NRSG370 Clinical integration

Module 1

The role of registered nurses across the clinical field is crucial in the delivery of care. Registered nurses offer patient-centered care using evidence-based research. They are tasked with providing the patient with care continuum and support the patient towards achieving the needed health outcomes. Further, the RN is tasked with leadership in areas of specialty and coordination of care for the benefit of the patient. Further, in informing clinical expertise, RN offers assistance to clinicians and practicing students in maintaining professional development and meeting the set standards for nurses which guides their practice, (Kendall-Gallergher & Blegen, 2009).

One of the critical issues of safety I experienced at the high dependency unit- HDU entails the issue of burn out. Burn out has been referred to as prolong exposure to chronic and interpersonal stress experienced on the job and soften due to excessive usage of work at the facility, (Burgess, Irvine & Wallymahmed, 2010). Burn out has been referred to as an occupational hazard not only in the medical nursing field but also various oriented professions. Nursing burnouts can have an effect on the wellbeing of the worker.

Burnouts at the high dependency units often emanate from work-related stress and these symptoms have been termed as frequent. Burn out reflect a psychological issue which response to long-term interpersonal and emotional stressors.

In my practice, experiencing burn out seems to be the challenge to cope, as it was draining my energy thus affecting my overall well being. This can have are purchase on the nature of health care quality on my professional care I provide.

Burn out prevalence has been associated with a high workload and time pressure. With intensive care unit composition, the work load is high and critical care is needed, thus at risks of experiencing of this effect. In my placement at the high dependency unit, there are several issues of concern which ouch on the safety of the registered nurse. High dependency units are often occasioned by high job discrepancies, overload responsibilities, end of life issues and interpersonal conflicts which affect and lead to high burn out cases, (Szecseny et al., 2011).

Intensive care units often provide support and treatment to critically ill patients. Registered nurses in this section often have feelings dissatisfaction due to burn out often occasioned by the high workload. Research has shown that this issue often leads to lower job performance.  Registered nurses working at high dependency units and ICU have been shown to have high prevalence and score high rates in terms of burn rates, (Garland, Roberts & Graff, 2012).

Burn out in the high dependency unit is associated with reducing and declining quality of care and lower patient satisfaction, increased incidence of medical errors, high infection rates and increased 30 days patient mortality rates. Burn out is often attributed to the working environment which the registered nurse is often exposed to. In ICU faculties, there is elevated patient morbidity and death occurrence. Further in a more extensive effect, health care professionals on experience post-traumatic stress disorders which affect their overall work quality., (all, Azoouly, Embriaco Poncet & Pochard, 2011).

High dependency unit often is characterised by highly stressful environment which has effects on the safety of the registered nurse and also the health concern for the patient on the quality of care being provided at. Enhancing nurses knowledge on job satisfaction and burnout in the nursing profession is key in focusing on patient care quality, nurse staff turnover, and poor communication, (Verdon, Merlani, Perneger & Ricou, 2008).

Hence as I enter into profession there is a need for me to be cognizant of the eminent safety factors which can arise at the curse of my workplace. Having adequate skills and effective coping mechanisms will be essential in my placement service at the high dependency unit.

Module two

High dependency units often exhibit a high change environment where expensive care is offered to patients who are critically ill. Ethical issues are more prevalent in these units especially among the different personnel involved there. Registered nurses at the high dependency unit thus need to show ethical competency. Critical areas of concern which are concern range from behavioral issues such as an end of life decision issues, respect, autonomy and poor communication between the different levels of staffs. Often medical criteria which play a fundamental role in nursing care revolve around the decision of wrong or right, or even being faced with conflict which arises from patient care process, (Tapper, Vercler, Cruze & Sexson, 2010).

Confidentiality in the high dependency unit is often important because of information sharing among health care professionals. If this patient information is not protected, the nurse-patient relationship can be diminished. Often patients don’t want their information to be shared, thus creating a trusting environment through respect to patient information and encouraging the patient to be honest on delivering healthcare information, (Park et al., 2015).

In high dependency units, the obligation of confidentiality often calls for the prohibition of nurses from disclosing patient information without permission. Appropriate care often calls for information regarding the patient to be discussed among the healthcare team. All healthcare team have the rights to access patient information and assume the duty of protecting the information. However medical electronic information needed adequate data protection policies which ensure patient confidentiality, (Truog et al., 2008).

Nurses in the HDU, can at times face ethical dilemmas when family members request to be disclosing information regarding their kin. At time unintended disclosures can be done among patients in this unit. A case example in high dependency unit is when a patient requires an urgent attention which calls for an urgent discussion and has the potential benefit of alleviating an individual from any danger. In this case, determining principle factor often is whether the perceived threat causes more harm than a danger to the patients, (Merlani et al., 2011).

There have been overriding situations which call for breach of confidentiality on high dependency unit. When the safety of the patient is breached, confidentiality tends to be broken. This can guarantee for access to high dependency unit patient access on medical information and data. However, in this, nurses often have the sole responsibility of protecting patients from credible threat and harm if they hold information which is key to their safety. The often crucial factor is whether there is a good reason for believing whether the threat is of any danger to the patient, (Yun et al., 2011). Here developing this skill of identifying potential risks of an ethical concern is of great importance in nursing practice at the high dependency unit.

Another fundamental reason which often needs a breach of confidentiality is legal requirements in a system of justice. State laws have outlined that any threat to public health warrant for disclosure of patient information. State and its organs have the jurisdiction of protecting the greater public from harm and any danger.

Module Three

Reporting

My reflection entails my nursing practice as a registered nurse at the high dependency unit offering critical; care to patients. In, high dependency unit, a lot of activities are involved which emanate from offering best care services to the patient. The issue which occurred during my practice involved healthcare ethical issue. In this case, the ethical challenge arose where challenge occurred with respect to breaching patient information. The issue involved sharing patient information to patient relative despite no approval request from the patient. This was a total breach of patient information.

Responding

My feelings regarding this issue made me feel not comfortable and felt that I had betrayed patient data information felt to have betrayed patient information and data. This action made me feel disoriented and felt that the information I had shared could be used to harm the patient. This is in line with a nursing ethical practice which calls for patient privacy to adhere to all healthcare staff. However as much as I felt disoriented, I asked myself critical questions regarding whether patient close next of kin has a right to patient information. This failure to act on this case led to an act of breach on patient confidentiality which can pose significant harm to nurse-patient privacy process.

Relating

My understanding of ethical practice is that it is key in healthcare practice and it is essential in enhancing and promoting patient relationship. Ethical dilemmas often arise in health care and are more critical when the healthcare professionals are faced with challenges to disclose patient information to close relatives of the patient. Patient confidentiality is a key aspect in healthcare practice, and as a nurse, there is a need for me to acquaint myself with these principles and to follow effectively so as to enhance and foster a nurse-patient relationship in the high dependency unit.

Reasoning

According to Principles of Nursing profession, ethical decisions and practices are essential and fundamental to nursing practice. There is a need for al nurses to respect patients and offer dignity in their care practices. Nurse need to create environments which built on mutual trusts and enhances respect for the patient and other relevant health care professionals in the unit. Maintaining confidentiality of patient is core nursing practice as it promotes the nursing practice and enhances patient outcome levels. Ethics of confidentiality promotes cooperation and collaboration between staffs. Breach of patient confidentiality could have negative impacts on patient quality of care and harms the relationship initiated at the unit.

Reconstruction

Developing and understanding patient safety and ethical principles in nursing practice, there is a need for me to enhance and improve my competencies in these areas. Identifying and having knowledge on coping measures which are necessary for coming up with burn out effects as a safety concern in nursing practice. Understanding the effects of burning out and identifying avenues which could be mitigated plays a crucial role in enhancing positive patient outcome and assuring the safety of health care professional concerned. Further en-calculating ethical principles and practices in my overall career as a registered nurse at the high dependency unit is critical so as to foster positive association and collaboration with the patient thus improving overall health outcome.

References

Burgess, L., Irvine, F., & Wallymahmed, A. (2010). Personality, stress and coping in intensive care nurses: a descriptive exploratory study. Nursing in critical care, 15(3), 129-140.

Garland, A., Roberts, D., & Graff, L. (2012). Twenty-four–Hour Intensivist Presence: A Pilot Study of Effects on Intensive Care Unit Patients, Families, Doctors, and Nurses. American journal of respiratory and critical care medicine, 185(7), 738-743.

Kendall-Gallagher, D., & Blegen, M. A. (2009). Competence and certification of registered nurses and safety of patients in intensive care units. American Journal of Critical Care, 18(2), 106-113.

Le, J. G., Azoulay, E., Embriaco, N., Poncet, M. C., & Pochard, F. (2011). Burn out syndrome among critical care workers. Bulletin de l'Academie nationale de medecine, 195(2), 389-97..

Merlani, P., Verdon, M., Businger, A., Domenighetti, G., Pargger, H., & Ricou, B. (2011). Burnout in ICU caregivers: a multicenter study of factors associated to centers. American journal of respiratory and critical care medicine, 184(10), 1140-1146.

Park, D. W., Moon, J. Y., Ku, E. Y., Kim, S. J., Koo, Y. M., Kim, O. J., ... & Koh, Y. (2015). Ethical issues recognized by critical care nurses in the intensive care units of a tertiary hospital during two separate periods. Journal of Korean medical science, 30(4), 495-501.

Szecsenyi, J., Goetz, K., Campbell, S., Broge, B., Reuschenbach, B., & Wensing, M. (2011). Is the job satisfaction of primary care team members associated with patient satisfaction?. BMJ quality & safety, bmjqs-2009.

Tapper, E. B., Vercler, C. J., Cruze, D., & Sexson, W. (2010, May). Ethics consultation at a large urban public teaching hospital. In Mayo Clinic Proceedings (Vol. 85, No. 5, pp. 433-438). Elsevier.

Truog, R. D., Campbell, M. L., Curtis, J. R., Haas, C. E., Luce, J. M., Rubenfeld, G. D., ... & Kaufman, D. C. (2008). Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College of Critical Care Medicine. Critical care medicine, 36(3), 953-963.

Verdon, M., Merlani, P., Perneger, T., & Ricou, B. (2008). Burnout in a surgical ICU team. Intensive care medicine, 34(1), 152-156.

Yun, Y. H., Lee, M. K., Kim, S. Y., Lee, W. J., Jung, K. H., Do, Y. R., ... & Jeong, H. S. (2011). Impact of awareness of terminal illness and use of palliative care or intensive care unit on the survival of terminally ill patients with cancer: prospective cohort study. Journal of Clinical Oncology, 29(18), 2474-2480.