The Author will describe the nurses role and discuss individualised patient care based around legal and ethical frameworks that guide and govern nurses in their roles as healthcare professionals. A five stage process to nursing care is one framework use to deliver this care and consists of assessment, diagnosis, care planning, implementation and evaluation and is an on-going, continuous cycle that only ends when goals are achieved and homeostasis is restored, or reasonable expectations of health for individuals are met.
There are many definitions on the role of the professional nurse and one put forward by the RCN (2002) states that Nursing is the use of clinical judgement and the provision of care to enable people to promote, improve, maintain or recover health or when death is inevitable, to die peacefully.
Good communication is vital for any nursing activities to begin. Patients often feel anxious, and vulnerable, they may have learning disabilities, depression or confusion caused by anxiety, especially on admission into a hospital setting. The relationship between patient and the nurse, is one based on trust. Patients have expectations to be cared for by a professional, without causing them harm within a safe environment. Clear verbal, or non-verbal communication using body language, respecting individual needs, wishes, and desires are key components to assessment in the nursing process (Kopp, 2002).
Nurses have a professional obligation to ensure they promote and protect the interests and dignity of patients and clients, irrespective of gender, age race, ability, sexuality, economic status, lifestyle, culture and religious and political beliefs (NMC, 2002).
A non-judgemental approach must be taken not just respecting the uniqueness of individuals, but also not letting the nurses own perceptions, personal beliefs, attitudes or any other factors discriminate against patients in the care they deliver (Koh, 1999). Assessment is not performed only once, but used throughout the whole care cycle. It also requires empathetic listening and good observation skills. Correlating information provided by them, family, friends, previous records and use of careful open questioning will allow the patient to be more descriptive about their symptoms (Kopp, 1996).
Permission or Consent must be acquired either verbally or non-verbally to perform procedures such as temperature, blood pressure, pulse and respiration. Non-verbal consent is an act the patient may do such as offering an arm for the nurse to take blood pressure, or open their mouth to have their temperature taken. Nurses must also work within their competence ensuring they seek a more qualified practitioner when they are unsure in their knowledge (Diamond, 2002). Accurate and relevant record keeping are essential to ensure the safety and continuity of care for patients and are legal documents that may be presented in a court of law to prove negligence (Pennels, 2002). All information given must remain confidential unless it poses a risk to the public. Examples of this are governed by acts of law like Public Health Control of Disease (1984), Public Health Infectious Diseases (1988), or cases where there is reasonable doubt about abuse, especially to children, Children Act (1989), and Prevention of Terrorism (Temporary provisions) Act (1989) cited by (Green 1999).
Translation of all the information gathered enables a diagnosis to be made about actual and potential problems the patient may have. For example, a patient has had back surgery which renders them immobile (actual), potentially they are at greater risk of suffering pressure sores and or constipation. It is the nurses job to use clinical knowledge and judgement to implement such procedures as air flow mattresses or assist the patient to frequently change their position. Give advice on fluid intake and where possible to advise...
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