit the Nightingale pledge. To affirm this assertion, Dahnke (2013) says no ethical code of conduct could predict the nature of ethical challenges that environmental factors in the 21^st century could bring to the practice.

Summary

This paper shows that although the Nightingale pledge is useful to modern nursing, it has some ethical limitations. These limitations stem from ambiguous phrases in the pledge. For example, this paper highlights the pledge to God as an ethical dilemma for nurses. Similarly, the pledge to help physicians in their work highlights the same dilemma.

However, broadly, the pledge has brought many positive contributions to the nursing practice. For example, this paper shows how it brought a structural change in the practice  focus on patients. Although it also contributed to other developments in the profession as well, its commitment to patients welfare touches the core of the nursing practice.

Therefore, changing the contents of the Nightingale pledge to appeal to new and modern challenges of the nursing profession is not feasible, in the short-term, because it may lead to different interpretations of nursing roles, thereby causing a lot of confusion in the field. Therefore, nurses should pledge their loyalty to it, at least in the short-term.

References

Dahnke, M. (2013). The Role of the American Nurses Association Code in Ethical Decision Making.

Finkelman, A., & Kenner, C. (2010). Professional Nursing Concepts: Competencies for Quality Leadership. New York, NY: Jones & Bartlett Publishers.

Haigh, C. (2013). Nightingales Relevance to Nursing Education.

Selanders, L., & Crane, P. (2012). The Voice of Florence Nightingale on Advocacy. The Online Journal of Issues in Nursing, 17(1), 1-10.

Shelly, J., & Miller, A. (2009). Values in Conflict: Christian Nursing in a Changing Profession. New York, NY: InterVarsity Press.

Modern tasks assigned to the nurse make this profession multifaceted and technologically complex. If, in accordance with the laws of dialectics, our society is now entering a new round of development of the attitude towards diseases, i.e., focusing on their prevention, it is necessary to accordingly form and develop a methodology for nursing in order to manage the health of not only healthy or sick people, but also society from the standpoint of public health.

In particular, the methodology of nursing diagnosis should be based on the mandatory principles of evidence-based medicine, providing the possibility of proving (or refuting) certain decisions and formalizing both the development of decisions for certain standard situations and the decision-making process in non-standard cases. In general, the successful solution of the tasks facing healthcare is largely dependent on the competence of nurse personnel, their professionalism, creative activity, and competency. Thus, a systemic consideration of hard and soft skills and knowledge of graduate nurses, as well as leadership requirements and potential challenges, seems to be necessary.

Implications of Graduate Nurse Work in Todays Healthcare Environment

Necessary Skills, Knowledge and Attitudes

At the present stage of medical science and practice development, the role of a nurse has significantly increased. According to available estimates, nurses make up the majority of medical personnel (up to 70%) and provide up to 80% of the direct patient care (Black, 2019). The main burden on the implementation of a huge variety of practical patient care lies namely on nurses. While specialists-doctors are increasingly moving into technological specialties, namely the nurse becomes the expression of the human side of medicine and healthcare.

First of all, new nurses should be well aware of nursing process stages, be able to apply the elements of the nursing process in practice, know the features of the course of various diseases and the principles of nursing diagnosis, as well as be able to help the patient and assist the doctor in performing the procedures. In addition, nurses should have certain personal qualities that will help them cope with a variety of tasks, often very difficult ones. In particular, it should be noted that the basic principle in the organization of nursing is to pay priority attention to the personality of the patient. The nurse becomes patients instructor, confidently abandoning the prevailing opinion that the less the patient in severe condition will do something himself, the better.

She motivates rehabilitation, prevention, and a healthy lifestyle (Pertiwi & Hariyati, 2019). Thus, helping the patient, she at the same time encourages him to be independent as much as he is capable of.

A Personal Communication with a Nurse Leader

A nurse leader specifically emphasized that it is necessary that nurses with a large amount of specialized knowledge acquired during study are not mechanical executors of doctors prescriptions, because this mode of work determines the low self-esteem of nurses as workers in the professional hierarchy. Meanwhile, the head nurses often point out the low level of training of graduates. One can hear from the head nurses that graduates have to be provided additional training at the workplace, or even have to be retrained. On the one hand, this is not unusual as each organization has its own standards and rules of work, starting with the appointment of the patient and ending with his discharge, and there is, after all, own internal corporate culture.

However, on the other hand, of course, this is due to problems in the quality of training. There can be several nursing educational institutions in one city, and they all teach students differently. According to the nurse leader, one of the directions for improving the training of nursing staff is a greater level of integration of higher medical schools and secondary medical institutions like colleges.

The Issues and Challenges Faced by New Nurses upon Entering the Workforce

Lack of sufficient communication skills, critical analysis, creative thinking, a scientific approach to acquiring new knowledge and skills, in particular, insufficient knowledge of evidence-based medicine methods and practical experience in this area are the main problems and challenges of new nurses entering the workforce. The situation is aggravated by the reluctance of a sufficiently large number of managers to recognize the right for managerial positions for nurses, because due to the prevailing patriarchal stereotypes, rigidity and inflexibility of mind, such leaders are accustomed to the mode that the doctor is the main one over the nurse (Ingvarsson et al., 2019). In this case, nurses cease to respect themselves, and their work does not bring well-deserved joy and satisfaction to them.

Special studies indicate that the majority of respondents  nursing students  would like to work with a mentor at first (Gimbel et al., 2017). In this fact, a certain pattern is seen: any young specialist, regardless of specialty, at the initial stage of entry into labor activity simply needs a mentor to support, guide, train, and protect him. The mentoring program seems to be the most effective at the adaptation stage when mastering the profession by a young nurse.

Conclusion

It is becoming increasingly apparent that under the conditions of socio-economic and administrative reform, the strategy for the development of nursing should be consistent with the changing paradigm of medicine, be socially acceptable and at the same time guarantee the high quality of medical care to the population. In the new model, a nurse with multilevel training background can play the role of a leader, actively participating in the rational organization of the medical diagnostic process, a creative person who systematizes and individualizes patient care, an active member of the medical team who correctly and independently provides assistance to patients using modern technologies of the nursing process.

Accordingly, the process of adaptation of graduate nurses should contribute to the formation of a positive attitude of young nursing professionals towards the organization, its unit and the assigned work tasks. This is a prerequisite for the provision of highly qualified nursing care and reducing staff turnover.

References

Black, D. (2019). Managing new grad nurses: The nurse managers guide to hiring, managing and getting new grad nurses to outperform. Davavi Media Group.

Gimbel, S. P., Kohler, P., Mitchell, A., & Emami, A. (2017). Creating academic structures to promote nursings role in global health policy. International Nursing Review, 64, 117-125.

Ingvarsson, E., Verho, J., & Rosengren, K. (2019). Managing uncertainty in nursing  newly graduated nurses experiences of introduction to the nursing profession. International Archives of Nursing and Health Care, 5(1), 1-8.

Pertiwi, R. I. & Hariyati, T. S. (2019). Effective orientation programs for new graduate nurses: A systematic review. Enfermeria Clinica, 29(S2), 612-618.

Research Goals

The first goal of this study is to explore the experiences and perceptions of nurses who offer psychological care to victims of burns in healthcare institutions. The second goal of the study is to highlight areas within the healthcare sector that require assessment, improvement or complete reforms to improve the quality of psychological care provided to victims of burns. The third goal is to ensure that victims of burns receive quality healthcare services.

Problem and Problem Statement

From the literature review conducted, it is clear that victims of burns should get proper psychological care. However, adequate research has not been carried out to determine the type of care they should be given. This is the main problem that the research would address. The problem statement is that most nurses do not have adequate knowledge of the psychological care they are supposed to provide to victims of burns.

Search Terms for Literature Search

Some of the search terms that would be used in the literature research include victims of burns, perspectives and experiences of nurses, psychological care and healthcare provision to victims of burns (Parahoo 2006).

Significance of the Research

The significance of conducting this research is that provision of psychological care to victims of burns is an area of interest to many healthcare providers. Although some research has been done in the past, in-depth studies have not been carried out to address the issue fully. Many healthcare providers overlook the psychological needs of the victims, but this is a critical area that should not be ignored. Most literature related to injuries caused by burns concentrates on the physical care alone. However, it is evident that victims of burns go through psychological suffering, which requires special attention.

Consequently, this research seeks to examine the current psychological care provided to victims of burns and the views of nurses who handle them. The results of the research would be used to make necessary adjustments to improve the type of psychological care available. This is because some aspects of the care might require reassessment and reshaping to facilitate the recovery process of patients.

Summary of Articles about the Research Area

The first article by Hulbert-Williams et al. seeks to find out whether the level of anxiety of burns victims is higher. The study was conducted by using individuals who had burns and others who had not. After the study, conclusions were made that victims of burns should not only be provided with physical care but also psychological care for them to deal with their conditions (Hulbert-Williams, Bunting, & Mcilroy, 2008). The second article by Greenfield underscores the importance of different people working together to provide psychological care to victims of burns. This requires the individuals to possess adequate psychosocial skills (Greenfield 2010).

Gaps in Related Literature

The area of study under investigation has some gaps that need to be filled. For example, researchers have not conducted enough research on how psychological care should be provided, although there is literature that addresses ways of dealing with victims of burns generally. The research would therefore seek to fill these gaps.

Research Question

What do nurses in health institutions think about the provision of psychological care to victims of burns?

According to the review of literature conducted, the psychological state of burns victims in hospitals should be of great concern to nurses and other healthcare providers. They are supposed to provide maximum care to them to make their recovery process bearable.

Research Approach and Design

The choice of research design is very important in any research since it helps researchers in achieving the desired results. In this research, a descriptive qualitative research design would be used to explore the experiences and perceptions of nurses concerning the psychological care they offer to victims of burns (Parahoo 2006). Qualitative research explains various experiences in a systematic and detailed manner. In addition, it allows researchers to explore the feelings, behaviour, perspectives and experiences of different people comprehensively. The approach applies holistic frameworks to carry out a deeper analysis of complex situations.

Qualitative research is contrasted with quantitative research, which entails the use of numerical data to make important conclusions. This method would not be an appropriate one to gather the data required for this particular study. The descriptive design would ensure that the most important findings of the research are discussed comprehensively, without any bias or distortion. Researchers would be able to find out new meanings, explain existing things, verify occurrences and group information into different categories. As a result, the qualitative descriptive method would be the most suitable approach because it would facilitate specific actions that are mandatory for the study.

Study Variables

In this research, variables would be used as opposed to concepts. Variables change within the course of a research undertaking and are classified into independent and dependent variables. Independent variables are those which change during the data collection period while dependent variables are variables that are tested during research. In this research, nurses would be the dependent variables because the research aims to investigate their perspectives and experiences in offering psychological care to victims of burns. The victims on the other hand would be the independent variables because they keep on changing from time to time (Muhall, 2001).

Target and Accessible Population

The most important group of people that would be targeted by this study is nurses. This is because they deal with victims of burns directly. The study would acquire a purposive sample of nursing staff from different hospitals. A sample would be appropriate because it would provide in-depth information, which would be important for the research.

Apart from the nurses, there are other groups of people such as doctors who would also be accessible during the study. Such groups would provide important information during the study. Some victims of burns would also be accessible during the study.

Sampling Procedure to be Applied in the Research

This research would employ the purposive sampling method. A purposive sample is selected based on certain characteristics of the people involved in the study. This would make it possible for the researcher to collect data from a targeted group easily.

Researchability of the Study Area

Researching this particular study would be easy because there are numerous cases of burns in different hospitals. This implies that getting information from nurses on their experiences and perspectives about the provision of psychological care to victims of burns would not be difficult. The second reason is that healthcare is a critical area of study that affects many people. All groups that would be involved in the study would willingly give valuable information that would be used to make important improvements in the provision of healthcare to victims of burns.

Feasibility of the Study

The proposed study is feasible because it addresses a subject that is critical and different organisations would be willing to support it. Its feasibility is also tied to the fact that it would be possible to gather the data required in the study and make relevant conclusions.

Lessons Learnt from the Research

In preparing this research proposal, I have learnt that it is important to identify the research problem before the actual research begins. This is because a researcher might research an area that would not yield the desired results. I have also learnt that conducting an in-depth literature review and identifying the most appropriate methods to use in carrying out a study is important before the actual research begins.

Challenges of the Study

There are also challenges involved in conducting this research which includes limited financial resources, uncooperative respondents and inaccessibility of some areas.

Conclusion

In this paper, I have discussed how to conduct a study on the experiences and perspectives of nurses who offer psychological care to victims of burns. This is because the psychological aspect of their condition is often ignored. The paper has looked at other areas such as methods to use in carrying out the study, target population, design of the study and possible challenges during the study.

References

Greenfield, E. (2010). The Pivotal Role of Nursing Personnel in Burn Care. Indian Journal of Plastic Surgery Supplement. 43, 94-100.

Hulbert-Williams, N., Bunting, B., & Mcilroy, D. (2008). Anxiety in Recovery from Severe Burn Injury: An Experimental Comparison. Psychology, Health & Medicine, 13(2), 162-167.

Munhall, P. (2001). Nursing research: A qualitative perspective. Sudbury: Jones and Barlett.

Parahoo K. (2006). Nursing Research: Principles, Process and Issues. London: Palgrave Macmillan.

Introduction

Developing a nursing course design requires an understanding of the fundamental concepts relevant to the changing nursing environment. It is clear from the analysis of the three assignments that the nursing environment has changed due to the changes brought about by technology. In order to develop an effective nursing course design, nursing educators must ensure that technology is made an integral part of the learning process. According to Axley (2008), learners can only be able to use technology in their nursing practices only if they used it in their learning process. In this paper, the researcher will look at how to develop a nursing course design that meets the needs of the current nursing environment.

Summary

In this paper, three assignments have been compiled into a comprehensive document that analyses how to develop an effective nursing course design and effective evaluation methods. It also identifies course teaching and learning activities. Nursing course design should be developed in a way that does not only make it easy for the students to use technology in their nursing practices, but also appreciate its relevance as a way of improving their service delivery. When developing evaluation methods, it is important to appreciate the fact that no single method can be considered to be sufficient when used on its own. The use of multiple methods sometimes may be necessary. It is also important to identify the specific learning activities to make it easy for the educator to identify what has been achieved and what has not been achieved after a given learning process.

Reflection

In this synthesis project that brings together the three previous assignments, a number of factors come out clearly concerning the issue of developing a nursing course design. These documents show that the role of nurses and the approach they need to take when addressing their duties is slowly changing from what it has been in the past. Technology has become an integral part of nursing activities. However, the traditional nursing course design lays little emphasis on the issue of technology. As shown in the documents compiled in the section below, the first step in reviewing the course designs is to integrate technology into the learning process. The three documents have thoroughly reviewed how learners can be evaluated in order to determine their competencies in using technology in nursing activities. They also define what should be included in the learning activities to achieve the expected results in this new technology-based nursing course design. These documents offer a strong foundation for educators when it comes to developing course designs for nursing students. When used properly, they can help in developing a comprehensive curriculum that is relevant to the current society. The rationale for the choice of course design as presented in the sections below was based on the desire to produce a document that addresses the current concerns in the nursing practice. The design had to demonstrate how nurses can use IT to enhance their tasks. The choice of the design also factored in the diversity among the students, including those with disabilities.

Conclusion

In the current societal setting, the role of nurses is being redesigned. This means that their training methods and the content of their courses should reflect the changes. The use of emerging technology in nursing can no longer be ignored. It should be integrated into the learning system in order to produce technology-capable nursing graduates.

Compilation of Assignments

Nursing Course Design.

Curriculum Development, Assessment, and Evaluation.

First Section

The basis for the objectives

The widespread lack of nursing informatics skills and technological expertise among the nurses has been an area of concern in the healthcare sector (Hamilton-Hill, 2009). Although technologies have reached the healthcare facilities and learning institutions, some nursing professionals and students lack the competencies to use them in a safe, effective and competent manner to deliver healthcare services and education. Apart from possessing excellent nursing skills, nurses should have good technical skills, or at least have basic computer skills for working in the modern healthcare environment (American Nurses Association, 2008). Nurses should possess the ability to protect the patients privacy within the electronic health record systems, capture and store the patients data in the system effectively, use various software applications in nursing environments, administer medications, and communicate properly through such modes. It is, therefore, imperative for nurse educators to establish nursing informatics competencies for nurses roles (Axley, 2008). One effective method of enhancing nursing informatics competencies in the nursing profession is to introduce such courses and topics in nursing curricula (National League for Nursing, 2008).

Why the course topic was chosen

The course topic chosen for nursing students is an introductory course in Computer Competency. Computer technologies have introduced several methods to teach nursing students and deliver nursing content. According to Hamilton-Hill (2009), technologies have become extensively embedded in modern healthcare systems. These changes have resulted in a greater demand for quality care at affordable prices and accountability in the healthcare sector. It is therefore imperative for nurses and other healthcare professionals to adopt and use various IT systems in their jobs to enhance optimal outcomes for patients and nurses. According to Bassendowski, et al. (2011), the use of IT in healthcare delivery could reduce cases of medical errors. This requires nursing students to have informatics competencies obtained through training (Dykes & Collins, 2013).

Method of content delivery

The course content will be delivered through the traditional mode or online mode for distance learners. The traditional model of content delivery shall be used to facilitate face-to-face interaction with the learners. The course content would be designed to be learner-centered rather than teacher-centered. Students and educators who are not able to conduct classroom learning because of distance or time would be able to use information technologies to connect and overcome such learning barriers (Choi & De Martinis, 2013).

What students will learn and achieve in this course

After completing an introductory course in Computer Competency, nursing students are expected to demonstrate several learning outcomes. First, nursing students are expected to be able to use the information and communication technologies to record and assess patients quality of care, promote patients education, and care accessibility at any location or time (Bassendowski, et al., 2011). Nursing students must be able to record the patients vital signs and other data using clinical information systems (Dowding, Turley, & Garrido, 2011). Nurses may also develop technical aptitude as they handle technical aspects of their jobs. Further training, work experiences, and comprehension of different aspects of the job will ensure that nurses can offer solutions or suggestions to some issues. A course in informatics should prepare nursing students to develop competencies in clinical areas (Dykes & Collins, 2013). Finally, the course topic should also equip the nursing students with interpersonal skills.

Second Section

Computer Competency shall support nurses and patients as they rely on different information technology platforms to process information. This course will aim to introduce the nursing students to the basic informatics concepts used in both personal and professional areas, use various IT platforms to conduct research and apply findings to nursing practices and patient care, promote nurse interaction and socialization with colleagues, apply different methods of content delivery in teaching the nursing students and promote the development of various skills in IT among the nursing students

Description

Given various challenges related to the use of information technologies that current nurses face in their roles, it is imperative for nurse educators to integrate nursing informatics into the nurse curricula. The course topic will prepare students to face the dynamics of a nursing practice environment.

Objectives, competencies, and expectations

The primary objective of this course is to ensure that nursing students possess the necessary skills applicable in nursing practices.

Areas of competencies that will be emphasized include the following:

• Skills in using technologies to deliver services to the patients
• Use of technologies to communicate in different settings
• Application of IT in enhancing patients care outcomes
• Use of IT in managing patients data.

Conclusion

The design of the nursing course topic of Nursing Informatics would ensure that the nursing students are able to offer safe and effective healthcare outcomes and reduce the nurses workload and burnouts with the help of IT platforms.

Course Evaluation Methods

NURS: 514 Curriculum Developments, Assessment and Evaluation

Introduction

According to Redman, Lenburg, and Walker (1999), nurse educators face several challenges. Evaluators should determine the best evaluation methods based on the courses goals and objectives. It should meet both the expectations of nursing students and nurse educators (Carr, 2002). The most important needs should focus on whether the learners have achieved the intended competencies and whether the learning has resulted in improved performance. Nurse educators can use evaluation outcomes for many purposes, including curricula redesign, collecting data for improving self, and developing teaching portfolios.

Course Evaluation Methods

The primary goal for this course is to ensure that the nursing students possess the necessary skills and competencies applicable in the nursing practices

Objectives

• Students shall demonstrate skills in using technologies to deliver services to patients and to communicate in healthcare environments.
• Review data from different sources and apply the collected data in decision-making
• Demonstrate an understanding of healthcare terminologies used in the healthcare environments
• Uphold data integrity, security, confidentiality, ethical standards, regulatory conditions, and the patients rights to privacy
• Use healthcare technologies to address different challenges in the healthcare sector

Competency Performance Assessments (CPAs) and Competency Performance Examinations (CPEs)

CPAs and CPEs are two methods applied to evaluate the nursing students competencies and skills. CPAs are applied when evaluating various forms of class tasks that affect the overall grade, including papers, projects, participation and presentations (Redman et al., 1999). On the other hand, CPEs are applied in clinical situations to assess clinical outcomes (Redman et al., 1999). Nursing students must demonstrate single, distinct, observable learning outcomes that are compulsory for skills and competencies under evaluation. A nurse educator can only develop critical elements for evaluation within the accepted standards of practice, course objectives, and with the support of evidence-based practices (Redman et al., 1999).

Informatics nursing students will be focused on specific competence and skill outcomes alongside other critical elements required in the course to ensure that they meet the standards of performance expected from the course (Redman et al., 1999). The students may complete various assessment tests of the course. They may have opportunities to use technologies in real hospital settings to demonstrate their knowledge and skills, ask relevant questions, conduct thorough practices, and show their proficiency in priority areas under the course (Dolan, 2003).

Assessment of Competency Learning

This assessment evaluates whether the training material has been learned and it is best conducted at the individual level (Carr, 2002). The educator can determine an individual students performance with the aim of evaluating the reactions to the course and understanding of materials. It is vital to assess the learners reactions to the course because negative reactions could imply poor internalization of course contents and thus less likely to improve their skills and competencies.

Assessment of Competency Application

An educator may use this assessment method to evaluate Whether the competencies have been applied to improve performance (Carr, 2002). The method may help the educators to justify their teaching methods, costs, and materials among others. It provides an opportunity to evaluate the performance and propose appropriate changes. Any changes from the learned concepts should be reflected in behavior change, competencies, and skills. Hence, when nursing students demonstrate such improvements, the nurse educator should justify the use of the learning materials and strategies (Yanhua & Watson, 2011). For a clinical setup, a nurse educator can effectively evaluate how the nursing students apply the learned concepts in various clinical situations.

Methods of collecting assessment data

Course evaluation methods require appropriate ways to obtain the required data. In this regard, various methods of data collection were used. These methods include questionnaires, knowledge reviews, observations, skill gap analysis, and content analysis.

Conclusion

Nursing course evaluation is an important process for both nursing students and nurse educators. Course evaluation outcomes may have serious implications for nursing students, educators, and the institution (Redman et al., 1999). Nurse educators and students can improve their performances based on the evaluation outcomes (Mahara, 1998). Multiple evaluation methods are important in discovering more insights for expanding the possibilities of nursing education.

Course Teaching and Learning Activities

NURS 514 Curriculum Developments, Assessment and Evaluation.

Course Teaching and Learning Activities.

Introduction

Instructors can use several methods to teach their nursing students and ensure that they grasp the basic nursing concepts. The methods chosen should incorporate the key concerns of the instructor or educator. The diversity of student populations in terms of age, background, and ethnicity informs the methods chosen to teach these students. Kinetic and auditory learners differ from visual learners. Thus, teaching this group of students requires the utilization of strategies that mix these methods.

Problem-Solving Learning

The first strategy is the problem-solving method that provides an effective method for educators to impart knowledge to their students. In this method, the educator provides problems for students to solve using the theories and concepts learned over time. According to Waltz, Jenkins, and Han (2014), the problems that these students are provided with should be related and specific to the objectives of the course. The aim of problem-solving teaching is to transform the physical and logical practices into a form that the students can store in the form of knowledge. According to WHO, this method of teaching aims to ensure that the students master complex knowledge to solve problems in the future (Rahnavard, Nodeh, & Hosseini, 2013).

Group Teaching

In this form of learning, the instructor encourages the students to carry out group work and present their results as a group. Instructors provide activities that the students are required to carry out in groups (Williams, McKenna, French, & Dousek, 2013). While in their respective groups, students are assigned individual tasks that contribute to the overall group activity. These students are assessed in groups; hence, the performance of the individuals in the groups contributes to the combined group performance (Williams, McKenna, French, & Dousek, 2013). The rationale for using group work as a learning method includes the provision of skills that cannot be acquired individually. Weak students learn from their colleagues in the group while strong students polish their skills and improve in areas where they are weak (Callen, Smith, Joyce, Lutz, Brown-Schott, & Block, 2013). In a group setting, learners work in an environment that they like, are familiar with, and with colleagues with whom they can associate (Callen et al., 2013). Students working in groups share responsibilities and results (Williams, McKenna, French, & Dousek, 2013). According to Jackson et al. (2014), working in groups also ensures that students attain self-discipline and a sense of duty.

Problem-Solving Group Learning Method

Instructors and nurse educators can combine group teaching with problem-solving to ensure that their students attain the best clinical skills. In this form of learning, educators get the students to work in groups and provide problems for them to solve. According to Billings and Halstead (2012), students can enrich their skills with the relevant theories and teaching practices. The aim of this form of learning is to encourage problem analysis, cooperation, the relationship between the facts in patient management, problem interpretation, and to ensure that students work more effectively in groups (Billings & Halstead, 2012). The rationale behind the use of a problem-solving group learning method is that students are unable to express their problem-solving skills in individual work. Iwasiw and Goldenberg (2015) state that problem-solving creates challenges that students can relate to within the management of future patients.

The other method of teaching that works in nursing schools is the use of tutorials. In this learning method, an educator can establish some of the challenges that the students have and know them personally (Raurell-Torredà et al., 2015). This method of learning also ensures that the students can know their educators and familiarize themselves with the expectations of these instructors. Role-plays and simulations constitute the other methods important in teaching nursing students. In role-play, students act a part of practice or imitate individuals. The rationale includes that students learn out of the experience and through visualization (Raurell-Torredà et al., 2015).

The last method that may be useful in teaching nursing students is developing games in which, the students are required to participate. Games may be developed for students to ensure that they grasp the important concepts in technology-based nursing care. When developing the games for use as a learning method, educators need to consider the diversities in the group of learners (Iwasiw & Goldenberg, 2015). The rationale behind the use of games as a learning method includes the ability of students to participate actively in these activities.

Conclusion

From the discussion above, it is clear that nurse educators have a variety of methods that they could use to teach their students. These methods chosen should consider diversities in any group of students. Some of the teaching methods discussed include the use of group activities, simulations, role-play, problem-guided learning, and the use of games.

References

American Nurses Association. (2008). Nursing informatics: Scope and standards of practice. Silver Spring, MD: American Nurses Association.

Axley, L. (2008). The Integration of Technology into Nursing Curricula: Supporting Faculty via the Technology Fellowship Program. The Online Journal of Issues in Nursing, 13(3), 34-78.

Bassendowski, S., Petrucka, P., Breitkreuz, L., Mantesso, J., MacDougall, L., Hanson, B., et al. (2011). Integration of Technology to Support Nursing Practice: A Saskatchewan Initiative. Online Journal of Nursing Informatics, 15(2), 635.

Billings, D., & J, H. (2012). Teaching in nursing: A guide for faculty. St. Louis, Mo.: Saunders/Elsevier.

Callen, B., Smith, C. M., Joyce, B., Lutz, J., Brown-Schott, N., & Block, D. (2013). Teaching/Learning Strategies for the Essentials of Baccalaureate Nursing Education for Entry-Level Community/Public Health Nursing. Public Health Nursing, 30(6), 537-547.

Carr, W. F. (2002). Designing an Effective Training Evaluation Process. Web.

Choi, J., & De Martinis, J. (2013). Nursing informatics competencies: assessment of undergraduate and graduate nursing students. Journal of Clinical Nursing, 22(13-14), 19701976.

Dolan, G. (2003). Assessing student nurse clinical competency: will we ever get it right? Journal of Clinical Nursing, 12(1), 132141. Web.

Dowding, D., Turley, M., & Garrido, T. (2011). The impact of an electronic health record on nurse sensitive patient outcomes: an interrupted time series analysis. Journal of the American Medical Informatics Association, 19(4), 615-620.

Dykes, P., & Collins, S. (2013). Building Linkages between Nursing Care and Improved Patient Outcomes: The Role of Health Information Technology. The Online Journal of Issues in Nursing, 18(3), Manuscript 4.

Hamilton-Hill, S. (2009). Nursings Problematic Informatics. Web.

Iwasiw, C., & Goldenberg, D. (2015). Curriculum development in nursing education. Sudbury, Mass.: Jones and Bartlett.

Jackson, D., Hickman, L. D., Power, T., Disler, R., Potgieter, I., Deek, H., & Davidson, P. M. (2014). Small group learning: Graduate health students views of challenges and benefits. Contemporary Nurse: A Journal for the Australian Nursing Profession, 48(1), 117-128.

Mahara, M. S. (1998). A perspective on clinical evaluation in nursing education. Journal of Advanced Nursing, 28(6), 1339-1346.

National League for Nursing. (2008). Preparing the Next Generation of Nurses to Practice in a Technology-Rich Environment: An Informatics Agenda. Web.

Rahnavard, Z., Nodeh, Z. H., & Hosseini, L. (2013). Effectiveness of clinical teaching associate model in nursing education: Results from a developing country. Contemporary Nurse: A Journal for the Australian Nursing Profession, 45(2), 174-181.

Randall, V. R. (2010). Learning Domains or Blooms Taxonomy. Web.

Raurell-Torredà, M., Olivet-Pujol, J., Romero-Collado, À., Malagon-Aguilera, M. C., Patiño-Masó, J., & Baltasar-Bagué, A. (2015). Case-Based Learning and Simulation: Useful Tools to Enhance Nurses Education? Nonrandomized Controlled Trial. Journal of Nursing Scholarship, 47(1), 34-42.

Waltz, C. F., Jenkins, L. S., & Han, N. (2014). The Use and Effectiveness of Active Learning Methods in Nursing and Health Professions Education: A Literature Review. Nursing Education Perspectives, 35(6), 392-400.

Williams, B., McKenna, L., French, J., & Dousek, S. (2013). Measurement properties of a peer-teaching scale for nursing education. Nursing & Health Sciences, 15(3), 368-373.

Yanhua, C., & Watson, R. (2011). A review of clinical competence assessment in nursing. Nurse Education Today, 31(8), 832836.

Introduction

As a profession, nursing has long ago extended in meaning from simple caring about patients. Nowadays, it is also about providing advanced help and creating a partnership with a patient. This approach correlates with the Theory of Interpersonal Relations and Essential IX, which is a crucial part of a masters level nursing practice.

The Theory of Interpersonal Relations

While looking for the right definition of nursing, Peplau (1991) calls it an interpersonal process and often a therapeutic one (p. 5). She claims that although the operations involved are partly technical ones, the interaction between a nurse and a patient makes the process personal. Besides, she stresses that nursing is a function, and nurses have the responsibility for effective patients outcomes as well as doctors (Peplau, 1991). It means that nurses should do their best to provide the positive result of the treatment, even when it is not up to them to make a diagnosis.

Also, constant communication with patients gives a priceless experience that can be used for further benefit. For example, a nurse can use previous cases to determine the way to help the patient. A skilled nurse can share knowledge in plain language and explain how to prevent health issues with the patient. Thus, the patient becomes the nurses partner, and they solve the problem with common effort. Using this principle of guidance represents professional therapy.

Comparison of Peplaus Theory with Essential IX

Peplaus theory has common fundamentals with nine essentials. Their concepts coincide in the following: health policy and advocacy; interprofessional collaboration for improving patient and population health outcomes; clinical prevention and population health (DeNisco, 2015, p. 22). Peplau (1991) also mentioned the advantages of collaborating with other professionals. The main point is that cooperation in improving patients conditions leads to the constructive process of treatment and a healthy community environment which are especially needed for the patient. Besides, these ideas correspond to the Theory of Culture Care Diversity and Universality (Leininger, 2006). It claims that the role of cultural aspects in a medical process is barely considered and that understanding and responding to patients needs would significantly improve the performance of health specialists.

However, Peplaus framework regards nursing as an instrument to provide more creative, personal relations with a patient. Meanwhile, Essential IX is more focused on nursing as a means of influencing healthcare outcomes for not only single patients but also populations and systems. Besides, it pays much more attention to the ability of a nurse to use gained knowledge and skills in practice.

Example

In my personal experience, knowledge of cultural particularities of a patient helped with his further successful treatment. He felt unsure about the prescribed medicine, and obviously, felt insecure in the hospital. Luckily, I understand that a patient is not an object, but a vulnerable human who needs care. My attempt to find the right way to communicate with him was successful. It turned I could use the basic skills learned from psychology and the theories discussed above very soon. All that patient needed was a trustworthy person, who would explain why the medicament was so necessary, and also, some general, simple chat. After all, the patient lost his fears, and the process of treatment became healthy and stable.

Conclusion

To sum up, experts admit that advanced nursing practice could be defined as a multifunctional form of interaction with patients. Nurses have the power to influence patients outcomes, even though they are not physicians. This idea is to be widely recognized and used by nurses to make the process of communication with patients more interpersonal and productive.

References

DeNisco, S. M. (2015). Advanced practice nursing. Burlington, MA: Jones & Bartlett Publishers.

Leininger, M. M., & McFarland M. R. (2006). Culture care diversity: A worldwide nursing theory. Burlington, MA: Jones & Bartlett Publishers.

Peplau, H. E. (1991). Interpersonal relations in nursing: A Conceptual frame of reference for psychodynamic nursing. New York, NY: Springer Publishing Company.