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Foundations Of Nursing And Evidence-Based Healthcare

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Introduction: Foundations Of Nursing And Evidence-Based Healthcare

Since the publication of Florence Nightingale's "Notes on Nursing", nurses are seeking the best evidence-based practice available in the healthcare facility to make better clinical decisions. The essay states the role of nurses in managing their practices following the NMC code of conduct (NMC.org, 2018). As Opined by different authors, evidence-based practice is the integration and explicit use of the recent best evidence to make the best decision about individual patient care. Reflection and evidence-based practice are essential to every clinical practice as it contributes a retrospective viewpoint on current practices and question the reasons behind them to make clinically relevant and fundamentally sound decisions.

Reflection and evidence-based nursing help to build effective treatment and care practices for patients. The thesis statement of this essay demonstrates the importance of evidence-based practice and reflection in the nursing practice. How it supports the fundamental codes of the NMC (2018) Professional standards by focusing on prioritizing people and holding their dignity is also assessed. The structure of the descriptive essay reflects on the importance of evidence-based practice and reflection and the way it supports the underpinning fundamental standards of NMC codes for the practice and behaviours of nurses and midwives through the Driscoll model and Gibbs model of reflection. Dignity means the “Condition of the differentia of being deserved of integrity and regard”. In addition, dignity can be the state of a people that can be respected altogether and they can be trusted in any situation in life. 

The major role of healthcare professionals in the healthcare settings is providing high-quality patient care and services to patients to overcome their critical health issues. Based on the nursing practices of the Royal College, the profession body and nursing union are representing a huge healthcare services and support to all members of this organization (Rcn, 2023). Moreover, in this organization the healthcare practitioners are able to provide high-quality patient care to patients to support them for overcoming critical health issue and leading a healthy and normal lifestyle. Patient care with dignity and respect assists patients to increase their self-esteem level and self-confidence level. As a result,

It can be seen that nursing is all about maintaining the dignity of the patients as well as the dignity of the position. Care along with dignity supports the patient's self-respect and can help in recognising the capabilities and ambitions of the patients. Human dignity can be retained with proper communication, respect for the patients and a consumer-centred approach. There are different aspects of the maintenance or care in the nursing practice that can preach about dignity. Interdependence, partnership, individuality, choice, respect, privacy and rights are the different notions of keeping dignity intact in the nursing practice. In this assignment, the importance and relation of dignity in evidence-based practice have been assessed.

Discussion on the requirement of evidence-based practice

Importance of evidence-based practice and reflection in nursing

The equation of evidence-based practice with effective decision-making by avoiding habitual practice with improved clinical performance is of prime importance in nursing practice. Evidence-based practice and reflection are necessary for the implementation of the best and most effective evidence in practice by honing the skills of nurses to develop clinical questions and searching the literature, analyzing, and evaluating the best current shreds of evidence, and adopting actions (Yancey, 2019). In the case of nursing, the responsibility of the nurse can be the recovery of the patients and in that case, dignity matters the most in the case of evidence-based practice. The nursing practice can have dignity in their endeavour through choice and control. Communication, on the other hand, can help in assessing the actual problem of the patients, which can highlight the disease, or the inconvenience that they are going through (Hendy, 2022). In addition to that, food and nutritional care are also important in the care format, which can matter most in recovery and evidence-based care. Proper food and nutritional needs are analysed by the nursing staff in the healthcare platform.

However, it is difficult to raise reverent clinical questions in their daily practice due to time constraints and limited ability. The rising question is important in nursing which is based on the clinical experience and expertise of the nurses (Portney, 2020). Reflection, on the other hand, is the ability to make sense of or be aware of or learn from daily nursing practices which results in improved and enhanced patient outcomes while increasing their level of work satisfaction. On the other hand, social inclusion is also a matter that can include dignity within the profession. Some of the patients can be very depressed with their condition and for that, they cannot have the communication that is needed in their treatment (Franco et al. 2021). In that situation, the role of the nurse is to include the patient in the social circle so that they can be easy with their situation. In addition to that, practical assistance is needed in the nursing evidence-based practice that can help the nurse and the patient to take out from the adverse situation. Assistance in every step can help the affected person to come out of the situation or the clinical condition.

The most important aspect that can be added up to the dignity of nursing staff whether they are registered nurses or assistants, maintaining privacy is what they need to do for the patients. Maintaining privacy and confidentiality of the patient's condition if they are not willing to disclose is showing dignity to the people (Simões and Sapeta, 2019). Maintaining confidentiality can be the apex of the safety of the patients in society. Some diseases or ailments can be very private to the patients and in that case, they do not want others to know about the situation (Mullen et al. 2019). In that case, the nurse must maintain the choice of the patients to keep up their dignity.

It helps the nurses review the significant clinical interaction and identify if the process of interaction is going according to the plan. The process of reflection enables them to criticize their activities, find relevant evidence, learn, and apply their funding to future activities (White, Dudley, and Terhaar, 2019). The evidence makes more use of the nurse's field experiences and expertise, which yields more meaningful clinical practice. Evidence-based practice and reflection increase the clarity about practice and enriches the professional understanding of the nurses. Maintaining personal hygiene can be another aspect of nursing that can help to hold dignity in evidence-based practice. Providing help and assistance through educating and practically helping to maintain personal hygiene can be beneficial for the clinical condition of the patients. In that case following the norms in the nursing practice can be better for including dignity in the professional approach (Lindwall and Lohne, 2021). Providing independence to the patients in the clinical platform with the requirements of the patients can be including dignity in evidence-based practice. In that case, choosing the right care format and providing the right nursing assistance can be fruitful for the clinical setup.

The Dignity in the Nurse’s Role and NMC code practice:

Care along with dignity can be retained in the role of the nurse and those capabilities can help the patients to be cured. There are different strategies that can be embedded with the concept of dignity and that can be practised in the healthcare and nursing sectors (Combrinck et al. 2020). Practising acceptance and acknowledging others can be safe practices with dignity and that can help in the care procedure (Combrinck et al. 2022). Supporting the patients along with providing fairness in the cure can be based on dignity and that can emphasise the mutual understanding between nurses and the patients (Cerit et al. 2021). Physical as well as the emotional safety can be ensured in the nursing practice which can be included in the notion of dignity. 

According to the NMC code of nursing practice, the professional standards need to be maintained in the care of patients. In that situation, the aspect of dignity can collaborate with the NMC code of conduct for the nursing staff (NMC.org.uk, 2018). Treating people with care and treating them as individuals with dignity can be helpful for the curing of people. Maintaining human rights can be included in the NMC code of nursing practice. Listening to people and responding to their preferences can also be upheld with dignity which can highlight the physical, psychological and social well-being of the patients must be retained.

Driscoll's model

The reflective model of Driscoll is an experimental cycle that includes the three questions "What", "So what" and "Now what" to describe an event, reflect the feeling about the event, and seek further actions[Refer to Appendix 1]. 

What

What: While working in the healthcare service I have found that nurses give less importance to the individual needs of people, and neglect their basic rights. One of my colleagues had a very ignorant and disrespectful attitude toward patients which lead him to often made mistakes while taking care of patients. She used to work in her way while ignoring the patients' conditions and appropriate clinical protocols. This behaviour of hers and lack of deductive quality of clinical practices once caused major complications in an allergic patient, as she fed the patient foods that caused an allergic reaction to the patient leading to anaphylactic shock. In that condition, she didn't know how to manage that patient and what will be the emergency procedure to rescue the patient. I believe that she lacks the proper knowledge of the NMC code of conduct and does not adopt evidence-based practices which help to make better clinical decisions. I think that maintaining dignity is the main need for the nurses in the clinical care units and that can result in a positive for both patients and nurses. I have seen to breach the fairness in the nursing profession in my professional practice span and I think that the reduction or the discarding of dignity can slow down the process of recovery for patients. I have always considered better communication and making a good relevant relationship with the patients so that they can feel comfortable speaking about their issues. In addition to that, I think that I have given enough privacy to the patients as per their demands in the healthcare sector. I also have maintained a better sanitation system along with the proper care as per the ailments of the patients.

The NMC code 2018 contributes to the professional standards for nurses, nursing associates, and midwives (Ellis, 2022).Following the standards is necessary to act in line with the code and uphold the standards in the healthcare facility. The standards focus on prioritizing people, effective practice, safety reservation, and promotion of professionalism and trust among nurses in the health care facility (Pearson and Wallymahmed, 2020). The standard about prioritizing people suggests putting the interest of people first using nursing services which I believe is the most important aspect to manage a patient effectively. The NMC standard expresses the importance of the people's care and safety and preservation of their dignity while recognizing, assessing, and responding to their needs and desires.

Nurses should give significant importance to the treatment and respect people and uphold their rights without any discriminatory behaviours or attitudes. The evidence-based practice supports the NMC code with safe, compassionate, evidence-based, and patient-centred nursing services while maintaining the patient's dignity and human rights (Smart and Creighton, 2022). In my opinion, reflection on the other hand allows the nurses to make sense of their practices which aids in learning and enhancement of professional skills to ensure better care of the people which would have helped my colleague to make better relations with her patients. Reflection helps to improve the interaction process with a person as it further helps the nurses to uphold the dignity of the people and treat them as individual entities.The "experience" stage of the Gibbs model has a connection with the "what" stage of the Driscoll model as it both describes the event or the experience that is faced.

So what

When I encountered the incident with my colleague I felt extremely anxious about her nursing practice and lack of ethical knowledge which lead to the situation. I believe that if she had the proper knowledge of NMC codes of conduct or if had adopted those standards the incident might have not occurred. If she had followed the evidence-based practices which suggest asking patients about their food allergies, this situation might have been mitigated. Further, at the time of the situation, she didn't know about the current evidence-based practice about managing an allergic patient going through anaphylactic shock which worsened the condition more. The current evidence-based practice suggests minimizing the cytokine storm with an epinephrine injection followed by immune therapy and identifying what food component is responsible for the allergic reaction.

There was extreme tension at that moment which I believe might have made her confused and very anxious. I think through this situation she gained insight into her deficiency in nursing practice in terms of giving importance to the individual needs of the patient and prioritizing them. She experienced that valuing the patients is the foremost function of the nursing practice to give effective care to them. The incident might help her to adopt evidence-based approaches to find more recent practices in health care and questions about it through reflection. The process of reflection might seem complex, abstract, and intimidating but it will provide her the opportunity to utilize the results from her reflection, and experience, to understand the patients' needs more clearly and enhance the quality of practice and care (Ardian, Hariyati, and Afifah, 2019). The NMC standards will help her to treat people individually and maintain their dignity while respecting their human rights. The kindness and compassion required to handle a patient can be achieved through reflection on the communication and interaction process with the patient and listening to them and respecting their preferences. Similar to this stage the "feeling" and "evaluation" stages of Gibbs's reflection model demonstrate the evaluation of the experience in terms of good or bad.

Now what

The incident that happened with my colleague was extremely unfortunate but it made her realize the importance of prioritizing patients and listening to their individual needs and preferences to make the care process more effective and wholesome. She learned the value of evidence-based practices to make effective clinical decisions in the time of emergency to ensure proper care of the patients. If she had a proper understanding of the patient's needs and conditions the allergic reaction might not have occurred. With the help of evidence-based practice and reflection, she can modify her clinical as well as professional skills which will help her to avoid this kind of situation in the future. The process of reflection occurs in three stages that are awareness, critical thinking, and developing a new approach or perspective which will aid in clinical practice in taking good care of the patients with better and improved approaches. I believe that self-reflection on daily basis increases creativity. The NMC code demands clinical practice that is best suited to an individual patient, thus it is important to look for current evidence-based practices in the healthcare facility (Nursing and Midwifery Board.gov, 2023). Further, the reflection process will help to improve the interaction with patients and their families for better clinical examination and care. 

Conclusion

The importance of evidence-based practice and reflection in healthcare facilities is very significant as it enables nurses to research current practices and improve their daily activities. The NMC standards prioritize people while holding their dignity to make the care delivery more effective. It is the prime duty of nurses to give importance to the individual needs of the patients and provide quality service with better communication and interaction. 

References

Books

Peate, I., (2019). Alexander's nursing practice e-book: hospital and home. Elsevier Health Sciences.

Portney, L.G., (2020). Foundations of clinical research: applications to evidence-based practice. FA Davis.

White, K.M., Dudley-Brown, S. and Terhaar, M.F. eds., (2019). Translation of evidence into nursing and healthcare. Springer Publishing Company.

Yancey, N.R., (2019). Evidence-based practice in nursing for teaching-learning: But is it really nursing?. Nursing science quarterly32(1), pp.25-28.

Journal

Ardian, P., Hariyati, R.T.S. and Afifah, E., (2019). ‘Correlation between implementation case reflection discussion based on the Graham Gibbs Cycle and nurses’ critical thinking skills’. Enfermeria Clinica29, pp.588-593.

Cerit, B., Ço?kun, S., Çal??kan, M.A. and Temelli, G., 2021. The relationship between nurses’ ethical sensitivity levels and their attitudes toward principles about die with dignity. Journal of religion and health60, pp.162-177.

Collier-Sewell, F., Atherton, I., Mahoney, C., Kyle, R.G., Hughes, E. and Lasater, K., (2023). ‘Competencies and standards in nurse education’: the irresolvable tensions. Nurse Education Today, p.105782.

Combrinck, Y., Van Wyk, N.C. and Mogale, R.S., 2020. Nurses’ professional dignity in private health care: a descriptive phenomenological study. International Nursing Review67(3), pp.395-402.

Combrinck, Y., Van Wyk, N.C. and Mogale, R.S., 2022. Preserving nurses’ professional dignity: Six evidence?based strategies. International Nursing Review69(1), pp.106-113.

Ellis, P., (2022). ‘Evidence-based practice in nursing’. Evidence-based Practice in Nursing, pp.1-100.

Franco, H., Caldeira, S. and Nunes, L., 2021. Dignity in nursing: A synthesis review of concept analysis studies. Nursing ethics28(5), pp.734-749.

Ingham-Broomfield, B., (2021)’A nurses' guide to using models of reflection’. TheAustralian Journal of Advanced Nursing38(4), pp.62-67.

Karlsson, M. and Pennbrant, S., (2020). ‘Ideas of caring in nursing practice’. Nursing Philosophy21(4), p.e12325.

Kelsall-Knight, L., (2022). ‘Practising cultural humility to promote person and family-centred care’. Nurs Stand.

Lindwall, L. and Lohne, V., 2021. Human dignity research in clinical practice–a systematic literature review. Scandinavian journal of caring sciences35(4), pp.1038-1049.

Morrell-Scott, N., (2022). ‘A phenomenological insight into what final year undergraduate student nurses perceive is the role of the Registered Nurse and who they learn this from’. Journal of Research in Nursing27(8), pp.767-778.

Mullen, R.F., Kydd, A., Fleming, A. and McMillan, L., 2019. Dignity in nursing care: What does it mean to nursing students?. Nursing Ethics26(2), pp.390-404.

Pearson, S. and Wallymahmed, M., (2020). ‘The new NMC standards: Changes to student supervision and assessment’. Journal of diabetes nursing24(03), pp.136-136.

Simões, Â. and Sapeta, P., 2019. The concept of dignity in nursing care: A theoretical analysis of the ethics of care. Revista Bioética27, pp.244-252.

Smart, A. and Creighton, L., (2022). ‘Professionalism in nursing 1’: how to develop professional values. Nursing Times118(4), p.1.

Stenhouse, R., (2021). ‘Understanding equality and diversity in nursing practice’. Nurs Stand36(2), pp.27-33.

Stephen Ekpenyong, M., Nyashanu, M., Ossey-Nweze, C. and Serrant, L., (2021). ‘Exploring the perceptions of dignity among patients and nurses in hospital and community settings’ An integrative review. Journal of Research in Nursing26(6), pp.517-537.

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