Nursing

Community nurses are the nurses who work in a particular community for its welfare. With their ability to understand, they can deal with the health of residents living in any community. They work in the field of public health in order to perform tasks including population and community evaluation, development and implementation of community health programs and working in teams in order to work with discipline. Nurses in acute care settings work along with other health care specialists (Green, 27). The nurse is involved in the healing, security and recovery of intensely sick patients, looking after the health of healthy patience and operations of patients who are suffer from life threatening ailment. They perform non-clinical job that are vital for health care. Death and birth care is also provided by the nurses. Nurses practice in variety of acute settings that are available to them. They work in hospitals, schools, pharmaceutical companies, clinics, camps, militaries (Burbach, 98). Even though, nurses from different area of expertise seem to be more or less in abilities, we cannot conclude that nurses working in acute care settings are not capable. For example, Nurses working in critical care settings are experts on pregnancy and birth related aspects than community nurses. The question comes whether to justify that it is a false impression or a fact that a skill in one setting can be use as a skill in another (Humphrey, 19). When developing intermediary plans with requirements of constant management, the need of feedback and extra training is mandatory. This can help the nurses to put into practice and increase experience in non acute care settings before complete service changes are ready. This would enable the nurses to use their abilities and be confident to work in non acute settings. Equally essential, it is important for non acute setting nurses to continue with their education (Conrad, 28). The skills of dressing and taking care of wounds, having complete knowledge about the community’s resources, information on diabetes, patient family support and good communication skills with third party payers are very important when working in the community. These are the skills that help the nurse when working in the community. These nurses work under their leaders, learn in the learning atmosphere and accommodate themselves to adjustments to changes (Feldman, 17). They have the ability to work efficiently which has been dictated to them. They have the ability to work in a peaceful atmosphere and ignoring their colleague’s weaknesses. Nurses working in acute settings require the information, capabilities and experience to take care of their patients and the families. At the same time, the nurse creates loving, kind and restoring health environment. At the same time, they fulfill various responsibilities. They work directly with patients, they provide education to fresh nurses, they work as researchers, and they are managers (Shea, 67). A community nurse works independently as compared with nurses who work in acute settings. The main aim of a community nurse is to focus on the population and persons who do not necessarily seek out the services. Nurses working in acute care settings differ from community nurses in many ways. Nurses working in acute care settings do not have the access to direct clinical practice. They do not have the advance skills to provide education and teaching skills to patients and family (Loreti, 32). They work under superiors. They are not consultants and they do not take part in research. They carry out duties that are instructed to them. They do not require any leadership quality. They do not write policies or build partnerships.   They are restricted in certain working conditions (Stephany, 13). Nurses working in the acute care settings assess the critical and acute patient’s health status. Community nurses have to demonstrate the ability to make decisions for a variety of situations. They also need to demonstrate the need for promoting the rights of clients. They have to ensure the safety of their patients. Communications skills are very important for nurses working in the community and acute care settings. However community nurses require effective communication skills as compared with nurses working in acute care settings because the former might interact with poor and marginalized sections of society. A community nurse has to reflect primary health care principles to ensure that clients become independent and responsible (Brent, 10). An acute setting nurse on the other hand has to keep and document the health history of critical and chronically ill patients. A community nurse must have leadership and management skills to ensure that multiple approaches are used to assist the client in health issues (Wood, 17). Community nurses have to apply a public health framework to build community health nursing. They must plan and integrate health promotion into the aspects of community health nursing. They must also apply knowledge of health promotion to achieve public health policies (Hunt, 36). They must coordinate the development and implementation of health promotion plans. An acute settings nurse on the other hand is more concerned with assessing the needs of additional screening after initial assessment findings. They must have adequate skills to assess the impact of acute or chronic injuries on the individual (Bailey, 714). A nurse working in acute settings needs to be very quick and capable of working with complex and dependant patients. In the community settings, assessment and decision making abilities play an important role in the delivery of patient care. Nurses in the acute settings must quickly identify outcomes based on actual or potential diagnosis (Sobolewski, 12). Intervention plans are individualized according to the characteristics of the patients. The plan is developed in collaboration with other health professionals and family members.   They ensure that there is continuity of care and properly documented. A community nurse on the other hand must demonstrate the ability to have effective problem solving strategies. They must also make the use of systematic decision making techniques. These decisions need to be based on experience and clinical judgment. Community nurses have a higher degree of autonomy as compared with nurses working in acute settings. They have to participate in decision making to ensure accountability. They must also make appropriate solutions in response to a range of options (Harris, 14). Nurses in the community need to demonstrate the ability to make autonomous decisions and independence. They have to resolve complex situations using multiple approaches. A nurse working in the acute setting on the other hand does not have a high degree of autonomy. They also do not need to demonstrate a level of independence. Nurses working in the community differ from those who work in acute settings. They have work in developing community health programs and teams. Nurses in acute settings on other hand work for healing and recovery of intensely sick patients. Works Cited: Burbach CA. Community health and home health nursing: keeping the concepts clear. Nurse and Health Care. 1988; 9(2):96-100. Green PH. Meeting the learning needs of home health nurses. J Home Health Care Practice. 1994; 6(4):25-32. Conrad MB. Issues in home health nursing education. Home Healthcare Nurse. 1991; 9(4):21-28. Humphrey CJ. Home care nursing orientation model: justification and structure. Home Healthcare Nurse. 1992; 19(3):18-22. Shea AM. Transitioning professional nurses into home care: a 6-month mentorship program. J Home Health Care Practice. 1994; 6(4):67-72. Feldman R. Meeting the educational needs of home health care nurses. J Home Health Care Practice. 1993; 5(4):12-19. Stephany TM. Health hazard concerns of home care nurses: a staff nurse perspective. J Nurs Adm. 1993; 23(12):12-13. Loreti ST. Easing the transition from hospital nursing to home care: a research study. Home Healthcare Nurse. 1991; 9(4):32-35. Wood MJ. The educational needs of home health nurses. Home Healthcare Nurse. 1986; 4(3):11-17. Bailey C. Education for home care providers.JOGNN 1994; 23(8):714-719. Hunt P. When orientation is not enough.Home Healthcare Nurse. 1992; 10(6):36-40. Brent NJ. Orientation to home healthcare nursing is an essential ingredient of risk management and employee satisfaction.Home Healthcare Nurse. 1992; 10(2):9-10. Harris MD, Yuan J. Educating and orienting nurses for home healthcare. Home Healthcare Nurse. 1991; 9(4):9-14 Sobolewski S. `See you in home care.' Am J Nurs(Part 2: Career Guide). 1996; January:10,12,14.                                                             Nursing Nursing is like breathing for me. It is more than a purpose. Being a nurse will complement not only most people but my well-being as well. To become a nurse you need to be compassionate and able to pass college algebra and several science courses such as microbiology, chemistry, anatomy and physiology. I also need to take psychology, social sciences, and be proficient at written and oral communication. I need to be able to read at a tenth grade level. For many, 9/11 was a turning point in their professional lives. People began to find they were not satisfied in jobs that didn't make a difference in someone's life. Others had always wanted to become a nurse but other factors influenced their decisions and now they want to pursue a career in nursing. I might find it easier than you thought to have a second career as a nurse. Nursing is extremely hard work, both physically and emotionally. Not everyone is cut out for it. It's not just the blood and gore that might make you think twice. I have to understand what nursing involves before you choose this route. I don't have to just work in a hospital to be a nurse. I am about to find out more opportunities for nurses as well as the educational requirements to achieve these roles. Healthcare is one of the fastest growing professions throughout the world. The population ages, and healthcare costs rise, the demand for nurses will continue to increase as well. The health care delivery system is shifting, and nurses, particularly those with advanced education, will be in demand for quite some time.   With the rising costs of healthcare, physicians are spending less time with patients, and nurses are shifting into an ever expanding role of health educator, as well as providing more direct care to the patients. Effects of Nursing Shortage The present population of nurses is aging and approaching retirement. This will compound the current shortage of nurses worldwide. I am bent to become one of one the thousands of nurses that aspire to undertake this profession. The shortage nurses are causing a dramatic increase in salaries for nurses but this is not a hindrance to become a nurse. For one to become a nurse, he or she should be more than dedicated with his profession. Patients are to be treated like they are family as well, so as to feel at home during their confinement in the hospital. Hospitals and other facilities are competing for nurses with sign-on bonuses, and packages including cars, childcare and/or eldercare assistance, and housing assistance. Attractive salaries, bonuses, and job security are not the only benefits for nurses. Caring for others and making a difference in the lives of others everyday is a rewarding aspect to a career in nursing. It's something that can be said to be missing in many careers. The shortage of nurses has forced employers to not only adjust salaries, but to look outside the box at alternative and flexible working conditions. Many more opportunities are available for per diem, part time as well as full time employees. Flexible work schedules and job sharing opportunities are emerging in the field to help nurses meet the demands of their families while managing a rewarding career. One way you can see for yourself first hand is to become a patient, but that is not the recommended route. Many young people choose nursing because of past experiences as a patient or through the experiences of a loved one or a close friend. Other ways include volunteering in a local hospital. Many still use candy stripers, or have auxiliaries which train volunteers to read to patients, to assist with wheelchair transportation at discharge, running library carts, etc. Another way is to seek out a shadow day experience. Talk to your guidance counselor and see if it is possible to set one up. Sometimes local hospitals and clinics offer these periodically. Call your local facility and inquire. Perhaps you ca help them to do this if they don't already. Nursing schools may offer shadow day experiences. Some are beginning to offer Nursing Camps for a week during the summer. You live on campus and attend events and tours of their hospital facilities. You shadow nurses, and earn your CPR. You may also learn to take vital signs and visit laboratory facilities. You may get to enter a hyperbaric chamber and observe in the Emergency rooms and Operating Rooms. Yet this is what I aspire to be. Nursing is not just a profession for me it is passion that will take me places and would complement me as a person. Nursing Nursing is involved in identifying its own unique knowledge base—that is, the body of knowledge essential to nursing practice, or a so-called nursing science. To identify this knowledge base, nurses must develop and recognize concepts and theories that are specific to nursing. Theory has been defined as a supposition or system of ideas that is proposed to explain a given phenomenon. For now, think of theory as a major, very well articulated idea about something important. The four most influential theories from the 20th century were Marx’s theory of alienation, Freud’s theory of the unconscious, Darwin’s theory of evolution, and Einstein’s theory of relativity. Most undergraduate students are introduced to the major theories in their disciplines. Psychology majors study Freud and Jung’s theories of the unconscious, Sullivan and Piaget’s theories of development, and Skinner’s theory of behaviorism. Psychology majors are also introduced to critiques of those theories. Sociology majors study Marx’s theory of alienation and Weber’s theories of modern work, as well as the critiques of their theories. Both sociology and psychology majors spend the majority of their time studying theories and approaches to research. This paper discusses how nursing theory is different from medicine. II. Background A. Purposes of Nursing Theory Direct links exist among theory, education, research, and clinical practice. a)  Ã‚  Ã‚  Ã‚  Ã‚   In Education Because nursing theory was used primarily to establish the profession’s place in the university, it is not surprising that nursing theory became more firmly established in academia than in clinical practice. In the 1970s and 1980s, many nursing programs identified the major concepts in one or two nursing models, organized these concepts into a conceptual framework, and attempted to organize the entire curriculum around that framework. The unique language in these models was typically introduced into program objectives, course objectives, course descriptions, and clinical performance criteria. The purpose was to elucidate the central meanings of the profession and to gain status vis-à  -vis other professions. Occasionally, the language of nursing syllabi became so torturous that neither the faculty nor the students had a clear understanding of what was meant. Many nursing programs have abandoned theory-driven conceptual frameworks. III. Discussion A. In Research Nurse scholars have repeatedly insisted that nursing research identifies the philosophical assumptions or theoretical frameworks from which it proceeds. That is because all thinking, writing, and speaking is based on previous assumptions about people and the world. New theoretical perspectives provide an essential service by identifying gaps in the way we approach specific fields of study such as symptom management or quality of life. Different theoretical perspectives can also help generate new ideas, research questions, and interpretations. Grand theories only occasionally direct nursing research. Nursing research is more often informed by midlevel theories that focus on the exploration of concepts such as pain, self-esteem, learning, and hardiness. Qualitative research in nursing and the social sciences can also be grounded in theories from philosophy or the social sciences. The term critical theory is used in academia to describe theories that help elucidate how social structures affect a wide variety of human experiences from art to social practices. In nursing, critical theory helps explain how these structures such as race, gender, sexual orientation, and economic class affect patient experiences and health outcomes. a)  Ã‚  Ã‚  Ã‚  Ã‚   In Clinical Practice Where nursing theory has been employed in a clinical setting, its primary contribution has been the facilitation of reflection, questioning, and thinking about what nurses do. Because nurses and nursing practice are often subordinated to powerful institutional forces and traditions, the introduction of any framework that encourages nurses to reflect on, think about, and question what they do provides an invaluable service. An increasing body of theoretical scholarship in nursing has been outside the framework of the formal theories presented in the next pages. Benner (2000) argues that formalistic theories are too often superimposed on the life-worlds of patients, overshadowing core values of the profession and our patient’s humanity. Philosophy is used to explore both clinical and theoretical issues in the journal Nursing Philosophy. Family theorists and critical theorists have encouraged the profession to move the focus from individuals to families and social structures. Debates about the role of theory in nursing practice provide evidence that is nursing is maturing, both as an academic discipline and as a clinical profession. B. Nursing Theories The nursing theories discussed in this paper vary considerably (a) in their level of abstraction; (b) in their conceptualization of the client, health/illness, environment, and nursing; and (c) in their ability to describe, explain, or predict. Some theories are broad in scope; others are limited. The works presented in this paper may be categorized as philosophies, conceptual frameworks or grand theories, or midlevel theories (Tomey, 2001). A philosophy is often an early effort to define nursing phenomena and serves as the basis for later theoretical formulations. Examples if philosophies are those of Nightingale, Henderson, and Watson. Conceptual models/grand theories include those of Orem, Rogers, Roy, and King, whereas midlevel theorists are Peplau, Leininger, Parse, and Neuman. a)  Ã‚  Ã‚  Ã‚  Ã‚   Nightingale’s Environmental Theory Florence Nightingale, often considered the first nurse theorist, defined nursing more than 100 years ago as â€Å"the act of utilizing the environment of the patient to assist him in his recovery (Nightingale, 1999). She linked health with five environmental factors: (1) pure or fresh air, (2) pure water, (3) efficient drainage, (4) cleanliness and (5) light, especially direct sunlight. Deficiencies These environmental factors attain significance when one considers that sanitation conditions in the hospitals of the mid-1800s were extremely poor and that women working in the hospitals were often unreliable, uneducated, and incompetent to care for the ill. In addition to those factors, Nightingale also stressed the importance of keeping the client warm, maintaining a noise-free environment, and attending of the client’s diet in terms of assessing intake, timeliness of the food, and its effect on the person (Nightingale, 1999). Nightingale set the stage for further work in the development of nursing theories. Her general concepts about ventilation, cleanliness, quiet, warmth, and diet remain integral parts of nursing and health care today. b)  Ã‚  Ã‚  Ã‚   Roger’s Science of Unitary Human Beings Martha Rogers first presented her theory of unitary human beings in 1970. It contains complex conceptualizations related to multiple scientific disciplines (e.g., Einstein’s theory of relativity, Burr and Northrop’s electrodynamic theory of life; von Bertalanffy’s general systems theory; and many other disciplines, such as anthropology, psychology, sociology, astronomy, religion, philosophy, history, biology, and literature. Rogers views the person as an irreducible whole, the whole being greater than the sum of its parts. Whole is differentiated from holistic, the latter often being used to mean only the sum of all parts. She states that humans are dynamic energy fields in continuous exchange with environmental fields, both of which are infinite. The â€Å"human field image† perspective surpasses that of the physical body. Both human and environmental fields are characterized by pattern, a universe of open systems, and four dimensionalities (Rogers, 2000). Nurses applying Roger’s theory in practice (a) focus on the person’s wholeness, (b) seek to promote symphonic interaction between the two energy fields (human and environment) to strengthen the coherence and integrity of the person, (c) coordinate the human field with the rhythmicities of the environmental field, and (d) direct and redirect patterns of interaction between the two energy fields to promote maximum health potential. Nurses’ use of non-contact therapeutic touch is based on the concept of human energy fields. The qualities of the field vary from person to person and are affected by pain and illness. Although the field is infinite, realistically it is most clearly â€Å"felt† within several feet of the body. Nurses trained in non-contact therapeutic touch claim they can assess and feel the energy field and manipulate it to enhance the healing process of people who are ill or injured (Rogers, 2000). c)  Ã‚  Ã‚  Ã‚  Ã‚   Orem’s General Theory of Nursing Dorothea Orem’s theory, first published in 1971, includes the related concepts: self-care, self-care deficit, and nursing systems. Self-care theory is based in four concepts: self-care, self-care agency, self-care requisites, and therapeutic self-care demand. Self-care refers to those activities an individual performs independently throughout life to promote and maintain personal well-being. Self-care agency is the individual’s ability to perform self-care activities. It consists of two agents: A self-care agent (an individual who performs self-care independently) and a dependent care agent (a person other than the individual who provides the care) (Orem, 2001). Most adults care for themselves, whereas infants and people weakened by illness or disability require assistance with self-care activities. Self-care requisites, also called self-care needs, are measures or actions taken to provide self-care. Self-care deficit results when self-care agency is not adequate to meet the known self-care demand. Orem’s self-care deficit theory explains not only when nursing is needed but also how people can be assisted through five methods of helping; acting or doing for, guiding, teaching, supporting, and providing an environment that promotes the individual’s abilities to meet current and future demands. d)  Ã‚  Ã‚  Ã‚   King’s Goal Attainment Theory Imogene King’s theory of goal attainment was derived from her conceptual framework. King’s framework shows the relationship of operational systems (individuals), interpersonal systems (groups such as nurse-patient), and social systems (such as educational system, health care system). She selected 15 concepts from the nursing literature (self, role, perception, communication, interaction, transaction, growth and development, stress, time, personal space, organization, status power, authority, and decision making) as essential knowledge for use by nurses. Ten of the concepts in the framework were selected (self, role, perception, communication, interaction, transaction, growth and development, stress, time, and personal space) as essential knowledge for use by nurses in concrete nursing situations. Within this theory, a transaction process model was designed (King, 2001). This process describes the nature of and standard for nurse—patient interactions that leads to goal attainment— that nurses purposefully interact and mutually set, explore, and agree to means to achieve goals. Goal attainment represents outcomes. When this information is recorded in the patient record, nurses have data that represent evidence-based nursing practice. King’s theory offers insight into nurses’ interactions with individuals and groups within the environment. It highlights the importance of a client’s participation in decisions that influence care and focuses on both the process of nurse-client interaction and the outcomes of care (King, 2001). IV. Conclusion In the natural sciences, the main function of theory is to guide research. In the practice disciples, the main function of theory (and research) is to provide new possibilities for understanding the discipline’s focus (music, art, management, and nursing). To Nightingale, the knowledge required to provide good nursing was neither unique nor specialized. Rather, Nightingale viewed nursing as central human activity grounded in observation, reason, and commonsense health practices. Theories articulate significant relationship between concepts in order to point something larger, such as gravity, the unconscious, or the experiences of pain. Reference: Benner, P. (2000). The roles of embodiment, emotion and lifeworld for rationality and agency in nursing practice. Nursing Philosophy, 1(1), 5-19. Nightingale, F. (1999). Notes on nursing: What it is, and what it is not. New York: Dover. (Original work published in 1860). Orem, D. (2001).   Nursing: Concepts of practice (8th Ed.). 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