Custom Competency Assessment Supplement (CAS)

Custom Competency Assessment Supplement (CAS)
Professional Accountability and Professional Responsibility
The deeds, beliefs, opinions, and attitudes of professional nurses should show that they are responsible and accountable in their jobs. Nurses are also skilled when they use the nursing process to show what they know about taking care of patients. I was going through our clinic’s emergency room when I saw an old patient in a wheelchair. The woman was with her family, but no one had paid her any attention for a while. (Competency #13) As a leader, I knew I had to find out what was going on in the area that was holding up patient care.

I walked around the area to see what was going on and figure out why patient care was taking so long. I noticed that the ER was busy that day and that all of the doctors and nurses were busy with different tasks, like helping a patient who needed to be resuscitated. At that time, I knew that the most important patients were the ones who were very sick (C. #8), and that trying to do more than one thing in such a busy place could only lead to mistakes and possibly bad results. I looked around and saw that there wasn’t quite enough staff that day, so I chose to help the old lady who I thought needed help right away.

First, I said hello to the patient and his or her family. I knew that getting to know the patient and his or her family was a very important part of being able to talk to them. Second, the patient’s family had to be involved in the process because he or she couldn’t talk well (C. #12). Nurses are supposed to converse in a way that is good for the patient’s physical and mental health. This means that they should talk to the patient face-to-face.

In order for a nurse to take care of a patient in a responsible way, she must always respect the patient’s rights. For example, the patient has the right to privacy, secrecy, and to refuse medication. This was one of the first things I thought about before going to help the patient. I knew I needed a different room where the patient and his or her family could talk easily (C. #7b). Second, the room could let the patient be looked at and evaluated without anyone else being there. Before I started my assessment, I told the patient and his or her family that they needed to give permission for any procedures and treatments the patient might get (C. #7a).

The next step was to find out what the patient was complaining about and why they were going to the doctor. I saw that the patient couldn’t say what she wanted to say because she was weak and had trouble speaking well. I found out from her daughter that she was recently diagnosed with oesophageal cancer and went to the hospital because she was feeling weak at home. I was very interested in how the family talked about how worried they were about their loved one. I told them that they were in the right place and that the healthcare workers there would do their best (C. #1). I was able to figure out that the patient needed a few treatments before the doctor could look at him or her. I did this by actively listening and using my clinical observation skills.

Oesophageal cancer is one of the usual long-term conditions that affect death and illness in older people in a big way. When I looked at the patient, I could tell that she was weak, had trouble speaking, and seemed nervous. I also knew from the patient’s background that she had not eaten for two days. In the back of my mind, I could make a connection between the signs I saw and what I would expect from a person with oesophageal cancer. The person might not have been able to eat because eating hurt. So, I could link the general body weakness I saw to not getting enough to eat (C. #6). I decided to check vital signs and get more information to help me make choices. The patient’s blood pressure was low, but I can’t remember what it was, and his breathing was a bit fast. I quickly checked the patient from head to toe and found that he or she was dehydrated, possibly because they weren’t drinking enough fluids. Before any other help could be given (C. #2), fluids had to be given, but I had to tell the doctor in charge first.

The key to improving quality in healthcare today is for people from different fields to work together. It includes different people who work in health care working together to reach the same goal. For example, while I was taking care of the patient above, I knew she needed help right away. As she waited for the ER team to be free (C. #10), I also knew it was important to talk to the doctor before giving water. After starting care, I felt confident that the patient could wait for the doctor and nurse in charge to look at him or her again. I also knew that once the IV was set up, I couldn’t leave the patient alone. So, I asked a care provider who wasn’t a nurse to keep an eye on the patient until the nurse in the area was free. The UCP’s main job was to keep an eye on the IV fluid and make sure the patient was relaxed while he or she waited for more help (C. #9).

In healthcare, not only the staff but also the patients and their families work together to reach set goals. It requires everyone to work together and take on parts and responsibilities as they carry out plans for patient care. For example, I took care of a patient who wanted to stop smoking but couldn’t because of pressure from other people. The patient’s biggest worry was that he didn’t have a hospital close. If he did, it would have been easier for him to get medical care and maybe stop smoking. I knew that people’s health was affected a lot by their surroundings and how easy it was for them to get medical care (C. #15). So, I had to look for ways to make sure this patient went back to the hospital or could see a primary care doctor.

The first step in taking care of the patient was to work closely with the institution’s mental health nurse. I brought the patient to the mental unit and helped make a plan for regular visits and follow-up to make sure the goal could be reached. Also, the patient’s family had to be involved to keep an eye on his smoking and give him the help he needed (C. #3). After talking with the patient’s family, I found out that they were willing to drive the patient to the center every week for sessions and help pay for them. I learned that working together with the patient and their family is a great way to reach the care goals.

People with different types work together in the healthcare field to make sure that patients get good care. When there are a lot of people together, there is always conflict because people have different ideas and ways of doing things. For instance, I got complaints from staff about how jobs were set up in different ways in the medical unit. The morning or day shift staff complained that the night shift staff always left the nursing table in a mess, making it hard for them to get started on the day’s work. Because of this problem, it was hard for the two people to talk to each other, and sometimes the report wasn’t complete because of the differences between them. I knew that there were often fights between staff and people who fought back with violence (C. #5).

As a leader, I had to come up with ways to solve the problem, which could have hurt patient care if it hadn’t been solved. I knew that the best thing to do was to look into the problem and figure out what caused it. The next morning, I got up early to go to the unit and take the morning report. I also took note of how the two teams talked and worked together differently. I noticed that the two people did not get along well and that the night shift staff had, among other things, left the nursing table in a mess. Before coming to a decision (C. #4), I planned to have each team explain the problem’s cause on its own. I planned to have a talk between the two teams to solve the problem after I found out what caused the problem.

Before the report started in the morning, I got all the players together for a small meeting where they each said what they thought had happened. The people on night shift said that there weren’t enough of them and that it was hard to keep everything in order because there was so much to do. On the other hand, the people who worked the day shift said it was hard to start their busy morning jobs when things were not in order. I saw that the two groups had a chance to make things work, but they both wanted to blame the other group. There wasn’t enough respect for each other’s tasks and responsibilities (C. #11). I planned to tell the staff what their jobs were because I knew the problem could be fixed.

The best way to solve a conflict is to find an answer that makes both sides happy. I was sure that the people on duty at night would have time to set up the nursing station and clean up the work area before the morning staff came. So, I told the staff that it was their job to make sure the nursing area was clean and organized before the next shift started. Even though they had a lot of work to do, it was also their job to organize patients’ files and give a full account (C. #22). When this method was used, the night shift staff realized that it wasn’t all about the numbers when it came to giving care. Instead, it was more important for continuity of care that each person did their job.

The second way was to explain what the day shift staff’s jobs were and how being flexible in their jobs could help improve patient care. For example, I asked them to feel for the staff who worked long hours to care for patients on two night shifts. If their nights were busy, it wasn’t fair to blame them for not getting the nursing station in order. Before starting the day’s work, the people on morning shift could make it a habit to check how organized the nursing station is (C. #46). But I made it clear that it was everyone’s job at the end of each shift to leave the work area clean.

I told them that I would be there the next day to watch the shift handover so that I could be sure that the problem was fixed. The next day, I found out that the people on the night shift had cleaned up and set up the work area halfway before the people on the morning shift got there. Because of this, I saw that the two teams worked together to set up the workspace before they got the report. I saw that both sides were happy with the plan and agreed to work together, since the shifts would eventually be switched. After a week, I went back to the unit and was glad to see that the way we handled conflicts had worked (C. #59). The nursing station and work area were always ready on time, so there were no more delays in making reports.

During the care they give, nurses give health information to help patients stay healthy and have good outcomes. As a nurse, it is my job to always give patients and their families information that is based on facts. For instance, I met a diabetic patient who wanted to know more about self-monitoring and ways to control their weight. On assessment. I saw that the patient had put on some weight and that his blood pressure was slowly going up. I knew I had to come up with a plan for health education that used technology to keep an eye on his weight and maybe his food (C. #14). I showed him how to control his weight and check his blood sugar levels with an app on his phone, as well as how to stay in touch with his primary care doctor.

The nursing code of ethics encourages nurses to stand up for their patients’ rights while they are getting care. Nurses are supposed to keep an eye on the patient at all times to make sure they are safe. For example, there was a problem with the way medications were given at the center where I work, and mistakes were made. The biggest problem was in the emergency room, where there were too many people and not enough staff, which led to mistakes by the doctors and nurses. I knew that the patient’s health was at risk because of all the mistakes, so I had to do something (C. #16). So, I looked at the problem with hiring in the unit and wrote a letter to the administration suggesting that they think about adding more staff to the ER. As more people were put to work in the area, the number of medication mistakes went down over time.

Patients get care all the way up to the community level to make sure they can take care of their health and use community tools. neighborhood health nurses make sure that patients can easily get to neighborhood resources that can improve people’s health. I remember that a coworker once told me that she didn’t feel like she had enough social support. I asked her to meet me over the weekend so we could talk about what to do next. I saw that she was so busy with work that she didn’t have time to hang out with people. I told her not to work as much extra as she used to unless she had to. Second, I told her to join women’s groups in her area to encourage sharing. She actually named a group of people who ran and worked out together on the weekends and said she felt relaxed with them (C. #17). Later, the nurse was very grateful to me for trying to get her to use community tools to improve on her weaknesses.

When giving nursing care, you see a lot of different people with different health problems, which requires you to use critical thinking and problem-solving skills. In the center where I worked, I remember taking care of a patient who needed blood. Before thinking about sending the patient to a different hospital for treatment, the doctor wanted the patient to get two units of blood. After 30 minutes of transfer, I noticed that the oxygen saturation was going down to 95% and then 90%. I thought right away that the answer was to turn on the oxygen, and that most likely everything would be fine (C. #19). I added 2L of oxygen, but the amount of saturation stayed at 91%.

The doctor wasn’t around, so I had to take over. I thought, Maybe I should hear him breathe. I could hear crackles in both of his lungs, which was a change from before (C. #20). Then I started to wonder what was wrong with the patient. I knew there was something wrong with the patient because he had too much fluid. I looked into his past right away and found that he had a background of CCF. According to the chart, the person drank +1.5 L, which probably made it hard for the lungs to expand. I talked to the doctor, and when the Lasix was given, good things happened (C. # 18). If the patient hadn’t been able to think critically, his situation could have gotten worse.

Nursing can be busy at times because there are so many things to do. Organizing your jobs could help you get everything done. I have been in a number of cases where I had to organize tasks in order to meet daily goals. For example, I once had a full plan because I was part of a team that was evaluating the unit’s quality improvement. At the same time, I had to plan for the move of patients and put together reports about the evaluation of healthcare workers. I asked myself, “What would be the best way to do these things?” I learned that setting goals for getting the work done was important. Second, I had to give some jobs, like evaluating QI, to a new team member to make sure that the day’s work got done (C. #21). At the end of the day, I was able to finish all of my tasks correctly by setting goals and giving tasks to other people.

Communication is an important part of nursing care because it helps people get to know each other and creates outlets for care. The nurse should choose ways to talk to the patient that are right for the care situation. I always use these three ways to talk to people when I’m taking care of them: I actively listen, I let them ask questions, and I give them the right kind of feedback (C. #23). For example, I always give my patients time to talk about their feelings and share their thoughts. I can show compassion and stay upbeat to make sure I give the best care possible and solve the patient’s problems. I’ve found that using these techniques helps patients open up and helps me build a therapeutic bond with my clients.

There are a lot of care workers in Canada who don’t have to follow any rules. They help doctors and nurses with everyday jobs in their areas of expertise on a regular basis. To make sure that great care is given, it is important to teach and guide healthcare assistants. I haven’t worked with UCPs before, but I have helped train staff in my unit who worked under me. For example, there was a time when the patients reported that their bathrooms weren’t cleaned on time, so they were dirty. As a leader, I took the initiative to teach the cleaning staff how important it was for patients to be in a clean setting (C. #24). There was a good response from the staff because the bathrooms were cleaned on time after that and patients were happy with how clean they were.

Leadership is important in health care because it helps the company reach its goals and move forward. Nurse leaders can use different styles of leadership, such as autocratic, democratic, transactional, transformational, and “let it go.” For example, there were problems with how resources were used in the clinic, and most health care workers did not take care to use gloves the right way. I noticed that most people put a lot of gloves in their pockets and got rid of them when their job was over. As the boss, I knew I had to do something. I thought about how authoritarian leadership was the best way to deal with problems and keep resources from being wasted (C. #25). I made it so that any staff member who was found to be misusing resources had to face a punishment, which could include buying the stock.

Every day, there are problems with how health care is given, and it is the job of nurses to spot possible health problems and help fix them. Nurse leaders have a special duty to look for risky behavior in the healthcare setting and do something about it. For instance, I was doing my usual rounds in the clinic when I saw that the people cleaning the floor didn’t have any signs to warn people not to slip. I saw that people were walking through without realizing they could fall. I also knew that patients, their families, and other health care workers were more likely to fall, which could hurt their health (C. #26). Staff had to be told to use “wet floor” signs when cleaning to avoid this risk.

For a healthcare worker to be able to help a patient, they need to know everything there is to know about the patient. After taking the patient’s history, general and focused assessments are used to learn more about their situation. For example, I met a patient who came to the facility because he or she was tired, had trouble breathing, and had a small headache. When the patient was looked at, her face was a little puffy and her lower limbs were swollen. Based on what I found, I chose to do a focused assessment (C. #27a) to learn more about the patient’s condition. I started by looking at my vital signs, which showed that my blood pressure and heart rate were high. I found out that the patient had high blood pressure and was taking medicine until a few days ago, when he started feeling sick.

Due to the patient’s condition and medical background, I talked with the doctor about the most likely way to treat him or her, which included doing more tests. The swelling in her lower limbs was a sign that she had too much fluid in her body because of her high blood pressure (C. #27b). Since the patient had been taking the same medicine for a long time and had not had any side effects, I offered a check of the kidney function, which could be a cause of fluid retention (C. #28a). I also had time to read up on the possible reasons why people with high blood pressure have too much fluid in their bodies. The doctor also thought the patient might have kidney problems because he was taking antidiuretics that could have helped (C. #28b).

More tests on the patient showed that he had acute kidney failure, which was probably caused by long periods of high blood pressure. To make sure the patient got good care, antidiuretics were given to get rid of the excess fluid. Unfortunately, the reaction was not good because the patient was getting more agitated and his blood pressure was going through the roof. The patient had crackles in both lungs, which showed that there was too much fluid in the lungs. Now, the most important care was to keep the patient breathing normally by giving them extra air and doing things like propping them up (C. #28c).

As the patient kept getting care, the doctors noticed that his kidneys were slowly slowing down. The only thing left to do was to start dialysis on the patient. Our building didn’t have a dialysis center, so the patient had to be moved to another place to get more care (C. #29). With dialysis, the usual balance of fluids could be restored, and the patient’s health could get better (C. #28e). At the hospital, we worked to track how much oxygen the patient took in and how much he or she gave out (C. #28d). While I was handling the transfer, I told the patient about the new way to treat his condition, which involved dialysis, and gave him health information about what to eat (C. #28f). The patient’s family was also told about the change in care plans. The patient left the facility in a stable state, ready for further care, because of how well everyone worked together.

Health is affected by many things, such as genes, how people act, physical factors, the surroundings, and how easy it is to get medical care. For successful care planning, nurses should think about these things and how they affect a person’s health. Once, I was in charge of a patient who was about to go home on medicine and needed a regular checkup. As I was giving the patient information and instructions about how to leave the hospital, I noticed that the patient did not understand what I was saying. I went back to the patient’s file to check on his or her education level and found that it was low, which probably made it hard to understand. So, I planned to educate the family before sending them home to make sure they knew the instructions (C. #30).

Nursing care includes a wide range of jobs, such as preventive, promotive, curative, rehabilitative, and palliative care. I think I have worked to care for patients based on the five areas of nursing care in my past jobs. For example, I have made sure that health is promoted by educating people about their health problems. One thing I remember is that pregnant women were taught in the MCH clinic how important it was to go to the clinic regularly during their pregnancy (C. #31a). The second part was giving care to keep people from getting sick or hurt by giving them medicine. I used the case of giving Lasix to a person with CCF (C. #31b) earlier as an example.

I’ve helped a lot of people with mental health problems at the center, especially those who come once a month for medication shots. I once took care of a patient with bipolar mood disorder who came in for regular checkups and got modecate shots once a month. When giving care, I always tried to understand the patient and tell them why it was important to get medical help. The patient’s family said that he didn’t want to take his medicines and had to be made to come to the facility sometimes. As we talked and got to know each other, I learned that the patient didn’t have anyone he or she could trust during treatment (C. #31c). After that, the patient tried to keep going to the doctor regularly, which helped his health get better.

Rehabilitation and palliative care services are important for nurses because they show that they care about getting people back to normal health. Several people who have been hurt come to my school to get medical care. I saw that most of the care was given to these people while they were in wheelchairs. I realized that these people needed walking aids so that they could at least walk normally again. I suggested to the administration that nurses and family members help patients stand up and walk by building walking bars in the exercise field (C. #31d). When it comes to palliative care, I have treated many people with terminal diseases like cancer. I have also helped train staff and coworkers on how to give opioid analgesics to these patients and how the institution’s policies affect how pain medication is given to cancer patients (C. #31e).

Healthcare workers and patients work together to make sure that patients get high-quality, patient-centered care. For example, I once worked with a doctor to teach a patient who was going home with a suprapubic tube about how to stay healthy. I knew the doctor could tell the patient more about how important the catheter was and when they should come back for a checkup (C. #32). On the other hand, it was my job to make sure the surgery area was clean and to show people how to empty and change the urine bag. The patient was cooperative and showed that he or she knew what was going to happen and what steps to take at home.

In any health care company, one of the most important things nurses do is give out medications. The nurse should remember the five rights when giving medicine: the right patient, the right drug, the right dose, the right route, and giving the medication at the right time. At one point, I noticed that nurses in the medical side did not follow the right way to give drugs, such as giving them at the right time (C. #33). I worked with the nurse trainer to show the students how to give drugs to patients, including how to get their permission before doing so.

In the past few years, the number of hospital-acquired diseases has gone up because hygiene rules were not followed and aseptic methods were not used when they were needed. For example, the wound dressing is one of the things that needs to be done in an aseptic way to avoid getting an illness. When I worked in the outpatient area, I saw a lot of people who needed help with wounds. When I was taking care of cuts, I made sure that sterile gloves and a sterile pack were used (C. #34). I also showed workers and students how to deal with the sterile field, like how to wear masks when dressing wounds.

During care delivery, nurses are required to get patients ready for tests and surgery. We don’t have a surgery room where I work, so all patients who need that kind of care are sent elsewhere. But I remember that when I was a student, I used to help people get ready for surgery, like a cesarean section. The first step was to talk to the patient about the operation and get permission to do it. Before the surgery, I always made sure the patient signed the permission form. Other things that were done to get ready for the surgery were shaving the area where it would happen, dressing the patient, and putting labels on them so they could be found easily. As part of the care that was given after surgery, the operating site was checked for bleeding and medicine was given (C. #35).

I’ve already talked about how the nurse thinks critically and solves problems while taking care of people. I can also think of a time when I helped care for a patient whose leg had been cut off. The patient was getting care at home and regular check-ups at another place. When the doctor saw the patient, the severed leg was in a lot of pain. In the doctor’s notes, there were instructions on how to give opium to help ease the pain. But the painkiller didn’t seem to help. Then the thought comes to me, “What if the pain is caused by a pinched nerve?” I had seen how people with diabetic neuropathy (C. #36) fought with nerve pain that didn’t go away with painkillers. So, I asked the doctor if we could try using gabapentin to see if it would help with the pain. The doctor agreed, and amazingly, when gabapentin was given, the patient’s pain went away. This made the doctor look at the situation from a different angle, and in the end, the patient was taken care of well (C. #52).

When taking care of a patient, the nurse should look at all the different parts of care and make decisions that are best for the patient. When I worked in the medical side, one of the doctors I worked with wanted to move a patient’s hip because they had been in an accident. Before the operation began, he told the doctor to give the patient 10 mg of diazepam through an IV to make them sleepy. But I didn’t agree with the choice because I thought a dose of 5mg was enough before using a higher dose (C. #37). I also noticed that the patient was taking hydromorphone at home to help him deal with his pain. I thought that taking a lot of diazepam could make it hard to breathe. I talked to the doctor, and we both agreed that 5mg of IV valium would work best. It did.

When giving care, the patient’s rights should always be taken into account. It is also important to involve the patient’s family in his or her care, but the patient must agree to the information being shared with the family. I remember having a hard time with an older patient who had been identified with ESRD. The patient didn’t want his family to know the news because he thought it would scare them. I had to tell the patient how important it was to involve his family and how they might feel if they found out he didn’t want to talk about it. In the end, the patient agreed to talk about the knowledge, but only with his oldest son. I knew it was my job to honor the patient’s request that only some of his family be involved in his care (C. #38).

In modern healthcare, technology is used to help make choices about how to care for patients. Care for patients is clearly better when technology is used. I remember using the electronic health record (EHR) system to change how patients were cared for in the outpatient area. The system helped me find out about a patient’s medical background, but we couldn’t find the patient’s file (C. #39). The patient’s information was easy to find in the EHR system, and it saved me time from having to take a full history and double-check the patient’s medicines.

A person’s health is the state of his or her physical, emotional, and social well-being. It is not just the absence of illness. When taking care of patients, it is important to know the different things that affect health and how to help people make the best decisions for their health. I remember taking care of a 25-year-old who had pre-diabetes and high blood pressure. During the assessment, I found that the person’s lifestyle and family background were linked to these conditions. I knew that having a background of diabetes in your family was a risk factor for getting the disease. But the patient needed to work on keeping a good weight and exercise to stay healthy (C. #40). So, I told the patient to exercise every day and eat well (C. #50).

Diversity in healthcare is important because it lets people from different backgrounds meet and work with each other. The health care provider should know that different people have different ideas about health and different ways of getting care. For example, I learned that sometimes it was hard to help people in the clinic who didn’t speak English or Arabic. Working with the office, we were able to bring in interpreter services to help people who had trouble communicating (C. #41). Second, the building had signs that pointed the way from the entrance to the different sections.

As the head of the nursing department at my clinic, one of my jobs is to tell nurses and nursing assistants how to care for patients. Because the clinic’s emergency room is always busy, there are nursing assistants who can care for patients under the direction of a nurse. I have asked this staff to help patients find their way to doctor’s offices, get files and records when needed, and help patients move around the busy unit. I know that this staff doesn’t have any special training, so they can only do simple jobs (C. #43).

I not only tell this staff what to do, but I also check on them often to make sure they are following the rules and following the hospital’s policies (C. #58). I remember a time when the ER was very busy and a patient needed to be watched while waiting for the doctor to look at them. After looking at the patient’s condition, I was sure that the nursing aid could keep an eye on the patient’s fluids and turn them off when they were full (C. #44). In the end, the assistant helped keep an eye on the patient while the nurses in the room took care of other urgent situations.

There is a code of ethics and professional practice rules that nurses should follow when they do their jobs. I’m proud of the fact that I work hard to do my job as described in the job description. For example, it is my job to figure out what each area in the facility needs to do to take care of patients. I do routine rounds to find out if there are any problems in the nursing areas or if any patients are unhappy (C. #45a). Second, I have to help spread the organization’s purpose, values, and vision. I always make sure that rules are followed in the institution to make sure that great care is given. For example, I recently sent an internal memo to nurses that reminded them how important it is to be on time and emphasized the least number of hours they had to work based on their shifts (C. #54b).

Nurses use therapeutic methods of communication to give patients help and knowledge. These methods include, among many others, active listening, acknowledging, reflecting, and clarifying. Whenever I do my regular rounds, I always see a lot of people with different problems. I have to take the time to listen to each patient and give the best comments or next steps (C. #48). I know that leaders should talk to and get to know their staff and customers to find problems and solve them in the right way. For example, three weeks ago, I was making my evening rounds when I met a patient who was upset about not getting enough care. The patient claimed that he hadn’t been given any medicine and didn’t think the institution was giving him the best care. As a leader, I talked to the nurse to find out what was going wrong (C. #47). I found out later that the patient’s medicine wasn’t in the drugstore and that the patient’s family had been told to bring the medicine. I told the patient the same thing, and he or she seemed very calm after hearing the news.

Health education is important in modern healthcare because it tells people about their health and lets them make good decisions. There are different ways to educate both providers and patients, such as through training, role-playing, and idea mapping. Even though educating people is important, I always make sure to teach them in different ways. For example, I taught mothers in the MCH about the signs of danger in kids that might make them go to the hospital right away. After the lesson was over, I asked the mom to show me what she had learned (C. #49). It was a good way to make sure that the client remembered what was told.

Nurses have a duty to help people stay healthy by influencing laws and making decisions that make people healthier as a whole. Nurses do things like go to seminars, conferences, and write reports to try to change choices made at the highest levels. For instance, I went to a meeting of nurse leaders from private practitioner groups. The goal of the meeting was to make private practice for nurses better (C. #51). At the meeting, things like licensing for private practice and making a union that could serve private nurse practitioners across the country were talked about. I felt like I was part of a team that was trying to improve the health of the country and make nursing a better job.

The meeting also had plans to spread the word about nursing events and make nursing a better job. I liked the idea (C. #53) of talking about how to cut down on nurse strikes in the country. I thought that nursing could be better and that our leaders needed to stand up for nurses when they needed help. As a suggestion, it was thought that the best thing to do was to review contracts and deals on a regular basis instead of waiting until strikes happened. I thought that this idea could help change nursing as a whole.

A plan of care is made before nursing care is given to a patient. The plan tells nurses how to help the patient. Depending on the state of the patient, it can be hard to follow the steps given, especially in an emergency. For example, routine nursing care for inpatients at the clinic includes getting the report, making the patient comfortable by making their bed and giving them a bath, giving them their medicine, and then doing tests based on what the patient needs. I remember a time when I had to skip a normal treatment and take a patient to an early morning abdominal ultrasound because I thought something was wrong (C. #54). The patient had been in an accident before, but he or she kept saying that his or her stomach hurt. I talked to the doctor about putting in the study, which might help find something they missed (C. #55). We found out later that the patient was bleeding inside, so we had to change how we were taking care of him. I was glad that I used my clinical sense to help come up with a new way to care for the patient that saved his life.

Changes in a patient’s health or the patient’s surroundings can happen quickly when it comes to providing healthcare. For example, accidents can quickly change how care is given in a hospital, especially if there are a lot of people hurt. A few years ago, I was working in the emergency room on the weekend when an accident happened nearby. Before making plans to move those who needed more advanced care, almost all of the patients had to be rushed to our hospital. Since most of our staff takes the weekend off, I had to use the backup plan to call for nurses to help in an emergency (C. #56). Also, IV lines, fluids, and medicines from other areas had to be brought in to help.

Organizational culture is important in healthcare today because it shows whether or not people are getting good services. Organizational culture can be seen in how patients are cared for, how families are involved in care, how problems are solved, and how workers are hired. For example, I’ve noticed that my hospital hasn’t had enough people working there for a long time. Before adding new staff, it has become normal for every area to complain. As a leader, I think that this mindset hurts the quality of care that patients get (C. #57). Because the number of patients is growing every day, changes need to be made so that there is a normal plan for hiring.

I’ve already told you why therapeutic dialogue is important and what it means. I always make sure to give my patients an ear when I talk to them by constantly listening and giving feedback. For example, when the patient said that the nurses didn’t pay attention to him, I realized how important it is to give feedback (C. #60). The nurses did the right thing by asking family members for medicine, but they didn’t tell the patient. But when I told the patient what happened, he was happy with the answer.

Transformational leadership, democratic leadership, and transactional leadership are all popular types of leadership used in today’s healthcare system. I think I’m a revolutionary leader because I always get my coworkers to take charge of their jobs and go above and beyond what’s expected of them. For example, I often meet with nurses outside of work hours to talk about the problems they face and how best to solve them. I try to look at problems in a positive way by building on past experiences and new changes in the company. These ways of being a leader have helped me become a good one who is liked at work (C. #61).

Evaluation is an important part of nursing care because it helps nurses figure out how well they are taking care of patients. For example, I was giving a diabetic patient information about leaving the hospital, such as how to self-inject insulin and change his or her food. After the education was over, I noticed that the patient knew more about the meal plan than how to give himself an injection. I had to change how I taught the patient how to self-inject when I saw that he understood better when I showed him online movies about it (C. #62). The review process helped me realize how important it is to use different ways to teach and learn.

How to Act Morally

Diversity in healthcare means that there are people from different races, social classes, and cultures. This means that nurses should take into account where their patients come from and how they want to be cared for. For example, I remember meeting a patient who didn’t want to be treated and just wanted to go home. As the head nurse, I was asked to try to convince the patient to stay at the hospital by telling him or her why it was important to do so. But the patient said she had small children at home and didn’t want to be accepted because she didn’t feel safe. As a nurse, I knew that patients had the right to say no to medical care unless it could put their lives in danger (C. #63). Before letting the patient go, I finally let the patient sign the “against medical advice” form.

Every day, nurses interact with many different kinds of patients. How they interact with patients depends a lot on their own values, views, and life experiences. For example, I had a patient who had been in an accident and then, while getting care at the facility, got complications. The patient had pressure sores that wouldn’t heal no matter what was done. It was so sad that the patient had given up, and that his or her family didn’t come as often as they used to. The patient’s health got worse because he couldn’t eat well and all he wanted to do was die. On my side, I thought that the patient would get better if he or she got the best care possible (C. #64). I talked to the staff, and we made sure the patient had a separate room where cleanliness, hygiene, and sterility were kept to a high level. In the end, I got better because of the treatments and my belief that I could get better.

I saw that this event had a big effect on how care was given at the company. First, the nurses became more sure that their care can make things better, even when things are hard. I also learned how important it is for health care providers from different fields to work together (C. #65). For example, nurses and doctors worked together to take care of a patient, which helped the person get better faster.

In today’s healthcare system, everyone agrees that ethical behavior is a key part of good nursing care. When taking care of people, nurses should know how to act in a moral and ethical way. For example, I know that keeping patients’ information private is important when caring for them (C. #66). I’ve always been able to build a good therapeutic bond with my patients that makes it easy for us to share information. I also know that the shared information should be kept private unless the patient gives permission for it to be shared. A good example is the ESRD patient I told you about earlier who only wanted his older son to know about his situation.

Ethical duty means being able to act in accordance with the rules set by a professional body, like the one that regulates nurses in a country. On the other hand, a government or system has legal rights that tell people how to act and how to get services. For example, I know that everyone has the right to medical care, no matter what race, gender, or culture they come from. At the same time, I know that the nurse should give medical care to patients based on the ethical ideals of beneficence, non-maleficence, and justice (C. #67). A patient has the right to medical care, but they also have the right to say no to medicine.

When nurses care for patients, they always make sure that the patients know about the care, including the risks and benefits. The patient can then give permission for care to continue or for a different method to be used. For example, one person who had fallen came to the ER with a hip that was out of place. During the exam and probe, it was found that the patient needed to be adjusted and moved while they were asleep. I had to tell the patient that sedatives would be used and that there was a chance that he or she wouldn’t be able to breathe after the operation (C. #68). I knew that the patient could refuse to take sedatives because of how they made them feel.

The nursing standards of care say that the nurse must care for patients in a safe, kind, and skilled way. For example, a woman came with her mother for a regular checkup in the outpatient area. I asked the mother to wait outside while I did the physical check and assessment so that we could keep things private. I focused on obstetrics, which included things like LMP and the normal flow of menstruation. I saw that the woman had a lump in her stomach, and when I asked her about it, she told me that she hadn’t had her period in two months. I probably knew she was pregnant, but she didn’t want me to tell her mother. But she was only 17, so I was allowed to tell the mother what happened because she was a child (C. #69). I tried to calm her down and asked her mother for help because she was afraid of how the parent would react. In the end, this showed that confidentiality could involve more than just the patient and the healthcare worker.

Interprofessional teamwork in healthcare is used to make sure that patients get the best care possible. The nurse must make sure that the patient’s information is safe and only shared when it’s necessary (C. #70) when working with other healthcare teams. For example, I had a client in the MCH clinic who came in because she was having stomach pain and sometimes had waste that smelled bad. She had been given medicine for possible UTIs, but it didn’t help. A speculum check had to be done to see if there were any problems. When I looked at the patient’s cervix, I saw strange growths that I didn’t know what they were. I asked the client if I could talk to him or her so that we could figure out the best answer. I went to see a doctor, who looked at them and said they were cervical polyps.

A good bond with a patient is an important part of treatment. But the nurse should be able to tell the difference between a social and a therapeutic connection with a patient. For example, it is my job to help patients with their problems and meet their needs. I used to talk to this patient in the surgical wing because she had been in the hospital for a long time. I could tell that our relationship was getting stronger because she started asking me for help. At first, I thought it would be nice to treat her special by giving her extra sheets and letting her use my phone to call her family. But when I thought about it, I realized that our friendship was becoming less therapeutic and more social (C. #71). I even started to avoid that ward because I knew she would take up most of my time. I finally had to tell her what was going on and how keeping up a therapeutic friendship could help us both.

The setting where nursing care is given has a lot to do with how the care is given. A good atmosphere helps people get better and heal, and it also helps people with terminal illnesses die peacefully. As the head of the nursing department at my hospital, I have made sure that all of the patient rooms stay clean. I know that keeping the surroundings clean is important to stop the spread of microbes that could slow down healing if they spread. Second, a caring setting has a nursing team that is focused on putting the patient’s needs first and giving care that is patient-centered. Through education, training, and motivation, I think my nursing team is ready to provide a healing setting for a wide range of patient groups (C. #72).

A therapeutic connection between a nurse and a patient is one that is built on trust, respect, faith, and hope. It’s the kind of friendship that lets you talk freely with the patient and get good results. For instance, when I meet a patient on the halls or in the emergency room, I always start by saying hello and telling them who I am (C. #73). Then I make sure that the patient or a member of his or her family introduces himself or herself before I ask the patient what’s wrong. I always have the upper hand with people of all ages when I use these methods. I also use active hearing, keeping eye contact, and interrupting when it’s the right time to do so. I’ve learned that these ways help people feel like they can talk to a healthcare provider who cares about what they have to say.

Caring is an important part of nursing because it lets nurses focus on the patient and help them without feeling like they have to. It shows up in what is done to the patient or what is seen during conversation. For instance, there was a patient who had been in the hospital for a long time because he couldn’t pay his bills. As I did my job, I could see that the patient was ready to help other patients eat and move around because he was steady. When it was a busy day and he had a good heart, the nurses would sometimes ask him to help. I was moved by how much the patient helped other people, so I decided to do something to help him pay his bills (C. #74). I talked to the management about this and set up small fundraisers inside the center to help the patients with their money. I was surprised that we were able to raise a lot of money and pay off the patient’s bills with it.

Nurses are advocates for their patients and make sure they get the right care all the time. When caring for a patient, there are times when you have to make a choice that is right from an ethical point of view. For example, when I worked with mental patients, I met one who refused to take any medicine at all. In the back of my mind, I knew that the patient’s situation would only get worse if they didn’t take their medicine (C. #75). I also knew that mental patients can be given medication against their will if they do something that could hurt themselves or others if they don’t take the medicine. I talked to the doctor, and in the end, I was able to give him medicine against his will.

In healthcare, diversity means caring for people from different neighborhoods, age groups, races, and cultures. Nurses should make sure that care is given that respects and includes differences. For example, I’ve had to figure out what Muslim patients should wear in the hospital, like hospital dresses or uniforms. Every patient who wants to stay in the hospital for care must wear the right hospital outfit so that they can be identified. But I know that some groups are very rooted in their traditions, and that these traditions should be respected even when giving health care (C. #76). So, if a patient says that their culture doesn’t let them wear different clothes, they are evaluated and the right choices are made about how to care for the patient.

Nurses have to make sure that patients always make choices that are well-informed. This is done by telling the patient about the risks and benefits of certain treatments or medicines. For example, I once saw a person in the emergency room who had a deep cut in the head from an accident. The cut would heal faster if it was stitched than if it was just dressed. The patient said he didn’t want to be stitched because he had seen much bigger cuts heal without being stitched. I talked about how stitching could help a wound heal faster and keep it from getting infected (C. #77). But the guy didn’t change his mind. I had no choice but to dress the patient and suggest that they do it every day.

Every patient is affected by the setting where they get care, as well as by the people who give them that care. Nurses have to speak up for the rights of their patients. For example, there was a time when the patient’s family members made it hard for me to plan how to take care of the patient. The patient’s femur was broken, so they had to put a cast on it, raise the leg, and keep a close eye on it. From what I know, our hospital didn’t have a good chance of taking care of the patient well, including any problems that might come up. When I told the patient to get a referral, I found out that the patient’s family didn’t want the transfer because they knew that our hospital was cheaper. I knew that the patient’s health was more important than making money, and I did only what was best for the patient (C. #78).

I talked to the medical department about the situation, and they agreed with the choice. I talked to the doctors, and they told me that the patient needed to be moved. Second, I asked the medical team to try to tell the patient’s family how important it was to move quickly before it was too late. The medical team worked with the patient and family because they were able to show them how important it was to get special care at a more advanced facility (C. #80). I was able to help the patient get the best care for his situation by working with other people and speaking up for him.

Self-awareness is important for nurses to grow as people and as professionals. It means being aware of one’s feelings, abilities, skills, weaknesses, and temperament, all of which affect relationships in a healthcare setting. For example, I always try to help new nurses and trainees get used to the culture of the company and the new healthcare environment (C. #81). I know how hard it is for new staff to find their place in the company while they try to give good care. During my free time, you can find me on the wards helping trainees rate patients and making sure their complaints are taken care of. I also always check in with new staff and give them guidance to make sure they are ready to give compassionate care.

I’ve already talked about how important it is to keep a professional distance from patients. The time I spent with the patient showed me how social relationships can affect how nurses care for their patients. For example, I learned that treating patients with equal respect while keeping professional limits with them was possible. Second, the practice has helped me avoid problems with people that could affect my job or even keep me from giving good care (C. #82). For instance, I could avoid going to the surgery ward because I didn’t want to see a patient with whom I had become very close.

When proper care and management aren’t in place, the surroundings of a hospital or clinic can either help people get better or stop them from getting better. One example is when there are problems with safety that could cause a patient to fall or get hurt. During my regular rounds, I noticed that some of the patients’ beds were not in the best shape. I had heard from a few people that patients had fallen because their beds didn’t work well. In my monthly report to the administration, I suggested that they think about buying new beds to replace the ones that were broken and could make patients more likely to fall (C. #83).

Some staff members also didn’t keep secrets, which was another thing I saw. I heard a staff member tell another staff member important information about a patient that I thought should only be shared between the patient and the client. I knew that if the patient found out, this behavior could get them both in trouble and was against the nursing code of ethics (C. #79). At this point, I didn’t want to do anything because I knew I had to first tell them and show them how their actions could affect their work and their relationships with patients.

Helping the People

The healthcare business has changed over time to include many different ways to care for and serve patients. Today, the healthcare business is dominated by the use of technology and practices that have been proven to work. For example, I went to a seminar about six months ago that talked about how technology affects the way care is given and how healthcare professionals need to change with the times (C. #84). I learned that using mobile apps to tell patients about their care helped doctors take care of long-term conditions like high blood pressure, diabetes, and obesity. With the help of these mobile app technologies, it would be easy to give people information about their discharge and health education before they leave the hospital.

When helping people in the community, nurses work with other members of the healthcare team who have different jobs. I remember that when the institution put together a program to raise knowledge about cancer, different people from the healthcare team took part. Because the people there were so different, it was up to the nursing team to teach them about breast and cervical cancer and how to stay healthy. I also made sure that top nurses worked with the doctor team to do cervical cancer screenings (C. #85). The physician team was also in charge of figuring out what test results meant and giving the right medicines to clients who had problems.

Different groups of people have different health care needs that nurses have to take into account when deciding how to divide up resources. For instance, my health care group helps all kinds of patients except those who need intensive care and surgery. When I think about the needs of the community where I work, I realize that most people who go to a doctor have problems with hypertension and diabetes (C. #87). These are chronic conditions that are an indicator of poor lifestyle choices by the community members. I remember three years ago the institution organized an awareness program on the burden of chronic diseases in the community. Perhaps many interventions should focus on educating the community about dieting and the value of physical exercises.

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