Nursing as an Art and Science: Nursing Concepts, Barriers, Facilitators

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Nursing is both an art and a science, and yet both in its own right. It is the act of utilizing the environment of the patient to assist him in his recovery (Nightingale, 1860). It is caring for others and providing support with their needs, be that physically or emotionally throughout their illness. Gilligan (1982) has previously suggested that in order for a patient to reach their full potential there must be a relationship between the nurse and the patient, with the patients own set of values and beliefs held at the core. The world of interaction plays a central role in the nursing profession as you are dealing with both people and their emotions on a day-to-day basis. There are a number of key concepts that guide and inform the nursing profession, with research conducted on every concept. In this essay, we will explore a number of these key concepts and also some of the barriers and facilitators of said concepts.

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Personhood is ‘a standing or status that is bestowed upon one human being, by others, that implies a mutual respect, recognition and trust.’(Kitwood, 1997, p 8-9) Kitwood also stated that each person has the capacity to take meaning away from the way he/she interacts with others, and is ingrained with resources from previous engagements as well as the ability to ponder about oneself. (Kitwood, 1997, p 15-17) Person-centered care, which was first articulated by Kitwood, is still to this day thought to underpin high quality care. (Pinto et al, 2012; Coulter et al, 2015) However, when this is not implemented correctly it can lead to negative results. (Fredericks et al, 2015) A lot of the research on this concept has been conducted in the areas of care for the elderly or those suffering from dementia. (Edvarsson, Winblad & Sandman 2008; Kitwood, 1997)

In a number of health-care settings, policy creators are adopting systems to strengthen the concept of person-centered care, in the aim to empower the patient and to improve the quality of care that they receive. However, this can be difficult in fast paced health-care facilities but research shows that when implemented correctly by staff effectively communicating a person goals and supporting them it can save time across the board. (Moore et al, 2016)

In 2010, the University of Gothenburg Centre for Person-Centred Care (GPCC) was set up with the intention of advancing and achieving person-centred care in clinical practice on the footing of three routines. They are based on obtaining the persons account of their ailment to begin the partnership; engaging in the partnership to achieve commonly agreed goals; and making use of the required documentation in order to preserve the partnership and keep track of the person’s narrative and shared goals. (Britten et al, 2016)

It is clear from research that in order for person-centred care to be facilitated, the health-care workers need to see the person being cared for n a different light. Usually, the patient is discussed without being prompted for their participation and they are never made feel, as they are part of the team. This in turn leaves the patient feeling isolated, overlooked, berayed and less likely to engage with the services being provided. (Gondek et al, 2016) The main issue with implementing person-centred care was getting the health-care workers to see beyond the patient’s disease and see them as a person with the same emotional needs as anyone else. (Britten et al, 2016)

Person-centred care involves a lot of time being allotted for staff to engage in proper training, education and developing a rapport between the health-care worker and the patients. Furthermore, advancement of communication skills is required for dealing with patients who have difficulty communicating and for those who’s first language is different to their own. (Britten et al, 2016) An example of this may be an older person who may not be as likely to directly offer personal information, but instead do so indirectly through the use of facial expressions, hints and body language. Therefore, the health-care provider must be trained to enhance their skills on picking up on these indirect methods of communication. (Van Der Cingal et al, 2016) The implementation of person-centred care can also differ depending on a number of factors such as the patient populance, who is providing the care and the setting in which it is being provided and how the health-care workers and the patients perceive caring. (McCance et al, 2009)

One of the main factors, which hinder its application, is found to be attempting to turnaround perspectives that were skeptical and judgmental was much harder than anticipated and requires constant attention and engagement with routines. It was found that healthcare workers needed to be reminded continuously that the patient is a person as it is quite easy for them to think of them as they had previously. (Moore et al, 2016) Despite some of the barriers that the implementation of person-centred care encounters, it has been identified through research that factors which helped rather than hindered its success were those such as organizational, leadership and training, perception and manner of healthcare workers and how person-centred care was implemented across some settings.

Another concept that is key to the nursing profession is that of compassionate care, which has been one of the key concepts right throughout the history of nursing. Since the 19th Century, the nursing profession began to take steps away from the religious domain and more towards the professional domain. The way in which society view nurses today is mainly down to the role of Florence Nightingale and the adaptation of her own religious values into a vision for nursing. (Straughair, C., 2012) She was key in establishing the basis for the role of the nurse, as we comprehend it to date. According to Nightingale herself, she received a ‘calling from god’, which led her to develop such a personal interest in nursing. She brought to light that nurses must aim to help ease the suffering in the ill through acts of compassion. (Nightingale, 1859) Since the era of Nightingale, it has been shown through studies conducted that as nursing became more technical, the ideology of compassion began to disappear.

Although the ethos for compassion has notably decreased over time it still appears that people entering the nursing profession do so as they wish to provide a high quality compassionate care. In a study, which took place in Australia it shows that the main factors influencing that drove nurses to enter the profession was their want to care for others. (Eley et al, 2010)

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