Nursing Associates and Care Quality

Nursing associates are referred to as new members of the nursing team in England who have the role to bridge the skill gap existing between the registered nurses and care assistants in providing support to the patients (NMC, 2019a). This role is going to offer greater flexibility for the nursing workforce to deliver improved and high-quality care to the service users (NMC, 2019a). It is informed that nursing associates are allowed to administer drugs to the patients on behalf of nurses in case of emergencies (hee.nhs.uk, 2019). In this assignment, the role of nursing associate in caring within an acute mental health ward is to be discussed. Moreover, the way this role is going to contribute in arranging quality care delivery for the patients in the mentioned mental health settings is also to be explained. The explanation and discussion are to be done based on few key themes such as nurse-patient relationship, evidence-based practice, accountability and nursing process to understand the exact role of nursing associate. Nursing associates are currently present in England and are allowed to work with patients of different ages as well as in a variety of health and social care settings (NMC, 2018). The nursing associate have the role to provide contribution to the key nursing team so that they can act to free registered nurses from work burden and focus on complex care activities (NMC, 2018). The Shape of Caring review performed by the Health Education England (HEE) in 2015 identified that there are skills and knowledge gaps present between the healthcare assistant and the registered nurses. This leads the England government to announce the creation of a new healthcare role in the country to be referred to as nursing associate so as to remove the gap identified and help in meeting the changing healthcare needs among the public and the patients (HEE, 2019). In the process, the HEE carried a six-week public consultation regarding the new role to assist its proper development. In the process, the Nursing and Midwifery were allowed to be legal regulator of nursing associate from July 2018 (HEE, 2019). In relation to this, the NMC developed the Standards of Proficiency for Nursing Associate in which guidelines are mentioned that are to be followed by nursing associates to work legally and ethically in an effective manner in any healthcare settings in England.

The nursing process is seen to function as a systematic guide for executing client-centred care by following five sequential steps (Rosser, 2016). The five steps of nursing process include assessment, diagnosis, planning, implementation and evaluation (Rosser, 2016). In the assessment stage, the nurses analyse a patient to gather psychological data as well as socio-cultural, psychological, economic, spiritual and lifestyle data (Toney-Butler and Thayer, 2019). As mentioned by Isobel and Edwards (2017), in acute mental health settings the nurses have to execute rapid assessment of the patient with acute mental illness. This is to ensure best treatment is offered to the patient at the earliest opportunity (Edwards, 2017). In this condition at the acute mental health settings, the nursing associate assesses and records the nature of behaviour and mental stability expressed by the client, their attitude towards the family members, efficiency in executing everyday tasks and others aspect. They also interact with the family members of the patient to retrieve preliminary information about the psychological condition of the patient, their economic efficiency, cultural and spiritual beliefs that are to be considered while offering care to the patient (NHS England, 2019; Barber, 2019). As argued by Rose et al. (2015), error in the assessment of the patients with acute mental illness occurs due to limited time of performing each assessment by the registered nurses. If the assessment for each patient is not conducted accurately it leads to poor patient outcomes and poor care delivery (Barber, 2019). Thus, in this condition, the nursing associate contributes to assist by sharing responsibility of executing rapid clinical assessment of the patient in right manner by the registered nurses (Barber, 2019).

The diagnosis stage includes clinical judgement by the nurses regarding the response of the patient to actual or essential health needs or condition (Rabelo‐Silva et al. 2017). In acute mental health settings, the nursing associate presents the recorded patient assessment data to the registered nurses to make quick diagnosis of vital mental health issues (Roulston and Davies, 2019). This indicates nursing associate informs registered nurses about the preferences along with care priorities to be considered along with informs them about the uncontrolled symptoms being repetitively shown by the client previously during diagnosis that has been presently overlooked. It helps the nursing associate to contribute to perform holistic and effective diagnosis of the patient to provide integrated care (Grainger, 2018). In planning stages, the registered nurses develop the care plan based on the patient diagnosis (Pérez Rivas et al. 2016).

The nursing associate in this stage in the acute mental health settings mentions the registered nurses about the roles they are to perform and share in the implementation stage. According to NMC code for nursing associates, they have the role to support rest, comfort, sleep and maintain dignity of service users, ensure hygiene, support hydration and nutrition to the service users (nmc.org.uk, 2019). Thus, in the planning stage, in acute mental health setting the nursing associate mentions the nurse that they are going to be involved in ensuring comfort, hygiene, hydration and nutrition of service users while other role of care is to be taken by the nurses to offer satisfactory care support to the patient.

In the implementation stage, the care plan developed for the patient is implemented (Abdelkader and Othman, 2017). In this stage, the nursing associate works to implement the specific role they are asked to act and ensures while offering care the dignity of the patients are ensured. They protect the dignity of patients by offering support in the way the patients requires and never forces the service users to accept care, in turn, protecting their right to make decision (nmc.org.uk, 2019). In the evaluation stage, the effectiveness of nursing care is determined (Hemingway, 2016). In this stage, in the acute mental health settings, the nursing associate shares the recorded data regarding the patient's progress with the registered nurses to help them understand and discuss it with the health professional in making proper changes in the care ways to ensure good health of the patients.

There are four phases through which an effective nurse-patient relationship is developed in any settings that are pre-interaction, introduction phase, working phase and termination phase (Uhrenfeldt et al. 2018). In the pre-interaction phase, registered nurses have the responsibility to gather data regarding the patients to develop interaction (Askola et al. 2017). Thus, the nursing associate in this stage at the acute mental health setting develop liaison with the family members of the patients to know about the emotional and behavioural attitudes of the patients which are to be take care while trying to interact with them (Byrne, 2016). They also make points of the behavioural issues portrayed by the patients to inform them to the nurses so that they consider the points and facts to initiate respectful and trustful interaction with the patients (Byrne, 2016). In the introductory phase, the registered nurses can meet the patient for the first time. In this phase, they have the key responsibility of building open communication to develop trust for them from the part of the patient for identifying and understanding the reason behind the patient being admitted and their specific needs (Strandås and Bondas, 2018). In acute mental health setting, the nursing associates act as the middle person who introduces the registered nurses with the patients to make them familiar so that the service users get assured to engage in effective conversation with them regarding care support. This is because the service users due to initial interact with nursing associates during preliminary examination have become familiar with them (Brown and Corbett, 2016).

In the working phase, therapeutic care in an empathetic and compassionate manner for the patients based on their mentioned needs and demands are provided to show value to the patients which later leads to the satisfactory care of service users resulting to develop effective nurse-patient relationship (Slimmer et al. 2016). This is because fulfilling needs of patients in care services which are being provided empathetically by nurses’ makes them trust the nurses leading to develop close-relationship (Slimmer et al. 2016). Thus, sharing the responsibility by nursing associates helps registered nurses have time to care in quality manner for each patients leading in development of successful nurse-patient relationship out of care satisfaction. In the termination phase of nurse-patient relationship, the nursing associate in the acute mental health setting has the role to recheck that the patient has fruitfully adapted coping responses and is relieved to ensure registered nurses to terminate their relationship by ending care (Slimmer et al. 2016).

The nurse-patient relationship is essential for effective care service delivery to the patients. In the process to build effective relationship in acute mental health settings, the nursing associate has the role to gather diverse information and share information regarding the patient with nurses, the wider MDT and provide support to nurses in ensuring effective communication, assist nurses in maintaining safety of the patient and enable effective care planning to be made and delivered to improve patient outcomes (Ozaras and Abaan, 2018). This means the nursing associate have the role to report response of the service users regarding the present care being provided; any sudden uncontrolled signs of distress such as anxiety, depression and stress; changes in their preference to accept care support and others. It is done so that the concerned nurses can create change in care plan and take immediate action to control symptoms of distress to provide satisfactory care to patients in turn leading to develop effective nurse-patient relationship (Zhu et al. 2018). In evidence-based practice, the evidence is to be used in an explicit, judicious and conscientious way for making decision regarding the care services to be provided to the patient (Schmidt and Brown, 2017). This practice also required effective clinical expertise and proper patient perspectives (Schmidt and Brown, 2017). The goal of evidence-based practice is to deliver improved quality care services to the patients by analyzing existing clinical data that reflects the needs, interest, values and choices of the patients to be cared in the healthcare settings (Campbell et al. 2016). According to Standards of Proficiency for Nursing Associate, the nursing associate require to know the principles of research and the way the findings of the research are to be used for executing evidence-based practice by the registered nurses (NMC, 2019a). Thus, in this respect, the nursing associates have the role to research and retrieve evidence from various journals, articles, previous patient records and clinical trials to help registered nurses have supportive information to resolve any confusion regarding care for the patients.

In evidence-based practise at the acute mental health settings, the nursing associates monitors and reports the efficiency of implication of evidence-based practice for the patient (Fleiszer et al. 2016). This means the associates have to collect health information of the patients such as physical health data, emotional progress, reasoning ability, psychological efficiency and others on a regular basis to be shared with the nurses to help them understand the efficacy of interventions (Fleiszer et al. 2016). They also have the role to discuss with the family members of the patients to understand their thoughts regarding present care support being provided so that it can be reported to registered nurses to create change in the current intervention so ensure satisfactory care (Peate, 2018). It would help registered nurses have more time for providing complex care and determine timely changes to be made based on evidence-based practice for particular patient without being overburden with responsibilities of monitoring the patient too. (Refer to Appendix 3) The nursing associates have the role to execute clinical tasks for developing diagnostic reports about the patients (nmc.org, 2019a). In relation to this, at the acute mental health settings, nursing associates have the role to perform various clinical tasks such as electroencephalogram (EEG), blood tests and others of the mentally-ill patients. The implementation of this role in the acute settings is going to help registered nurses directly access and use health diagnostic information of patients that they can share with the health professional to determine the way they are to offer care for patients (Baxter and Andrew, 2018). Thus, it helps the nurses at the acute mental health settings to focus on providing complex care to the patients avoiding extra responsibilities of also gathering and executing clinical tasks to analyse and determine care for the patient, which can be otherwise done by a suitably qualified professional instead, such as by a Nursing Associate (Baxter and Andrew, 2018).

The care plan is referred to as the means of communication and organisation of actions for the patients according to their needs and demands (Mariani et al. 2017). At the acute settings, during care planning, it is seen that the nurses feel stressed to develop a proper care plan for the patients that meet all their needs as they are unable to gather all the information to be focussed on in making the plan. Thus, in care planning, the nursing associate helps the nurses by collecting detailed information about the needs and demands of the patients in a documented form. This helps the nurses in making an effective care plan as they have detailed data regarding needs to be fulfilled for the patients (Rosciano, 2015). In acute mental health settings, the nursing associates have the role to provide psychological support to the patients which are done by interacting in an empathetic, polite and friendly way to the service users (Gabrielsson et al. 2016). It is effective to help the nurses in the setting to show value towards the patients as they often are seen to lack time to interact for a longer time with a single patient to make them feel homely at the environment (Morrison-Valfre, 2016). Thus, nursing associates by sharing the duty of the nurses to interact with the mentally-ill patients promotes the nurses be able to provide psychological support to the patients (Morrison-Valfre, 2016).

The risk assessment in nursing is the process in which the vulnerabilities related to the patients are identified and changes to be made for lowering or resolving the risk are identified to avoid adverse consequences to patients (Hagen et al. 2017). At the acute mental settings, it is seen that patients with various complex mental health condition are present who experiences different risk in the environment (Kunyk, 2015). In this case, the nursing associate has the role to review the surrounding environment as well as health of the patients to identify the vulnerable factors and risks related with the patients. They execute this by interacting with the patients as well as the family members of the patients as the mentally ill patients are not always able to inform about risk they may be suffering due to hindered cognitive ability (Kunyk, 2015). They later report the information to the nurses so that the nurses by consulting with the health professionals and authorities are able to arrange resources and make changes to minimise the risks (Anbari and Vogelsmeier, 2018). The registered nurses in acute mental health settings are often seen to be caring for more than one patient that leads them sometimes to find it difficult in ensuring safety and privacy of the patients. Thus, during work pressure on registered nurses the nursing associate is required as they arranges safeguarding actions and implements it to support registered nurses in ensuring safety and privacy of the patient (NMC, 2019a). This helps in improving the care quality and satisfaction of service users as the skill gap present between the registered nurses and healthcare assistants while caring for the acute mentally-ill patients. It also leads to improved reputation of the organisation as high-quality care can be established for acute mentally-ill patients that were previously unable to be attained due to lack of support to registered nurses. The nursing associates practically execute this by drawing attention of registered nurses on the safeguarding issues being experienced by each patient. Later, with the registered nurses help and assistance the associates contact required authorities to arrange and provide resources as well as implement actions to ensure safety of patients by resolving the raised risks.

Accountability can be defined as taking responsibility to complete the task faithfully (Battie and Steelman, 2015). Accountability is about protecting service user, health care workers, and employees from the effect of unsafe, negligent and bad practice (Battie and Steelman, 2015). In nursing practice, nurses are accountable for their decisions to the public, their employer, their regulatory body and any relevant supervisory authority (NMC, 2019a). In the acute mental health settings, while performing the role of nursing associates they have accountability similar to the nurses (Hui, 2016). This indicates the nursing associates in the settings are accountable to inform to the families of the patients regarding reason behind actions they took to support registered nurses in caring for the patient. The accountability in nursing is framed to safeguard the patients, as well as health organisation, to maintain high standards of clinical practice and transparency (Hui, 2016). In the acute mental health setting, the nursing associates are accountable to ensure well-being and safeguarding of the patients (Traynor et al. 2015). This is essential so that none of the patients are harmed or abused which may have an impact on their health condition (Traynor et al. 2015). Thus, in this respect, the nursing associates are also accountable to identify and ensure proper legislation and safeguarding policies are implemented at the setting to ensure safety of the individuals. According to NMC Codes of Practise, the registered nurses are accountable to deliver high-quality care to the patients (NMC, 2015). In relation to this, at the acute settings, the nursing associates are accountable to share responsibilities of care of patients by the registered nurses so that the nurses can concentrate in providing effective quality complex care to the patients with most deteriorated mental health condition in the settings (NMC, 2015). The nursing associates are also found to be accountable to work within a team (Campbell et al. 2016). This is because the nursing associates are implemented to reduce the skill gap between the nurses and health professionals and not to replace them. Thus, without working within a team in the acute mental health settings they would not be able to provide adequate care to the service users or provide assistance to the registered nurses in ensuring quality care delivery. Therefore, they consult with the registered nurses about the care activities to be performed them and which care is to be performed by the registered nurses for the patients to ensure effective care to the mentally-ill individuals. The above discussion informs that nursing associates are a new position developed by England to resolve the skill gap between the registered nurses and health professional. In acute mental health settings, the nursing associates are required so that registered nurses can concentrate on providing complex care and the initial care activities for the patients are executed by the associates. In the nursing process, at acute mental health settings, nursing associates are required to support registered nurses carry out care of mentally ill patients within limited time. The roles of nursing associates are to be implemented in the settings to help registered nurses avoid being overburdened with care of increased number of patients. In nurse-patient relationship, the nursing associate in the mental health settings has the role to ensure satisfactory care is received by the patients to ensure good relationship is built between them and nurses. In evidence-based practice in the settings, the nursing associates are to help in gathering evidence and they are similarly accountable like the nurses in caring for the service users.

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Appendices

Appendix 1

The Standards of Proficiency for Nursing Associate inform the nursing associate regarding the guidelines and actions to be maintained to remain accountable to their profession, promote health and prevent ill health, provide and monitor care, work in teams, improve safety and care quality and contribute to integrated care in successful manner (NMC, 2019a). In 2017, 2000 student nursing associate was placed at 35 Health Education England test sites across the country under a pilot program. The England government informed that by 2018, 5000 trainee nursing associates are introduced and by 2019 they are planning to attract a further 7,500 nursing associate trainees (RCN, 2019).

Appendix 2

At working phase, in the acute mental settings, the nursing associate has the role to support the nurses in caring for the patient to ensure dignity, privacy and safety through collaborative care. This is because acute mentally-ill patients are often seen to be isolated and treated inappropriately by other due to their deteriorated psychological state and it becomes difficult for the registered nurses to care for a single patient as similar patients who require equally complex care are present in the ward (Myklebust et al. 2018). Thus, sharing the responsibility by nursing associates helps registered nurses have time to care in quality manner for each patients leading in development of successful nurse-patient relationship out of care satisfaction. In the termination phase of nurse-patient relationship, the nursing associate in the acute mental health setting has the role to recheck that the patient has fruitfully adapted coping responses and is relieved to ensure registered nurses to terminate their relationship by ending care.

Appendix 3:

A nursing associate is a member of the nursing team who is providing support and care for the service users (Masters, 2018). A nursing associate role is regulated in England in order to address the skills gap between nurses and health care assistants. The nursing associate is trained in order to provide care and support to people of all the age in health and social care sectors (Masters, 2018).

Appendix 4:

Accountability is a responsibility of health care workers in order to complete the tasks and duties to fulfil the goals of the health and social care organization (Grace, 2017). Nursing staff ensure that the task must be appropriate in order to meet the need of the individual. Accountability is very important in order to develop good leadership as they are able to answer the outcome of choice, their action and behaviour in all situations that they are involved (Grace, 2017). The nursing associates in the acute mental health settings are accountable to provide response to the patients work as team and ensure safety of the patients.