The healthcare reforms of the NHS during the 1990’s were fuelled by a potent combination of technological advances, value for money, efficiency and effectiveness, and increasing consumer power. In the midst of these changes aimed at simplifying and uniting healthcare services are challenges to the traditional paternalistic models of professional service delivery. These challenges are very welcome and have led to many opportunities for nurses to clarify why they make a difference and to the development of innovative care delivery systems. Despite the influence of fear and the uncertainty about the future, the many challenges to professionals have forced nurses into demonstrating their shared and peerless contribution to health and care patient care. In our hospitals, nurses now share the responsibility for completing specific tasks and procedures necessary for effective and efficient patient care delivery. These procedures require various levels of competence and expertise. In many situations nurses are demonstrating ways in which they can enhance the quality of healthcare in hospitals for patients and their families. However, nursing cannot claim ownership of these new roles or procedures. The nurse endoscopist, who carries out sigmoidoscopies, or the surgeon’s assistant, for example, require skills currently shared among various healthcare professionals. Successful completion of such activities, including appropriate assessment, monitoring, problem solving, and reporting, is representative of work shared across the professions. Many healthcare workers, given the time, training and repeated practice, could become proficient in such situations. A competency-based contribution, however, is not indicative of the essential value of professional nursing service. To comprehend and explain the value of nursing we need to address the people being served by nurses and nursing knowledge. Increasing numbers of professional nurses are needed in our hospitals because people in their care have consistently indicated that they want and need professional and caring service during times of threat, loss, change, pain, suffering, vulnerability, and uncertainty (Gertis et al., 1993; Bruster et al., 1995). People needing hospitalization have clearly articulated that respect for what they are suffering, authentic concern, respect for individual concerns, privacy, integrity and dignity, and understanding of their situations are important to their health, comfort, and healing. People report wanting to be listened to and to be helped by authentic human relationships aimed at making a qualitative difference in their lives. Patients in our hospitals have indicated that, when nurses behave like ‘robots’, then it takes much more of their energy to get better or to stay alive (Mitchell, 1994; Jonas Simpson, 1996; Millar et al., 1996). Nurses interact with people during the intense and critical life situations that develop in hospitals, for example, facing major surgery, disfiguring surgery, awakening to spinal cord injury, being told they have cancer, or facing death. At such times it is important that as nurses we are open to helping people to perceive the meaning of personal health situations. If we are truly committed to delivering patient-focused care, then we are promising to be open, nonjudgemental, caring, sensitive and respectful. What takes place in the nurse–patient interrelationship is representative of the particular contribution of nursing. Nursing theories provide us with the knowledge to provide the care and sensitivity that our patients and families need as they struggle through difficult times. The performance of quality patient-focused nursing care cannot be broken down into tasks, procedures, or predefined plans for care. Theory-guided nursing practice transforms daily assessments and procedures so that the person as a human being remains central and in control. Nurses guided by nursing theory interact differently with changing patient data because their primary responsibility is to care first and foremost for the person and not merely their medical problem. The need for nursing is played out during person-to-person relationships, not in the tasks and procedures. Reflecting, as a nurse, on patient descriptions about nurses over a number of years makes it clear that a person’s experience in hospital is significantly influenced by the quality of nurse–patient relationships. Nurses who define themselves according to a list of tasks and procedures leave themselves open to replacement. I believe that nurses need to know how to be with people in order for the information that is given and taken to be significant. Any process that can be mapped out without the direction of the patient and family is not sympathetic to professional nursing care. In the 21st century, professional nursing care will mean process, quality and meaningful experiences as judged by consumers. That is why nurses matter in the delivery of a caring service to others. Finally, it is clearly not an easy task or undertaking, but as the poem reminds us: Life’s battles don’t always go To the stronger or bigger man, Sooner or later the one who wins, Is the one who says, ‘I can’
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Jul 6, 2017
Denys Predko + 1
Open Access
