Principles of nursing practice

The purpose of this essay is to discuss and reflect on two principles of nursing practice and relate these to practice experience. The principles that will be discussed in this essay are: the principle of treating everyone with dignity and humanity and the principle of managing risk, being vigilant about risk and keeping everyone within their care safe. A thorough research will help me demonstrate my knowledge on these principles. The research will also help me investigate the professional, legal and ethical frameworks that guide the principles. While discussing these principles and reflecting on my practice as a nurse, I have obtained all necessary consent and will ensure confidentiality with regards to patients name and trust details.

The principles of nursing practice were developed by the Royal College of Nursing. The set of statements in these principles describe the expectations that the society has on nursing (Scrivener, 2015). The principles were developed by the Royal College of Nursing in collaboration with and Department of Health (England), the Nursing and Midwifery Council, patient and service user organizations, nurses and other healthcare professionals (Manley et al, 2011).

According to Jackson & Irwin, (2011), the first principle of dignity and humanity is the starting point for nursing in all care settings. Dignity, diversity, equality and humanity are fundamental rights of individuals. Dignity is mainly about the feeling of an individual and how the individual thinks or feels about themselves and how they are valued by others (Jackson & Irwin, 2011). This principle was therefore developed to ensure that patients’ dignity and humanity were preserved during the provision of care (Manley et al, 2011). The principle helps in ensuring that quality care is delivered to patients. First, the principle helps nurses and the entire nursing team to work towards provision of quality care without discriminating on patients based on their age, gender, disability, race, marriage and civil partnership, pregnancy and maternity status, sex and sexual orientation. This principle helps nurses in upholding these patients’ rights (Nursing and Midwifery Council, 2008).

The principle of safety is based on three factors including: a requirement to deliver health services based on the experiences of the patients, delivery of safe and efficient care and a consideration of the context in which the care is delivered. The principle of safety therefore requires nurses to be extra vigilant in recognizing risks, having the right knowledge and skills of assessing the risks and ensuring that effective systems and structures are implemented so that the risks are managed (Currie et al, 2011). There are some contextual factors that are important in the delivery of safe care to the patients. Some of these factors include workplace culture, skill mix and staffing levels, patient acuity and turnover, effectiveness of the clinical leadership, provision of professional development to the nurses (Currie et al, 2011). The importance of this principle is that it promotes risk management within the care setting. This helps in improving patient safety thereby improving the quality outcomes for patients (Watterson et al, 2012).

The first principle of humanity and dignity will now be discussed. As has been stated above, nurses and nursing staff should always treat everyone with the dignity and humanity. This involves understanding the individual needs of each and every patient, showing compassion and sensitivity and providing care in a manner that shows respect and dignity for all (Nursing and Midwifery Council, 2008). While applying this principle in my daily practice, I have always worked towards helping people with their daily activities. I work in a busy facility that looks after patients from different walks of life. In this facility, we take a family-centred approach to care. All the patients who visit the facility are precious and are valued and respected by the healthcare professionals within the facility. We respect our patients’ decision making, dignity, privacy, cultural and religious conviction. The care provided to the patients is well researched and evidence-based. This has helped me and other healthcare professionals to take care of the emotional and developmental needs of the patients. While incorporating dignity, it is important to understand the cultural and religious backgrounds of patients. I have also learnt the importance of considering the unique characteristics of patients and providing care based on such unique characteristics (Kangasniemi et al, 2013).

While delivering care to patients, I always ensure that the patients and their families have a peace of mind making them ready to receive the care. I also explain myself to the patients on what I want to do. While at this, I encourage the patients to do much for themselves so that they can learn and understand new ways of doing things. I have learnt to understand the limitations of my patients and provide care to them for things that they cannot do while also being sensitive to different situations that the patients can be exposed to. According to Stievano et al, (2012), respect for human dignity resides in the nurses’ daily encounter with patients. The basic personal dignity of the patients must be respected by the nurses. This is because humans have an intrinsic human dignity that must be appreciated and respected. Through my practice, I have come to learn and understand that the concept of human dignity is not related to a specific human right. Rather, it is a fulfilment of all rights inherent to humans including patients. Through this, I have come to understand that if dignity will be used as a guiding principle for the national and international healthcare delivery system, then nurses and other healthcare professionals must first begin by respecting themselves (Scott, 2012).

Provision and maintenance of a patient’s dignity is an ethical responsibility that is bestowed on all nurses. However, in my practice, I have noted that the concept of dignity has become very complex to define and understand. This is because the concept has encompassed other issues like behaviour, manner and social status of patients. In provision of care, there is a day that two patients visited our facility. From the manner in which they were carrying out themselves, the patients looked to be from different social classes. One of them was black and did not communicate well in English since English was not his first language. Some of my colleagues preferred to focus more on the other patient who looked richer and could communicate easily in English. Much as care was provided to both patients, I felt that we were not doing the right thing because the care we were providing to these patients was not equal. In this case, we did not carefully follow the concept of human dignity while providing care to the patients. According to Edlund et al, (2013), dignity for patients means that the patients are treated with respect, they are considered as special humans who need care and are shown compassion and empathy. The different factors that affect human dignity include intrapersonal skills of nurses and other healthcare professionals, interpersonal interactions between the healthcare professionals and the patients and the quality of human and environmental features (Edlund et al, 2013).

After discussing the dignity principle, the next principle to discuss is the principle of safety.  Patient safety may be defined as prevention of harm and avoidance of preventable harm while delivering care to patients (Kangasniemi et al, 2013). The focus of patient safety in nursing refers to the availability of facilities, resources and knowledge to reduce and manage errors within the healthcare delivery system (Odom-Forren, 2007). Due to the complexity of modern healthcare systems, it is not very easy to identify the factors that make a healthcare delivery system safe. In addition, it is important to note that safety can be achieved only when all the factors have been considered. Patient safety is directly related to the ethical standards for nurses. Through promotion of patient safety, nurses can achieve the first principle of promoting human dignity (Odom-Forren, 2007).

While looking at the ethical perspective, the promotion of safety while delivering healthcare can be considered in two ways. The first way is the practical value. This is where the outcomes, benefits, effectiveness and economic drivers of the healthcare system are considered. While considering this, patient safety can be looked at as a way of reducing healthcare costs while increasing its effectiveness (Bastable, 2008). The second way is to consider patient safety as a moral value. This is where the role of a human being is considered and therefore there is a need to promote and protect human dignity. The implications of the above are that the practical and ethical reasons for maintaining patient safety are integrated and work together to develop actions and synergies for ensuring patient safety (Feng et al, 2008).

In this principle, nurses and nursing staff are required to manage risk, be vigilant about risk and help everybody within the healthcare system to be safe. In my practice, I have come to realise that most patients are always vulnerable. It is therefore important that as a nursing staff I look out for them. I have dealt with different patients and I have come to realise that different patients have different needs when concerning their safety. For example, patients under psychiatric care need more emotional care. If this is not provided to them, then the patients are likely to be violent and this may affect their safety and the safety of other patients and other healthcare professionals.

While providing care to patients, I use the nursing process that includes ‘access, plan, implement and evaluate’ to ensure that the care I provide is geared towards satisfying the needs of the patients (Fitzpatrick, 2014). The care facility that I work for has approved standards for accessing the risk levels of patients. After accessing their risk levels, I can plan their care like regularly checking their pressure levels and ensuring that they are always in a good sleeping position so that they are exposed to minimal risks. I would then evaluate the effectiveness of such care on the medical records of the patient.

Nurses play an important role in ensuring patient safety. This is because nurses have always acted as advocates of patient safety in different care settings (Leach et al, 2010). Some of the areas in which nurses can manage risk, be vigilant about risk and ensure patient safety include prevention of falls, reduction of infections and delivery of safe and nutritional care among other areas. In the care facility that I work for, there are different wards for patients with infectious infections like flu. The objective of this is to prevent other patients not suffering from such infections from being infected with the infection.  While attending for such patients in their wards, I have to ensure that I put on proper attire that will ensure that I also do not get infected with the infection. This will help protect my colleagues and other patients. In my practice, I have noticed that it is important for nurses and other healthcare professionals to provide safe and effective care to patients so that the patients are not harmed so that they recover quickly. This will increase the quality outcomes for the patients and reduce healthcare costs.

Apart from the healthcare costs, healthcare delivery systems pay additionally in case there are poor safety measures for the patients. Some of these costs are in the moral and ethical perspective and erode the confidence that patients may have on the healthcare system. As a nurse, I have an oath to provide quality care to patients while not endangering their lives and the lives of their family members. In my nursing practice, I have noted that medication errors are some of the most frequent mistakes that nurses make. These medication errors are very preventable yet they may lead to inappropriate medication use that may cause harm to a patient. The senior nurses that I have worked with have helped me a great deal in improving my confidence so that I avoid issues of medication errors that may lead to adverse drug events. Just as has been mentioned, our facility focuses on delivery of patient-centred care where care givers are members of interdisciplinary teams so that patient quality outcomes are improved (Sherwood, 2011). While interacting with my colleagues in practice, I have noted that many of us are interested in upholding the inherent universal values of improving healthcare quality. I get more satisfaction when the healthcare system is focused on improving quality for the patient. This is because I have a passion for nursing and for creating a difference in the lives of patients and their families. I have noted that in most cases, safety norms are not written. This has been a great dilemma for nurses and nurse managers in defining their characteristics.

The other ethical principles that need to be considered while providing patient safety include trustworthiness, justice, accountability and non-malfeasance. The ethical value of trustworthiness is related to the culture of the healthcare system. This is where all actions of the healthcare system are geared towards improving and maintaining patient safety. Trustworthiness is also related to justice. This is where the healthcare system is responsible and has a clear and transparent system for evaluating errors. The healthcare system also has a way of separating blameless acts and culpable deeds (Woodward, 2011). In my practice, I have learnt that trustworthiness requires publicity so that the public can trust the healthcare institution. In one occasion, we were faced with a situation where a medication error resulted in adverse effect on a patient. The nurse concerned did not provide the correct drug to the patient. Luckily, the patient did not die. In an attempt to manage the patient’s emotions and that of his family, we informed the family about the issue and promised to improve on the care that would be delivered to the patient. Unfortunately, the family did not believe us and sought to transfer their kin to another care facility. The reason for this is that the administration did not do enough publicity and the family was not convinced on our ability to improve on care.

In conclusion, the principles of nursing practice were developed by the Royal College of Nursing in collaboration with and Department of Health (England), the Nursing and Midwifery Council, patient and service user organizations, nurses and other healthcare professionals. These statements determine the expectations that the society has on the nursing profession. This paper has discussed two principles of nursing practice. These are the principle of dignity and the principle of safety. As a nurse, I work towards promoting and preserving human dignity. This should be done by providing quality care without discriminating on the patient. I also consider the emotional and psychological needs of the patients. Providing care is also done with utmost patience so that the patient is not exposed to danger. In this, I always consider the safety of the patient. I evaluate risks and manage the risks in a manner that does not create panic. The discussions in this paper have helped me understand new concepts like the importance of collaboration and organizational and personal culture in promoting human dignity and ensuring patient safety while delivering care.



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