Factors Impacting on Nursing Care Quality

Factors Impacting on Nursing Care Quality accounting entryNurses play an indispensable front-line purpose in patient role portion out within the NHS. However, issues such as fiber ambiguity, management concerns, reading deficiencies, and a limited evidence-base raise serious questions well-nigh the tint of health wield agrees dispense. This essay considers some of these issues.Role AmbiguityAlthough nurses offer a wide variety of patient get by services, there is considerable ambiguity about specific pasture responsibilities in some areas of breast feeding (Goll-McGee, 1999 Rask Hallberg, 2000 Hinsby et al, 2004 hellion et al, 2005 Needham et al, 05 Sekula, 2005). Forensic psychiatric burster is a good example. In a comprehensive survey of nurses views about their blood line responsibilities, Rask and Hallberg (2000) put up signifi so-and-sot differences between licensed mental health nurses and registered nurses in the emphasis attached to key nursing roles, such as a ssessment, medical tasks (e.g. giving medication), and actions relating to patients daily maintenance activities. Nurses frequently feel un accredited about whether they can undertake certain tasks autonomously without incurring the wrath of doctors. For example, frequently has been written about nurse-initiated thrombolysis for cardiac patients (Rawles, 1994 Smallwood, 2000 Smallwood et al, 2004 Kelly, 2004). Patients presenting at an A E unit with cardiac symptoms may turn a profit from nurse-administered thrombolysis prior 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 adulterate door-to-needle measures, until recently there was no precise definition of this role in nursing literature. Nurses are often unsure precisely what roles they are expected to perform to roll in the hay with problems like teenage pregnancy and STD tr ansmission (Campbell, 2004). This situation is confounded by the fact that sexual health needs vary considerably across specific patient groups (e.g. HIV incidence is significantly towering and access to health access seemingly more limited amongst African/immigrant communities) (DOH, 2001, 2002 2005a, 2005b also see Erwin et al, 2002). The exonerate effect of this haziness is that nurses may non always be entire certain of their role at captious moments, or may feel too stressed out, in situations where immediate patient upkeep 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 line Scale (Plant et al, 1992 Tyler Cushway, 1995), a standard measure of work stress experienced by nurses incorporates workload as one 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 article about school nursing (Martell, 2005). inform nurses are heavily under resourced but yet face an arduous workload, more so for those workings in the pubic sector. Staff shortages and a multiplicity of responsibilities means that not enough time is fagged on health promotion and in the classroom. More than half of school nurses report feeling emotionally drained, and work excess hours on a daily basis, several times a week. The aim of stress seems to vary considerable across different nursing fields. A recent muse found that registered nurses report higher levels of stress compared with psychiatric nurses especially in the absence of social support (Hughes Umeh, 2005). then(prenominal) there is the i ssue of readiness. Nurses in the UK receive extensive training before being employed to work on the frontline (Campbell, 2004). However, questions pack been raised about the adequacy of existing nursing education in several(a) 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 deficiency 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 undertaking specialist post-registration courses (Campbell, 2004 , p.169). Nurses often receive limited (if any) training 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 get hold spend some time working in such communities may gain some of the required expertise, but otherwise most nurses may be uninformed in this area. School nursing is other 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 course sessionAs with other branches of health care there is increasing emphasis in nursing care on evidence-based coiffe (Lewis Latney, 2003 Thompson et al, 2004 Ring et al, 2005). viable 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 Unit (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 chance with NHS Scotland, implementation 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 antenatal HIV exam to women for ethnic nonage backgrounds, to avoid appearing discriminatory (Gibb et al, 1998), even though such testing is a standard testimonial of the internal Institute for Clinical Excellen ce (NICE), DOH, and Nurse Agencies National tokenish Standards (DOH, 1994, 2000a). Guideline execution can be hampered by many factors including resource deficiencies, lack of training, resistance 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 indeed appropriate for nursing care.ConclusionThe quality of nursing care patients receive may often be compromised by workload issues, training deficiencies, a paucity 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 t he public compared with private sector. 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 carnal comfort (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. Journal ofFamily Planning and Reproductive health Care, 30, pp.169-170.Department of Health (1994) Guidelines fo r Offering willing named HIV Anti-Body Testing to Women receiving Antenatal Care. London, Department ofHealth.Department of Health (2000a) Nurse Agencies National Minimum Standards NurseAgencies Regulations.London, Department of Health.Department of Health (2000b) Black and ethnic nurses midwives and health visitorsleading change a report of the Mary Seacole leadership award the first fiveyears. 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