Exploring the Significance of Nursing Care: Person-Centered Approaches, Roles, and Accountability in Modern Healthcare

Introduction

Nursing is one of the most important professions in healthcare that plays a crucial role in satisfying the major objectives of healthcare such as providing compassionate care to patients, determine patients’ health needs, provide high quality medical and social services, disease prevention and health promotion [WHO, 2019]. This study is going to make a comprehensive discussion on nursing care by analysing its wide ranges of aspects such as person-centred care, its services in different sectors and roles of nurses. The topic is selected for conducting this study is highly relevant to the modern nursing sector, in which there is an ever-increasing number of health complications with critical health needs of patients. In the current healthcare field, the expectation from nurses in terms of providing high-quality care and meeting health needs of patients has been increased which enhances the overall responsibility on nurses to stand on this faith. In this context, the topic is highly useful in improving knowledge and understanding of nurses about how they can improve their services to patients, community and population. On the other hand, the topic provides high scope to health professionals, registered and trainee nurses to understand the responsibilities, the way of delivering care, accountability and importance of nursing care to promote health and wellbeing of patients. This study aims to conduct a literature search on articles of current person-centred care and shared decision-making in nursing. Additionally, the study will also evaluate the overall process through which nursing care is delivered to different sectors. Finally, the study will make a reflection on the professional accountability of the nursing profession in terms of health promotion and disease prevention.

A literature search of articles on current decision making and person-centred care: (LO2)

As mentioned by Aveyard (2014), a literature search is a comprehensive study as well as an interpretation of the selected literature addressing a particular topic. The literature search is the preliminary review of relevant literature that researchers do before starting the larger study. Literature search assists the researcher to analyse the literature in terms of critically discussing the research methods, pieces of evidence and the overall themes used over there on a specific topic.

In this project, the focus on this literature search is to retrieve as well as review the selected literature on current Person-Centred Care (PCC) and shared decision making in nursing practice. The purpose of this literature is to provide the new insight into the existing theories and themes on PCC and shared decision-making process through analysing and reviewing the selected literature rather than developing any new hypothesis or theories. This literature search is highly relevant to the nursing practice as it will highlight the growing importance of evidence-based practice (EBP) in terms of developing the best PCC and decision-making framework in the nursing field. As mentioned by Aveyard (2014), the knowledge summaries that the literature search represents is highly useful for students to gather relevant and appropriate references in the project in terms of maintaining the validity and authenticity of academic resources. In this project, the literature search on PCC and shared decision making in nursing is done to make the comparative discussion of an individual piece of research with the other research papers, by analysing their content, research process and pieces of evidence used in the article.

Public Health England (2015) mentioned in its article, that person-centred care is one of the most important aspects in nursing, in which patients as well as service users are involved in their recovery and treatment process. By analysing the concept presented by this article it can be stated that a registered nurse needs to use PCC in the service delivery process in which they need to motivate patients for their active involvements into decision making, effective treatment process, informed consent, surgery and counselling process. On the contrary, critics have argued that sometimes PCC and shared decision-making process make nurses to face ethical dilemmas that interfere with their professional accountability and integrity. For example, in case of mentally ill patients, their involvement in decision-making and their treatment process can be highly risky and life-threatening which makes nurses and midwives face huge ethical dilemmas while delivering PCC to them. In this context, Wade et al. (2019) stated that, health improvement is associated with implementing PCC and shared decision-making process in nursing practice, through which nurse can not only instigate patients for their participation into their overall treatment process but also nurses can maintain healthy relationship with patients and their family. By analysing the point of view represented in this article, it can be stated that in nursing practice, a registered nurse needs to implement PCC and shared decision-making in such a manner that would treat each patient with proper respect and dignity. In this context, NMC (2017) stated that, PCC is important in the current healthcare context, in which nurses have to deal with critical health needs of patients. The report also mentioned that, while providing PCC to patients, registered nurses and midwives need to focus on some major core standard such as promoting positive wellbeing of patients, respecting the honour of choice of patients, supporting their independence, improving their quality of lives and enhancing their dignity. Baird (2019) mentioned in the article that, while providing primary care to patients, nurses need to implement shared decision-making process along with PCC in terms of providing best and optimum care to patients. In this context, Lawrence et al. (2016), mentioned in their article, in modern nursing framework and health care context, usage and implementation of shared decision-making is important for nurses for making a positive and useful discussion with health professionals and other healthcare staff regarding patient health and wellbeing, understanding patients’ psychology and determining patient’s critical health needs. Shared decision making is an important part of modern nursing and healthcare practice that assists registered nurses to consult each decision regarding the treatment process with patients as well as with their family members and taking informed consent from patients before making any modification in the existing treatment process or conducting any new care setting.

Aveyard (2014) has mentioned in the article that, shared decision making and PCC are interrelated with one another in such a manner that if nurses have successfully implemented the PCC in their service delivery process, they can easily involve patient to share patients’’ decision and views regarding their treatment process with nurses. Additionally, the article highlights the importance of shared decision-making in useful implementation of PCC into nursing care such as through shared decision-making with patients, health professionals, healthcare staffs, nurses would be able to involve in an integrated as well as a combined care process that will be highly effective in promoting patients’ interest towards participating in their treatment and care process. On the contrary, critic mentioned that sometimes shared decision-making can not be integrated with PCC in nursing care, such as in case of a patient with dementia and other mental illness, nurses are unable to involve patients in the decision-making process regarding the treatment as it can enhance their health risk.

From the overall review of selected literature, it can be stated that, although there is criticism regarding the implementation of PCC and shared decision making in person-centred care, registered nurses need to use these two aspects into practice that would assist them to not only provide best as well as compassionate care to patients but also help them to determine the critical health needs of the patient which is important for the useful modification of the overall treatment process.

Description of nursing care delivered in different sectors: (LO4)

Based on the classification done by NHS, there are three main health care sectors such as primary care, secondary care and tertiary care. Nursing care is delivered in these healthcare sectors in terms of meeting the critical health needs of patients and providing high-quality treatment as well as compassionate care to patients.

Primary care:

Primary care represents the first point of contact in the healthcare system that acts as the 'front door' healthcare service of NHS [NHS, 2019]. Primary care consists of general practice, dental, optometry (eye healthcare) and community services. Wide ranges of nursing care are provided in the primary care framework that are as follows:

In GP practice, nurses act as a promoter of health. In day-to-day practice, registered nurses play important roles in promoting the health and wellbeing of patients by determining their health needs [NHS, 2019]. Registered nurses work in coordination with the NHS primary care group of doctors, healthcare staffs and committees in terms of discussing the health needs, current health status and progress of the treatment process of patients (Baird, 2019).

Nurses act as a care provider while providing primary care to patients by assuring that they follow the legal and statutory healthcare guidelines set by NICE in terms of providing the compassionate and best care to patients [NICE, 2019]. In terms of providing primary care to patients, registered nurses need to assure that each patient is treated with proper respect and dignity by prioritising patients’ choice of treatment and preferences [Beyer et al. 2019]. On the other hand, as a care provider registered nurse will assure that equal care and healthcare facilities are provided to each patient and patients are treated with equality and dignity irrespective of their race, gender, ethnicity and religion.

Senior registered nurses act as the team leader while working in the primary care framework, in which nurses need to take such leadership and management styles that would direct the entire team towards its desired goals (Baird, 2019). Through using democratic, transactional and transformational leadership styles, nurses can improve the overall productivity, professional skills and efficiency level of the team, which are helpful for nurses and health professionals to develop innovative treatment process and care settings for meeting the critical health needs of patients.

In GP practice, nurses act as participants who will take part in continuous learning and development process throughout their career in terms of developing their nursing skill, professional ability and creativity (Lawrence et al. 2016). Through taking professional training conducted by the senior health professional, today's’ nurses actively take part in shaping their skills and ability after they get the placement. This assists nurses to cope up with the ever-changing disease symptoms and changing health needs of patients in a day-to-day care.

In GP practice, registered nurses give useful advice to services users in terms of improving their habits, lifestyles and nutritional intake (Baird, 2019). On the other hand, nurses play important roles in conducting counselling and health awareness course in the GP clinic for service users to improve their physical, mental, emotional and spiritual wellbeing.

Secondary care:

Secondary care is referred to as the hospital and community care that is either emergency as well as urgent care or planned care, for example, cataract operation [NHS, 2019].

In a secondary care delivery process, registered nurses play important roles in accessing patients’ current health status by checking their BP, Blood sugar, pre-medical history, patients’ mental status and any ongoing medications [NHS, 2019]. In addition to this, nurses assured that all patients admitted to the hospital are properly interrogated about their preference, interest and food choices and health issues.

Nurses are responsible in the medicine managements process in which they manage proper handling, storage and application of medicines so that they can ensure that appropriate medicines are given to each patient timely (Wade et al. 2019).

Senior registered nurses in NHS hospital act as the manager who manage the day-to-day activities of health staffs in hospitals (Lawrence et al. 2016). Registered nurses manage regular data entry on patients current health status, the progress of their treatment process, regular interaction between nurses and patients, medicines that are provided to patients in regular wise, any changes in the treatment process and everyday duty chart for each healthcare staffs, additionally, the nurses have to manage the healthy relation among the team members in a terms of eliminating any chances of conflict that can interfere with their professional integrity.

While providing emergency hospital care to patients, registered nurses need to be highly efficient in maintaining transparent and quick information delivery system in the ward, which will assist them to inform all details of patients’ health to doctors, senior nurse, senior healthcare authority and patients’ family members (Beyer et al. 2019).

Nurses need to have adaptability and adjustability skill, that will assist them to work with different health teams in terms of providing the best and optimum care to patients.

Registered nurses in NHS hospitals play important roles in maintaining strong as well as a healthy relationship with patients that would be highly effective in determining patients’ health needs, their problems and choices of treatment.

Registered nurses play important roles in using highly useful leadership and management styles in the team, that assist the entire team to take such healthcare strategies that would be highly effective in meeting critical health needs of patients admitted in emergency ward (Wade et al. 2019).

Tertiary care:

Tertiary care is referred to as the highly specialised treatment process such as transplant, neurosurgery, secure mental health service [NHS, 2019]. In tertiary care, registered nurses play manifold roles which are as follows:

NHS registered nurses act as caregivers in a tertiary care framework, in which nurses provide equal and high-quality care to patients in a variety of care setting (Beyer et al. 2019). They also promote patients' mental and physical wellbeing, manage the physical needs of the patients, prevent their illness.

NHS nurses play a role of teachers while providing tertiary care to patients in terms of providing them proper knowledge on managing medical status, developing healthy habits and educating them about the disease prevention and precautionary measures [Lawrence et al. 2016].

Nurses act as a counsellor to conducting useful counselling and mental assessment for mentally ill patients in terms of strengthening their mental, emotional and spiritual health.

Nurses while providing tertiary care play an important role in advocating patients' rights, their equal facilities and care needs. Nurses would provide equal care (Baird, 2019). Registered nurses play important roles in providing sufficient information to patients and their family members that will help them to take useful health-related decisions.

NHS nurses act as administrators while providing tertiary care to patients that involves manifold duties such as overseeing the performance of nursing staffs, supervising the responsibilities of assistant administrator and motivating nursing staffs to give the best while providing tertiary care to patients.

Reflecting on the roles of the nurses in disease prevention and health promotion by maintaining professional accountability: (LO5):

Under The Code of the professional standard set by NMC [Nursing and Midwifery Council], nurses need to follow the statutory guidelines and codes of conducts while it comes to health promotion and disease prevention. Through implementing the Codes of Conduct set by NMC into practice, nurses maintain their professional accountability in terms of promoting mental and physical wellbeing of patients. Nurses would perform the following roles in health promotion and disease prevention with maintaining their professional accountability.

Under the guidelines of NMC Code regarding professional accountability, nurses would be understanding their professional responsibilities in health-promotion such as determining patients’ critical health needs, facilitating health education to patients and their family members and treating each patient with respect and dignity (Lawrence et al. 2016). Additionally, nurses need to adopt healthy lifestyles in terms of maintaining their fitness that will assist them to deal with the critical health needs of patients.

Under the NMC Code, registered nurses would provide a non-discriminatory, sensitive and person-centred care to patients all time. Nurses would motivate patients to share their values, beliefs, background information, language-preference, treatment needs and cultural characteristics that are important for nurses in determining the physical and mental health needs of patients.

The registered nurse is involved in playing key roles in improving the physical, emotional, mental and behavioural health and wellbeing of service users, patients and communities [PHE, 2015]. Nurses will provide a useful support to people at any stages of their life as well as at all care setting for assisting them to develop informed choice regarding managing health challenges in terms of improving health outcomes and maximising life expectancy of service users.

Registered nurses play crucial roles in determining factors associated with health inequalities in society, thereby preventing and eliminating these factors by taking right decision and choices such as providing free treatment and check up for deprived people, conducting free health education to poor communities and providing advice regarding healthy habits to community people [NMC, 2018]. Under NICE guidelines, registered nurses need to be highly professional in interacting with community people to understand current health status, the type of inequality they face and the reason they think are responsible for their poor healthcare facilities. Through providing positive social support, health education, healthy lifestyle choices and useful counselling training, nurses can maximise the physical and mental wellbeing of community people thereby reducing their prevalence towards disease.

Conclusion:

From the above-mentioned discussion, it can be stated that nursing care is one of the most important aspects of healthcare that deals not only with health needs of patients and meet these needs accordingly by providing compassionate care but also promote healthy habits, positive thoughts and good health outcomes in the community. There are three major healthcare sectors in which nurses provide their endless effort in promoting health and wellbeing of patients such as primary care, secondary care and tertiary care. The discussion also represents that, primary care is the first point of care in which registered nurses play manifold roles such as providing health advice to patients visiting GP clinic, respecting patients' rights, supporting patient’s health needs and improving the regular habits and lifestyles of the patients. Secondary care in hospital and community care in which nurses provide high-quality treatment and care service to patients in terms of improving their physical, emotional and mental health. Tertiary care is specified treatment framework such as transplant, neurosurgery, secure mental health service. Nursing care in the tertiary care process is highly crucial for maintaining the strong information delivery system, determining the current health status of patients and promoting health and wellbeing of patients. Registered nurses need to follow the Codes of the professional standard set by NMC in terms of being professionally accountable while promoting health and wellbeing in patients and preventing illness at the community level. In this context, registered nurses will communicate the individual health needs of people, community, service users and population, promoting healthy habits in them, providing free health education to people and develop positive and healthy thoughts in them.

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