Analysis of Nursing Ideologies: Leg Ulcers and COPD Case

Analysis of care for Ideologies Leg Ulcers and COPD Case master Studies tryThe aim of this essay is to address various tradeal c be for ideologies and how they lowlife be applied to nursing practice. This lead be undertaken in show to assess the authors knowledge and envisioning of the various themes of the Professional Studies module. In order to assess knowledge and understanding this essay will answer trinity questions, to each one pertaining to peculiar(prenominal) strands of professional studies. These include eventors that so-and-so influence the promotion of distinguish- ground upkeep, the philosophy of affectionateness and managing the livery of c atomic number 18. Examples of practice apply in this assignment will be from published interrogation. The answers given will be supported by explore pertaining to the treatment of venous tholepin ulcers and chronic obstructive pulmonary disease (COPD).It is suggested that show-based practice (EBP) or evidence -based worry is a high point on political and professional agendas (Wright, 2001, p198) having gained popularity in health armorial bearing following concerns over the continued use of practices based on tradition or habit, rather than evidence of their efficacy (Flaherty, 2001, p4). EBP contrasts with this in that it intends to promote treatment and care that is based on systematic paygrade of the evidence of the effectiveness of interventions. It is suggested that the Department of Health (1998, p17) has adopted the principles of EBP, changing the focalisation from individual staff seeking to trace the take up course of motion in given clinical situations to national initiatives to minimize variations in healthcare provision across regions, exploitation national standards of health care and debatably as veritable what is deemed the most(prenominal) effective use of finite NHS resources. However, it is argued that the implementation of the national standards of health care which are in the body-build of guidelines issued by organisations such as the National Institute for clinical Excellence ( slender) are often slow (Shannon, 2003, p1368). Debatably, this is a result of various factors such as lack of finances, time, disceptation to change and lack of conviction that change will be beneficial. Having utter that, it is alpha that wet-nurses understand what theoretical knowledge is takeed in accessing and selecting evidence for use in supporting practice.It is recommended that nurses, who employ evidence-based care, recognize the distinction surrounded by EBP and inquiry-based practice. EBP acknowledges that even where there is an absence of empirical look for, evidence in the form of case studies or expert opinion might exist that hindquarters inform practice (Hewitt-Taylor, 2003b, p43). In addition, arguably non each(prenominal) research is of high tonus, and practices may be described as researched-based, even where the research u pon which they are based is non of a full standard, or not intended to be applied in a particular setting.Theoretically, EBP is touch with gathering all the forthcoming evidence, evaluating the evidence and deciding what would constitute the best approach to a particular aspect of care in a given clinical situation (Hewitt-Taylor, 2003b, p44). The evidence that fucking be utilize includes research, consensus expert opinion, cost and patient preferences (NICE 2003, p3). It is suggested that as well as pickings into account a variety of sources of evidence, the use of EBP with health care involves the business leader to evaluate the type of all these forms of evidence and there application to certain clinical circumstances. Therefore, it is proposed that nurses indispensability to be able to critically analyse all of the proposed evidence that is to be used before employing evidence-based care to practice.It is too suggested that nurses imply to affirm knowledge of the ind ividual component skills of evidence based-practice. These include research and information technology skills, awareness of study information types and sources, as already mentioned, the ability to analyse critically evidence against set standards, dissemination of hot ideas about care to colleagues and the ability to palingenesis own practice (Cranston, 2002, p39).As previously mentioned, nurses need to have the knowledge and skills to be able to identify and analyse which evidence is most appropriate for a given clinical situation. Therefore when implementing EPB in a care situation it is important to understand that research evidence is only one part of the picture when considering clinical decision making. For instance, at present there is pricey quality research evidence which indicates that the most effective treatment for uncomplicated venous stagecoach ulcers is the application of compression bandaging (RCN Institute, 1998, p7). It is suggested however that research evi dence cannot merely point to the best type and method of bandaging to apply. Therefore, individual nurse clinical experience and the patients preference in hurt of comfort of bandaging will come into play when making a decision about the best way to treat the leg ulcer. It is debated that it is crucial for nurses to understand that arguably very few treatment interventions or nursing practices have a purely research evidence base from which to chair practice (Cranston, 2002, p40).Therefore, it is argued that nurses must also be able to draw on all aspects of evidence, including patients and families perspectives, the results of research, and their own and colleagues expertise to reach the best holistic, person-centred care for each patient (Howitt Armstrong, 1999, p1324). Apart from the importance of holistic care and person-centred care, the theory of caring is also a key issue relevant to the advancement of nursing.It is proposed that in recent years several issues pertainin g to the development of nursing knowledge have been addressed. Debatably, these include uncovering phenomena considered cardinal to nursing and nursing theories and models that have emanated from them (Chinn Kramer, 1995, p24). 1 important concept at bottom nursing that is gaining increasing attention in nursing literature is that of caring (Kyle 1995, p506). A range of theories have been presented in nursing literature that have caring as a central concept and are based on a human apprehension perspective. One of these theories is that of Simone Roachs (1992) theory on caring. In her literary works she discusses the uniqueness of caring, arguing that caring is not unique to nursing only if it is unique in nursing. Furthermore, she presents the idea that this one concept includes the of the essence(p) characteristics of nursing as a economic aiding discipline (Roach, 1992, p12). The main concepts of this theory are the attributes of caring, or the five Cs. Roach compassd t he five Cs as a broad framework suggesting categories of human behaviour within which professional caring may be expressed (Roach, 1992, p69). The five Cs are defined as compassion, competence, confidence, conscience and commitment (Roach, 1992, p19). It is acknowledged that it has been difficult to govern any practical examples of Roachs work. This could be due to the fact that it is not formally considered a theory for nursing.Debatably, while the five Cs including are essential to caring within nursing, it is proposed that the third C, confidence is unavoidable to enable the nurse to deliver holistic care. (Roach, 1992, p63) defines confidence as the quality which fosters commiting relationships. In Roachs writings she accentuates the need for a caring confidence between the nurse and patient that promotes a trusting, truthful, straightforward and respectful relationship that happens without any attached conditions, misrepresentations, anxiety or oppression (Roach, 1992, p64) .In a practice setting, it is suggested that if patients cannot feel that the staff are be truthful and candid in their contact with them they will not trust or believe in them. Debatably, at the center of patients making certain choices is that nurses are honest and give truthful information, therefore, if they do not perceive honesty the patients cannot be sure they are making the right decisions. It is essential that nurses trust in their own abilities and they need to possess confidence in their own skills and judgements and as well as knowing their limitations (Fry, 1989, p9, Pusari, 1998, p6).With this in promontory it is proposed that nurses could use the Johns Model of Structured materialisation (1994, pp71-75). Arguably, this model can help the nurse reflect on the above factors that constitute confidence in caring. The model asks questions that allow nurses to reflect on their abilities, actions and what they tried to achieve in a given clinical setting. It helps nurse s to reflect on how they responded as they did in a care setting and if they could have dealt better with the situation. On construction the model might help nurses to have the confidence to care in a holistic, person-centred, knowledgeable and reflective manner.It is suggested that in order to manage the delivery of holistic, patient-centred care, that care needs to be of high quality and performed within underway policy guidelines. Delivery of healthcare can be undertaken on three takes ancient election, secondary and tertiary care ( violet College of Physicians (RCP), 2001, p292). It is proposed that the delivery of COPD care can be undertaken at all levels of care however, it is argued that COPD care is normally managed within primary and secondary care settings. Patients suffering from COPD can access primary care from there commonplace Practitioner (GP). Some GPs might have an interest and an expertise in the management of COPD and therefore could provide specialist nurs e-led clinics within their surgeries. Secondary care for COPD sufferers is normally a hospital-based service whereby patients have accessed this level of care either from a referral from their GP of through Accident and Emergency. It is proposed that most district general hospitals have a highly trained respiratory medicine team (RCP, 2001, 292).One example of managing the delivery of COPD within primary care is that of the introduction of Quality Outcome Framework (QOF) practitioners. Arguably, this is a major incentive to improve primary care COPD management and the QOF for COPD became part of the General medical Services Contract (Booker, 2005, p33). Debatably, the QOF targets can form the basis of good COPD management as in most cases evidence-based rationales were used for the inclusion of particular targets such as smoking cessation advice. However, it appears that in some areas the QOF and the NICE guidelines disagree on the management of COPD care. The NICE guideline suggest s that reversibility testing is not routinely necessary for initial diagnosis (NCCCC, 2004, p1), but the QOF requires spirometry testing add-on reversibility testing as a premise for diagnosis. Evidence suggests that reversibility testing to a single, acute dose of bronchodilator is not reproducible and can be misleading. It is suggested that the volume of COPD cases can be accurately diagnosed from the clinical history and then substantiate with spirometry testing (Calverley, 2003, p659). Debatably, despite the disagreements between NICE guidelines and QOF, the QOF scheme is a good starting point and arguably, has served to increase the profile of COPD in primary care.Nurses need to understand and become knowledgeable about professional nursing theories and ideologies. Person-centred holistic care is often based on clinical evidence and research. It is important therefore that nurses can appreciate the usefulness of evidence but also be conscious of the relevance of the evidence in everyday practice. Nurses need to be able to critically analyse any evidence-based research or guidelines for its effectiveness in practice. Knowledge of the theories of nursing can help resurrect practice by understanding key concepts pertaining to care and delivery of care. Reflection as a concept within care is important for developing safe, quality, holistic, patient-centred care. In contemporary nursing managing the delivery of care is often maneuver by current policy. Nurses need to be aware of the current care guidelines that plan their care actions. It is important to note that clinical care guidelines can enhance patient care by providing rules on ethical, safe and quality care. However, it is important to note that guidelines are there for the safety of the healthcare profession as well as the patients.ReferencesBooker R (2005) COPD, NICE and GMS acquire quality from QOF, Primary Care, 15, 9, 33-36Calverley PMA (2003) Bronchodilator reversibility testing in COPD, Th orax, 58, 8, 659-664Chinn PL Kramer MK (1995) Theory and Nursing A Systematic Approach, 4th edn, St Louis, Mosby year Book PressCranston M (2002) clinical effectiveness and evidence based practice, Nursing Standard, 16, 24, 39-43Department of Health (1998) A First Class Service Quality in the new NHS, London, HMSOFlaherty R (2001) Medical Myths todays perspectives, Patient Care, 15 September 410Fry ST (1989) Toward a theory of nursing ethics, Advances in Nursing Science, 11, 4, 9-22Hewitt-Taylor J (2003b) Reviewing evidence, Intensive Critical Care Nursing, 19, 43-9Howitt A Armstrong D (1999) Implementing evidence based medicine in general practice audit and qualitative study of antithrombotic treatment for arterial fibrillation, British Medical Journal, 318, 7194, 1324-1327Johns C (1994) Clinical notes nuances of reflection, Journal of Clinical Nursing, 3, 2, 71-75Kyle TV (1995) The concept of caring a review of the literature, Journal of Advanced Nursing, 21, 506-514NCCCC (2004) Chronic obstructive disease NICE rule of thumb for management of COPD in adults in primary care, Thorax, 1, 1-232NICE (2003) Factsheet General instruction About Clinical Guidelines, NICE, LondonPusari N (1998) Eight Cs of caring a holistic framework for nursing terminally ill patients. coetaneous Nurse, 7, 3, 156-160RCN Institute (1998) The Management of Patients with Venous leg Ulcers, London, RCN PublishingRoach S (1992) The Human Act of Caring, Ottawa, Ontario Canadian Hospital Association PressRoyal College of Physicians (2001) Consultants physicians working for patients, 2nd edition, London, RCPShannon C (2003) Money must be available for NICE guidance, minister says, British Medical Journal, 327, 1368Wright SM (2001) Contribution of a lecturer-practitioner in implementing evidence-based health care, Accident Emergency Nursing, 9, 3, 198-203