This assignment explores the concept of professionalism in nursing terms. It will also seek to examine the terms communication, compassion, and person-centered care. I will use literature and examples from personal experience to explore the relationship and roles of professionalism and the importance of communication and compassion in delivering person-centered care.
Professionalism is a difficult concept to define as there is not a concise and definitive definition available. To be a professional means different things to different people. Morrow et al, (2011) highlighted this difficulty during their study investigating students' perceptions of professionalism in health care professionals. Their study focused on students including chiropodist podiatrists, occupational therapists, and paramedic students. This study did not include nursing students but it is important as it highlights while there is no one definition of professionalism there was an agreement between the students that professionalism depends on many different aspects. It is a holistic concept. It is about the relationship between the practitioner and the patient service user. It includes how the practitioner behaves and communicates, their appearance, body language, uniform, and dress, and the context in which treatment is to be given.
The holistic concept of professionalism is a view shared by (McCormack and McCance, 2006). They established four prerequisites in their work to develop a framework to develop person-centered care. These prerequisites focused on the attributes of the nurse, the care environment, person-centered processes, and expected outcomes. It is the relationship between the prerequisites that are important to delivering effective care, each being dependent on the other.
The Code of Practice (NMC, 2018) goes further and formally sets out what constitutes professionalism in the nursing profession in the form of standards. The standards are set out under the four headings prioritize people, practice effectively, preserve safety, and promote professionalism and trust. The Code and literature highlight that professionalism in nursing is not solely based on the technical knowledge and the competency of the nurse practitioner but is an integrated approach with relationships being at the core.
Relationships are central to the care of patients. Building up a good rapport with patients is important. (Lawal, 2019) show the importance of good relationships when helping patients and service users suffering from diabetes manage their conditions effectively. The building up of trust and good communication improves the patient's service users' experience and raises their expectations of nurses. The NMC (2018) emphasizes that nurses should be ambassadors for their profession and that professionalism is the responsibility of each individual nurse. Continual professional development and learning to enhance skills together with reflecting on practice will lead to care with the patient being prioritized and them receiving safe and effective care. (NMC, 2021).
The media also play a part in forming the public's perceptions of what it means to be a professional both good and bad. Morrow et al (2011) found that paramedics could be seen as taxi drivers if patients didn't watch dramas such as Casualty. The clap for carers showed the public appreciation for the work of the wider medical profession. (McKay et al., 2021). The NHS showed in a positive light. The negative tweets that appeared for the clap for carers focused on the lack of resources, PPE, and the treatment of some staff on the frontline. With the good also comes the bad and horror events such as the Muckamore Abbey Hospital abuse scandal can have a damaging effect on how the public sees the nursing and wider medical professional as it was the hospital staff that allegedly mistreated patients with severe learning difficulties and mental health problems. The case is still ongoing with a twenty-seventh arrest being made. (Campbell, 2021). Those who do not uphold the professional standards of the (NMC, 2018) receive sanctions and can be removed from the medical register depending on the severity of the offense. They are no longer a professional.
Being heard and listened to makes communication meaningful. (Alsawy, et al, 2019), in their research examining the importance of good communication for people suffering from dementia. They also found when people feel they are not being listened to they are reluctant to engage in further communication.
Quinn, (2018) concludes that practitioners need to listen to patients to gain a greater understanding of how illness affects each individual so that we have can develop our own learning, especially in relation to delivering care with compassion. Sinclair et al (2016) found that compassion involved showing unconditional love through actions. The patients suffering from cancer wanted to be understood, that is what was important to them. By showing understanding the practitioner showed love.
Person-centered care is about as the name suggests putting the person you are caring for at the center of their care. Each patient is different and comes with their own needs, requirements, wants, and desires. For example, an elderly lady that I cared for was diagnosed with cancer and required treatment. The lady refused the treatment as she did not want people to know that she was sick and didn't want to lose her hair. Treatment would have been beneficial but I had to put my own personal thoughts aside and give my support in any way possible. The NMC (2021) describes this as 'working with instead of doing to'. It is about listening to the patient and working with the patient and working together to come up with a treatment plan that is right for the patient. In the above example, treatment would have helped the patient but her wishes were respected and she was listened to.
The Department of Health (2018) produced a report showing how an integrated approach across all the health and social care systems in Northern Ireland would lead to an improvement in the health and well-being of the population. It is about working together, valuing people, focusing on being person-centered and empowering people to take decisions about their care.
The importance of person-centered care was very evident during my time on placement in a hospital ward. When the patient arrived on the ward the nurses immediately communicated with the patient asking them their name and how they would like to be addressed. The nurse introduced themselves and asked them how they were feeling and asked if they required further assistance. Permission was gained for consent to administer nursing care. An assessment booklet was completed with the patient. This is a useful opportunity for the nurse to sit down and communicate with the patient, build up a relationship, and get to know the patient. Assessment booklets to the ward require much information to be recorded about the patient so that an all-around picture of the patient can be achieved. One particular area asks what is important to the patient. A female patient with five children had been admitted to the ward with a headache and raised blood pressure. Returning home as soon as possible was imperative for her as she had three children with additional needs. One of the children was unable to cope with the change of routine at home and he was self-harming in school. This news was not conducive to the patient getting better. The medical team in agreement with the patient decided it was best for the patient to return home. The patient was to monitor her blood pressure daily and was advised to come back if her blood pressure went above a certain level. She was also given outpatient appointments to address other concerns. The patient was listened to and all of her needs were addressed. The patient was very happy with her care and thanked everyone for the way she had been looked after.
A male patient who had a limited English vocabulary was admitted to the ward. The staff used language apps and an interpreter was made available to help the patient understand what was happening. One of the housekeeping team could also communicate with him. After a meeting with the medical team in which the interpreter was present, it was decided with the patient's agreement that he would go for a scan and if the results were clear he would be able to return home. This pleased the patient. However, after the team and interpreter left the patient became very agitated and aggressive. He kept shouting home. The staff tried to communicate with him but he did not want to engage with anybody. He opened curtains when a patient was receiving personal care. He pushed a nursing student who fell to the ground. He was shouting and waving his arms around. He would not speak to the interpreter. The other patients in the ward were frightened and told him to stop. The manager told him he could leave and so he did. The patient did not want to receive more nursing care even though he was happy during the meeting and the interpreter said that he was happy to stay in the hospital.
Relationships break down when a suitable conclusion for both parties cannot be reached. The hospital staff tried to work with the patient had tried to communicate with the patient using several techniques but the patient did not want to engage with them. The language barrier and the patient himself were the obstacles to receiving person-centered care. The staff remained calm and tried to resolve the situation. The ward manager had showed good leadership. He remained calm and was a good role model. He did his best in a difficult situation.
Other potential barriers could be if a patient has special needs and is unable to communicate or express their thoughts, wishes, or feelings. In this case, the nurse needs to act as an advocate for the patient. NMC (2018) For example, a male patient in his sixties with diabetes and a learning difficulty needed to be wakened every hour to record his ketone and blood sugar levels. The gentleman was very ill but permission was still asked to carry out the procedures. The patient was still involved in his care. The hospital staff worked alongside the patient, his family, and the nursing home.
The global Covid Pandemic has been shown to have had a detrimental impact on NHS staff with immense pressure put on staff looking after sick and dying patients. (McKay et al., 2021) and (de Oliveira, da Cunha Reis, de Melo Franco, and Braga, 2021) show the negative impact especially the burnout rate among nurses. They ranked sixth in the world. More research is needed in this area to establish the full effects of the pandemic as there is a lack of research available at present. RCN Northern Ireland, (2021) has commissioned a study to highlight the experiences of nurses in Northern Ireland during the pandemic. Southern Trust (2021) has launched an appeal to ask for nurses and healthcare assistants to come to work as they are short-staffed. When nurses are sick and the hospitals are short staffed there is not always the time to give patients the time they want at that particular time. In this case, the NMC (2018) advises expressing regret and making time later in the shift, and ensuring that at the end of the shift report if the patient needs extra support or time to talk.
Professionalism and leadership are strongly linked. Every nurse can be a leader as it involves demonstrating good practice in whatever role you are in. As a student nurse, I was able to observe examples of good role models. These included those nurses who demonstrated compassion and were humble. They respected their patients treating them as Quinn (2020) puts it as ‘partners’ in their care. They also had good medical knowledge, answered patients' questions fully, and if they didn't know the answer they went and found the answer before returning to their patient and reporting back. I felt honored and proud when patients referred to me as a nurse even when they knew I was a student and I was commended for my attentiveness.
For future practice, I will continue to strive to be the best nurse that I can be, reflect on my actions, and learn from my colleagues and patients remembering that each patient is a unique individual.
Communication and compassion are at the heart of building up relationships which are essential in delivering person-centered care. They form the basis of professionalism in nursing.
Reference Section
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