Factors Impacting on Nursing Care Quality

Factors Impacting on Nursing Care QualityIntroduction keep backs admit an indispensable front-line place in patient deal within the NHS. However, issues such as role ambiguity, management concerns, training deficiencies, and a limited evidence-base raise secure questions about the reference of health care nurses dispense. This essay considers some of these issues.Role AmbiguityAlthough nurses offer a wide variety of patient care services, at that place is considerable ambiguity about specific work responsibilities in some areas of care for (Goll-McGee, 1999 Rask Hallberg, 2000 Hinsby et al, 2004 Dickens et al, 2005 Needham et al, 05 Sekula, 2005). Forensic psychiatric care is a good example. In a comprehensive survey of nurses views about their job responsibilities, Rask and Hallberg (2000) found significant differences between licensed mental health nurses and registered nurses in the violence attached to key treat roles, such as assessment, medical tasks (e.g. giving med ication), and actions relating to patients daily living activities. Nurses often feel uncertain about whether they can constrict certain tasks autonomously without incurring the wrath of doctors. For example, much has been written about nurse-initiated thrombolysis for cardiac patients (Rawles, 1994 Smallwood, 2000 Smallwood et al, 2004 Kelly, 2004). patient ofs presenting at an A E unit with cardiac symptoms may benefit from nurse-administered thrombolysis antecedent to formal medical screening. This would include performing an electrocardiogram and administering a thrombolytic agent via a standard protocol. Although nurse-induced thrombolysis may significantly reduce door-to-needle times, until recently in that location was no precise definition of this role in nurse literature. Nurses are often unsure precisely what roles they are expected to perform to deal with problems want teenage pregnancy and STD transmission (Campbell, 2004). This situation is confounded by the fact that sexual health needs vary considerably across specific patient groups (e.g. human immunodeficiency virus incidence is significantly high and access to health access seemingly more limited amongst African/immigrant communities) (DOH, 2001, 2002 2005a, 2005b also see Erwin et al, 2002). The net nucleus of this haziness is that nurses may not always be entire certain of their role at critical moments, or may feel too emphasize out, in situations where immediate patient care is paramount.Workload, Time Management Training IssuesThe issue of work-related stress (Ewers et al, 2002) is directly implicated in workload time management. It is no secret that nursing staff in the UK can be overworked at times (Kilfedder et al, 2001 Hinsby Baker, 2004 Hughes Umeh, 2005). A major reason for this is the severe time constraints created by the multiplicity of tasks nurses are required to perform. The Nursing Stress Scale (Plant et al, 1992 Tyler Cushway, 1995), a standard measure of wo rk stress experienced by nurses incorporates workload as cardinal of several separate and distinct sources of stress, highlighting the importance of this factor in nursing care. The workload problem was emphasised in a recent denomination about school nursing (Martell, 2005). School nurses are heavily under resourced exactly yet face an arduous workload, more so for those working in the pubic sector. Staff shortages and a multiplicity of responsibilities means that not enough time is spent on health promotion and in the classroom. More than half(a) of school nurses report feeling emotionally drained, and work excess hours on a daily basis, several times a week. The level of stress seems to vary considerable across different nursing fields. A recent study found that registered nurses report higher levels of stress compared with psychiatric nurses especially in the absence of social support (Hughes Umeh, 2005). Then in that respect is the issue of training. Nurses in the UK rece ive extensive training before being employed to work on the frontline (Campbell, 2004). However, questions have been raised about the adequacy of existing nursing upbringing in various aspects of patient care. For example, although it has been suggested that nurses can play a crucial role in evaluating and caring for victims of sexual assault, nurses in the UK currently receive no formal training in this area (Dinsdale, 2005). Another area of training wishing is in HIV prevention. Although the Nursing and Midwifery Council (NMC) approves specific training courses for nurses in this area, universities and colleges are not compelled to offer them, Pre-registration training for nurses does not include mandatory education relating to sexual health services. Nurses working in sexual health gain post-basic education in an ad-hoc manner through working in the specialty, and by travail specialist post-registration courses (Campbell, 2004, p.169). Nurses often receive limited (if any) tr aining in the care of specific patient groups. For example, few nurses have special knowledge of the health care needs of ethnic minorities communities (DOH, 2000b Andalo, 2004). Those who by chance spend some time working in such communities may gain some of the necessary expertise, but otherwise most nurses may be uninformed in this area. School nursing is another area in which training needs are not being met (Harrison, 2004 Martell, 2005). Martell (2005) reports that school nurses often have limited access to essential training for their role.Research Evidence-based practiceAs with other branches of health care there is increasing emphasis in nursing care on evidence-based practice (Lewis Latney, 2003 Thompson et al, 2004 Ring et al, 2005). Feasible evidence-based practice requires an adequate evidence base (Lewis Latney, 2003). However scientific literature in certain areas of nursing care is often patchy, delaying the development of appropriate best practice statements that will ensure consistency in the quality of care nurses dispense across all sectors of the NHS and private sector (Hoskins, 2000 Serrant-Green, 2004). The importance of evidence-based best practice guidelines cannot be overstated. The Nursing and Midwifery Practice Development building block (NMPDU) emphasises their importance in achieving consistent care delivery across nursing sectors. Unfortunately, even where best-practice guidelines have been widely developed for nursing care, as is the case with NHS Scotland, instruction execution is often slow and inconsistent (Ring et al, 2005). Nurses rarely refer to an evidence base when making decisions about patient care (Thompson et al, 2004). For example, midwifes often fail to offer prenatal HIV testing to women for ethnic minority backgrounds, to avoid appearing discriminatory (Gibb et al, 1998), even though such testing is a standard recommendation of the matter Institute for Clinical Excellence (NICE), DOH, and Nurse Agencies Na tional Minimum Standards (DOH, 1994, 2000a). Guideline execution can be hampered by many factors including resource deficiencies, lack of training, subway to change, lack of emphasis or prioritisation, absence of local nurse leaders who can champion best-practice ideology, and resistance to change. Fulbrook (2003) notes that nursing knowledge and care often derives from more experiential and in-depth one-to-one interactions with patients, rather than formal scientific doctrine. Thus, it is questionable whether existing best practice statements, which are rooted in positivist literature, are thus appropriate for nursing care.ConclusionThe quality of nursing care patients receive may often be compromised by workload issues, training deficiencies, a dearth of an adequate research evidence base, inconsistent implementation of clinical guidelines, and poorly defined job responsibilities. It appears these problems are rather more pressing in the worldly concern compared with private s ector. A recent study of the work-related perceptions of nurses working in non-NHS facilities found that nurses in this sector reported greater levels of support, cohesion, job clarity and physical puff (Dickens et al, 2005). However, they also indicated greater work pressure. There appears to be significant variation across various nursing specialties in the importance attached to key aspects of nursing care, such as patient assessment. Furthermore, certain nursing domains, for example school nursing, suffer from severe staff shortages, a multiplicity of responsibilities, and significant training issues. Overall, nursing care in the UK appears to lack the support it needs to meet expectations.ReferencesAndalo, D. (2004) How to sell. Nursing Standard, 18, pp.14-17.Campbell, P. (2004) The role of nurses in sexual and reproductive health. 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