...developing acute skills for nurses in critical care wards. In this section of the literature review, we will discuss policies in the nursing profession, case studies and various approaches to work based acute skills learning programmes. For our purposes we conducted a literature search using popular medical databases and terms such as ‘acute skills’ ‘learning programmes’ and ‘critical care learning’. Our review highlights on the several important approaches to work based learning ranging from reflective practice to experiential learning and work based formal practical training to enhance professional skills. A learning programme for acute ward nurses responsible for caring of critically ill patients has been the central focus of nursing practice development. According to Coad et al (2002), a work-based learning approach has been found to empower ward staff with the necessary skills of nursing and the authors studied the efficacy of a five-day competency based high dependency skills course in enhancing professionalism and quality of care in nursing. The aims of comprehensive critical care are developing leadership potential and enhancing networking opportunities for nurses within critical care and acute ward areas. Critical care is the most challenging aspect of nursing care and acute skills in nursing are enhanced not just by work-based learning programs but also from first hand nursing and emergency experiences. Titchen (2003) describes emergency care in which one professional...
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...Ethical and Legal Issues in Nursing NUR/391 Ethical and Legal Issues in Nursing As nurses, it is our duty to advocate for our patients. At times, we are faced with personal and professional challenges that impact how and when we chose to advocate. It is imperative we have a healthy awareness of these potential challenges. Improvements in health care technology have provided patients with an array of treatment options as well as assumed or possible increased chance of survival. As a result, nurses are met with a rise in ethical decision making. This paper will discuss the legal, ethical, social, and personal factors that can impact our decision making process, with the focus on two specific case studies. American Nurses Association Code of Nursing Ethics Role in Practice The American Nursing Association (ANA) has created a set of ethical standards for the profession of nursing to abide by, which is entitled the ANA Nursing Code of Ethics. The ANA Code of Ethics states that collaboration is central to the care nurses deliver and to their ethical commitment to the patient (Garity, 2005). In the end-of-life case study, the nurse (she) has an unwritten obligation to the patient; the family appears to be in conflict with how to proceed with the patient's medical treatment. The medical team has an obligation to give the family all of their options and possible outcomes. If the family remains in conflict, it would then be appropriate for her to refer the family to...
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...and research as both BSN and ADN nurses can sit for the same NCLEX-RN exam. There are multiple answer to this question, however the short answer is that nurse with a BSN degree has more opportunities to work in a variety of health care settings that offer an extensive array of opportunities for professional growth. (Moore, 2009) BSN student learn skills at a higher level that are required for exceptional practice. (Huston 7) The difference between the ADN nurse and the BSN nurse is not limited to the opportunities allotted but spans out to the education. The BSN nurse completes a curriculum that has a different focus than that of the ADN curriculum. The BSN curriculum emphasizes evidence based practice, leadership, critical thinking, and public/community health. (Moore, 2009) As part of this curriculum you receive crucial training in key areas like communication, leadership, and critical thinking- enhanced knowledge that will become ever more valuable in the complex and changing future of health care delivery. (Simons, 2012) BSN nurses can be and are not limited to bedside nurses, educators, case managers, discharge planners, administrators, and work in public health, home health, and community clinics. If you are thinking of joining any branch of the military, you will need to have your BSN. The BSN degree is not only a minimum for the military but also a minimum for most medical institutions, as it is the preferred degree. The ADN nurse has learned the...
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...EDUCATION Critical thinking and analysis: a model for written assignments Sharon L Edwards W hat is critical analysis? In the author’s personal experience this question has been answered by the following statement: ‘It is being critical of the literature.’ However, this does not answer the question. A literature search also failed to provide any information on critical analysis. The justification for developing a model for critical analysis, however, was not solely the lack of available literature. Other reasons included: to provide a definition of the terms; and to help both educationalists and students interpret the concepts involved. Nurse educationalists and nursing students lack a clear understanding of the critical processes and this could severely diminish the profession’s ability to articulate issues that are imperative to the advancement of nursing practice in the future. This article recommends a model of critical analysis that can be used by students and educationalists. It suggests that critical thinking and analysis are interrelated and complementary, but not synonymous. It gives examples of the model’s components in order to clarify their meaning. The model will hopefully give students a premise on which to base their assignments, and nurse educationalists will be able to incorporate it into their teaching practice. It will also provide an element of reality to critical analysis which will prevent it from becoming so abstract and idealistic as to render...
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...Six Caps Case Study University of Phoenix Undergraduate Nursing Studies Introduction In the words of Albert Einstein, “the world we have created is a product of our thinking; it cannot be changed without changing our thinking.” Today more and more nurses have to change their thinking process to ensure clients receive quality care. Therefore, clinical judgments cannot be based on speculation but on outcome, directed thinking. As the client health status changes, the nurse must be able recognize, assess, and evaluate all the presenting information to make an outcome decision that is best for the client and client’s family. To make appropriate decisions require nurses to put on their thinking caps. Edward de Bono’s six thinking caps integrates knowledge, comprehension, application, analysis, and evaluation allowing the nurse to make quality, outcome based decision. The purpose of this paper will focus on a case study using six thinking caps to critically analyze and make clinical decisions in promoting client safety and quality care. White Cap Thinking Looking at the case study with the White, Ms. Marianne first presented with a severe headache. The nurse uses her knowledge base about hemorrhagic stroke to decide what additional information is needed. Since information cannot be obtained from the patient, the nurse ask the patient’s family questions about the patient’s health problems, family health problems, medical history, medication regimen...
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...is the most common nosocomial infection in Critical Care units. VAP is linked with high mortality rates, increased hospital stays, longer mechanical ventilation and increased costs to hospitals and patients (Rosa, Hernandez, Carillo, Fernandez, & Valles, 2012). Patients who have an endotracheal tube (ETT) with mechanical ventilation are more likely to develop VAP. These patients have a poor cough reflex due to a decreased level of consciousness and diminished movement of the respiratory tract mucocila, leading to the inability to clear secretions. These contaminated secretions will then sit on top of the ETT cuff and eventually leak down and invade the lungs. Also aiding as a reservoir for microbes is a biofilm that can form on the ETT and enter the lungs causing infection (Mietto, Pinciroli, Patel, & Berra, 2013). Nurses are responsible for applying pharmacological and non-pharmacological measures to help prevent VAP which poses a very difficult challenge. Nurses must research and incorporate the use of evidence-based practice into their daily care of patients on mechanical ventilation (Sedwick, Lance-Smith, & Nardi, 2012). This paper will look closely at the evidence-based research and protocols implemented which best prevent ventilator-associated pneumonia. To help prevent further complications and improve outcomes in patients on mechanical ventilation, a standard of care was created by the Institute for Health Care Improvement (IHI) in 2004 called the Ventilator...
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...education a nurse has plays a significant role in the competency of nurses to give the best care outcomes for their patients. Nurses with Bachelor of Science in Nursing (BSN) degrees are better prepared through education to meet the demands placed on today's nurses in this highly demanding field. BSN nurses are recognized for their critical thinking skills and leadership abilities. BSN nurses are also educated in the areas of case management and health promotion. Nurses who obtain a bachelor degree are thought to have better adaptability to practice across a variety of settings, both inpatient and outpatient. Many healthcare organizations identify that baccalaureate degree nurses bring a unique value to the practice settings of the many fields of nursing (Bushy, 2014) There are 3 levels of education for those wishing to be a Registered Nurse. A Diploma Nurse, AND or Associate Degree Nurse, and a BSN or Bachelor Degree Nurse. A diploma nurse trains for 3 years in a hospital, an ADN trains for 2-3 years in a community college, and a BSN trains for 4 years at a university or upper level college. All three sit for the same NCLEX-RN exam to obtain their licensure to practice. The areas in which each nurse can practice are mostly similar except BSN nurses have management opportunities in which ADN nurses generally do not. The thought being that a BSN educated nurse is exposed to the additional education needed to handle the increased responsibility and critical thinking needed...
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...Associate Degree Nurse Versus Baccalaureate Degree Nurse A registered nurse is a trained nurse that, through formal education, completes their college degree and then proves their competency by passing the National Council Licensure Examination (NCLEX ). Registered nurses can be educated on three different levels, but this paper will address only two: the associate degree, and the baccalaureate degree nurses. Although there are many similarities in competencies, there are also a number of differences. The associate degree trained nurse (ADN), attends a two year program typically taught at a community college. The main part of the curriculum is preparing for clinical competency, but this degree lacks instruction in theory and science of nursing. The ADN program was developed in response to a shortage of nurses following World War II. Mildred Montag developed the two year ADN program in response to the nursing shortage. Montag defined the ADN as a technical nurse which included skill and some judgment to function at the intermediate level. Leadership and management classes were not part of the curriculum. Baccalaureate degree nurse or Bachelor of Science in Nursing (BSN) programs are taught at four year colleges and universities. Clinical competency is achieved, as in the ADN program, but there is also additional areas of study such as: leadership and management, critical thinking and community health care. In a study by Giger & Davidhizar (1990), BSN nurses significantly...
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...level nurse have their BSN degree. Employers are seeking out magnet status. In order to obtain this elite status they must have a high ratio of advanced degree nurses with their BSN or higher. The evidence behind having more nurses educated at a higher level is patient centered care. The differences in education between an associate degree nurse and a baccalaureate prepared nurse will be looked at thru this paper. The second item that will be addressed in this paper is how the care for patients differs between the ADN and BSN prepared nurse. Differences in education A person wants to go to school for nursing but are overwhelmed with a decision does this person obtain an associate’s degree in nursing or continue on further for a baccalaureate degree prior to entering the field of chosen study. This dilemma has been debated on for many years. The obvious difference between the two educations is the length of study. Both are able to sit for the same board exam the NCLEX at the end of study and they are both technically skilled for an entry level position. One may think then that there is really no difference in education other then the last three letters behind their name. The baccalaureate student not only studies for a longer period of time but there is an emphasis on evidence-base clinical practice and leadership within the curriculum. Numerous research studies have showed that the skill between ADN and BSN competency upon graduation, however, within a year the BSN nurse shows...
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...Techniques At the Critical Care Unit, visiting hours are restricted in a guise to allow patients to rest and nurses to provide care in a setting that guarantees modesty and patient privacy. Over the years, though, perceptions have changed and practitioners believe that family presence plays is crucial for improved patient outcomes (Kable, Chenoweth, Pond, & Hullick, 2015). Research, however is necessary to assess whether this new perception is realistic or influenced by certain unrealistic factors. However, further research is always necessary before making such major changes in the healthcare sector. Possibly, nurses are expressing interests in the change without a consideration of the initial factors that were considered when the policy was adopted. Random sampling is necessary to avoid biasness, include all crucial participants, and for certainty of reliable findings (Sawbridge & Hewison, 2013), which is necessary for the evaluation of the validity of the new perceptions before instituting any change is necessary. Since the study ought to capture a diverse group of nurses, patients, and family members, then sampling is appropriate. Researchers will gather information from three samples; nurses, patients, and family members. With a properly structures research question, hypotheses, and questionnaires relevant to the three groups, it will be easy to gather enough data from the three groups. Usually, data collected from a sample during a study is interpreted as a representative...
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...Experience of Moral Distress in Critical Care Nurses Jessy Thomas Grand Canyon University: NRS-433V May 24, 2015 Gender and the experience of moral distress in critical care nurses Patricia Banner, an American nurse theorist defined the ethical compartment as “the embodied skilled know-how of relating to others” in ways that are respectful and support their concerns (Corley MC, Nurses Ethics 2002). Moral distress is fairly new topic of discussion in the print and media. The term begins when Jameton recognized the negative feelings when one person realize the morally correct course to be taken but can’t practice due to the restriction imposed by the place they work. Moral distress can happen in variety of setting and roles. Many researchers studied this topic among various health care workers among nurse educators, students, critical care and medical-surgical nurses and administrators. The moral distress among nurses may vary depending upon many factors such as gender, ethnic back ground or the context in which they practice. A meta-analysis of 19 studies on moral sensitivity and moral judgment found that females are higher in the case of moral sensitivity scores. (Christopher B, Gender and moral distress) Problem Statement The problem of this study aimed to address was: “Critical care settings are highly technical, dynamic patient care environments”. Often nurses need to make sudden judgments and decisions of complex nature that can take care of patients needs while keeping...
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...Nurses Manage Patients Who Refuse Nursing Care Procedures Grand Canyon University: NRS 433V March 9, 2014 Nurses Mange Patients Who Refuse Nursing Care Procedures This paper will critique a qualitative research study about how nurses manage patients who refuse nursing care procedures. These articles also explains how nurses view informed consent as not being essential to nursing care procedures. PROBLEM STATEMENT The clinical problem being examined in the research study is the way in which nurses obtain consent prior to administering nursing care procedures, and the way nurses manage patients who refuse any nursing care procedures. By stating that nurses “do not regard obtaining consent as an absolute requirement” also stating that “consent is preferred but no considered essential” the significance is established and a clinical problem identified (Aveyard, 2004). The author identifies the need for further education of nurses on the need to obtain informed consent for nursing care procedures, and the need for more research of this topic. The role of persuasion in situations of informed consent has been widely commented on. Many commentators argue that the health care provider has a duty not only to give information but also to persuade the recipient of care to accept the course of action considered most appropriate for the patients’ safety. PURPOSE and RESEARCH QUESTIONS The study clearly identifies the aim of the study as “to examine the way in which...
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...DIFFERENCIES IN COMPETENCIES BETWEEN ADN AND BSN Nursing professions is undergoing rapid changes and are inevitable. Nurses should be able to adapt and practice these changes in order to provide quality health care to the society. Nurses are the vital part of the evolving health care arena, since our profession is getting more complex and demanding it is our responsibly to be competent in the profession for the better outcome. As there are differences in curriculum, there are visible differences in competencies. Both programs provide essential education for the students in order to practice whereas baccalaureate program is broad base which also includes teaching in critical thinking, leadership and management (Differentiated Essential Competencies ,2010). Nurses who possess baccalaureate degree have the capability to meet the complex and unpredictable needs of the divers population even in an unstructured environment. Studies show that there are decreased rate in medication errors, death rates when patients are cared by baccalaureate degree nurses (AACN, 2011). Majority of the task and responsibilities remains same for both the associate degree nurses and baccalaureate nurses. The associate degree nurses are very proficient in bedside nursing as they acquire knowledge through hands-on practice, whereas the baccalaureate nurses are able to provide evidence based care. Also by utilizing their in depth knowledge in the areas of practice, a BSN addresses the concerns of a patient...
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...A Comparison of Critical Thinking Skills between Associate, Baccalaureate, and RN-to-BSN Nurses A Comparison of Critical Thinking Skills between Associate, Baccalaureate, and RN-to-BSN Nurses There are many differences in the competencies between associate and baccalaureate level nurses. Associate level nursing programs tend to concentrate on the more technical aspects of nursing which allows students once they graduate to provide appropriate care to patients and families, especially during times of illness. They may practice on a more restricted level, making their nursing skills limited to more direct patient care in nursing homes and hospitals. Baccalaureate nursing programs improve on these skills by teaching more critical thinking to allow a more thorough approach to caring for their patients. RN-to-BSN programs allow ADN nurses that have grown confident in their hands-on skills and want to gain more critical thinking skills the ability to build on their education and "prepare...for a broader scope of practice" (American Association of Colleges of Nursing, 2014). The American Association of Colleges of Nursing (AACN) notes multiple research studies linking fewer medication errors, lower mortality rates and more positive patient outcomes to nursing education received at the baccalaureate level (2014). BSN programs also help teach the leadership needed for nursing supervision and prepare their nurses for graduate studies. Critical thinking competency is key...
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...A registered nurse is a trained nurse that through formal education completes their college degree, and then proves their competency by passing the NCLEX licensing examination. Registered nurses can be educated on three different levels, but I will address only two. The Associate Degree nurse and the Bachelor of Science Degree nurse levels. Although there are many similarities in competencies, there are also a number of differences. The Associates Degree trained nurse (ADN), attends a two year program typically taught at a community college. The main part of the curriculum is preparing for clinical competency, but typically lacks instruction in theory and the science of nursing. The ADN level nurse was developed in response to a shortage of nurses following World War II. Mildred Montag developed the two year ADN program in response to the nursing shortage. Montag's defined the ADN as a technical nurse which included skill and some judgment to function at the intermediate level. Leadership and management were not part of the curriculum. Bachelor of Science of Nursing (BSN) programs are taught at four year colleges and universities. Clinical competency is achieved, as in the ADN program, but also additional areas of study such as: leadership and management, critical thinking and community health care. In a study by Giger and Davidhizar (1990), BSN nurses significantly outscore ADN nurses in the professional category. They are were more concerned with research, teaching...
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