Introduction
The nursing practice in Australia has been evolving over the years. The recent changes in client demands and government regulations concerning the healthcare industry have had a great impact on the role of nurses in Australia and the world in general (Australian Nursing Federation, 2005). Technological advancements and need for cost control have led to the need for nurses to advance their roles through training and mentorship programs (Affara & Schober, 2006). The emergence of new nursing roles has made it difficult for the world to define the exact roles of a nurse. The concept of advanced or extended nursing enables nurses to have a taste of a variety of different professions in the course of their practice. This concept of advanced practice nursing has been approved by the Australian government thus giving nurses a chance to advance in their training as they specialize in their areas of interest (Australian Nursing Federation, 2005). It has been observed that the issues affecting nursing are common throughout the world regardless of the economic status and population size of the country. This paper will reflect on the concept of advanced nursing in Australia and the use of various domains in the improvement of health care services in the emergency department.
Main body
Nursing roles have been expanding into the medical domain because of the emphasis on expertise as a demonstration of advanced nursing (Barker, 2009). Advanced nursing roles can be used to enhance efficiency and proper organization in the health care industry (Barker, 2009). Various task forces appointed to look into the issues affecting the nursing practice have recommended that the nationally consistent titles be used to recognize nurses with special competencies. Australia has a great history in advanced nursing dating back to the early 20th century when general practice was introduced in the country by visiting practitioners from Britain (Sullivan-Marx, 2010). Specialist practice came into place in after the Second World War when general practice was labeled as a preserve for those practitioners who were returning from offering their services in the Second World War (Sullivan-Marx, 2010). Since then, a lot of emphasis has been laid on advanced nursing practice as a way of promoting professional growth of Australian nurses (Sullivan-Marx, 2010). The concept of advanced nursing has made the support staff in hospitals to carry out some task that were a preserve of nurses.
The emergency department is a very sensitive and important department in the hospital and it requires professional handling for it satisfy the needs of patients (Calvin & Clarke, 2002). Efficient nursing care in the emergency department can achieved through hiring nurses with advanced knowledge and skills to operate in an advanced scope of practice (Calvin & Clark, 2002). The nurses operating in the advanced scope should be in position to operate in both specialist and generalist capacities. Nursing care in advanced practice like midwifery and general practice requires a good patient-nurse relationship as a demonstration of true professionalism (Calvin& Clark, 2002). Advanced nursing care should achieve optimal outcomes through accurate decision making based on substantial medical evidence (Calvin & Clark, 2002). Medical errors occur due to incompetence on side of healthcare providers who can avoid that by being trained in extended practice with good mentoring from experienced practitioners (Carryer, 2002). The management of care given to individuals or groups requires the clients and the nurse to cooperate fully. A nurse in advanced nursing care should ensure that the right of individuals and groups are well protected and show full support to colleagues (Carryer, 2002). Strict observation of nursing care ethics is key to professional development of a nurse. All the nurses with aspirations of venturing into extended nursing care should be well aware of the laws and regulations governing the nursing practice and operate within them.
Many lives have been lost due to inefficiencies in hospitals especially the emergency department (Castledine, 2002). Providing nursing care in the emergency department will continue to be a great challenge if necessary steps are not taken to train nurses in advanced nursing practice and advancement of their scope of practice. The reluctance by some governments and nursing practice regulation bodies to fully define the scope of advanced nursing practice has slowed down efforts to improve nursing care in the emergency department (Castledine, 2002).
Holistic Nursing Practice is a specialty in nursing care whose practice standards have been developing over time. Integrative care and complementary modalities are key components of holistic nursing that every nurse with a desire to move to holistic nursing is supposed to be familiar with (Chiarella, 2006). The nurses in this specialty receive certification according to the standards laid down by the nursing practice regulatory bodies. The standards differ from one country to another but the values and philosophies governing holistic nursing are similar throughout the world (Chiarella, 2006). The real definition for holistic was hard to come up with since many health experts were coming up with varying definitions of holistic nursing. After extensive consultations, the Australian Holistic Nursing Practice Regulatory Body came up with the appropriate definition of appropriate nursing (Cody, 2002).
Holistic nursing concentrates on providing healing a person as a whole through the application of all the relevant nursing practices (Dreher, 2010).Through holistic nursing, all the dimensions of a person including psychological, biological, spiritual and sociological dimensions are identified with all the interrelationships between the four dimensions being properly defined. A holistic nurse facilitates the healing process with the patient being seen as a unitary whole (Dreher, 2010). All the professional standards and regulations governing the nursing practice are a basic integral of holistic nursing in a variety of clinical settings. Holistic nurses are expected to be responsible professionals who care for themselves and their clients (Furlong, 2005).
The healing process in holistic nursing is facilitated by the level of understanding the practitioner has in relation to other people and the community at large (Hanson & Hamric, 2003). Personal views and beliefs determine how the nurse views the nursing practice in general. Holistic nursing has got five major core values of practice according to recent Australian standards. The first core value is Philosophy and Education and it emphasizes on attaining the relevant knowledge and skills together with self- reflection (Jansen, 2009). The second core value emphasizes on research, theory and ethical principles as appropriate tools for becoming competent. The third value emphasizes the fact that a holistic nurse should practice high standards of self-care for him or her to be in a better position to take care of others (Jansen, 2009). The fourth core value calls for a holistic engagement between the nurse and the client as a way of attaining mutually-determined goals and aspirations. The fifth and final core value of holistic nursing is the treatment of clients with a caring attitude especially during the therapeutic care (Jansen, 2009).
The knowledge and skills necessary for one to attain competence in holistic nursing are drawn from creativity, knowledge and extensive research (Cody, 2006). A holistic nurse requires theories to be able to reflect and thoroughly understand the nursing practice. The modeling and role modeling theory emphasizes the need for nurses to understand that clients are different and need to be treated and nurtured with great care (Cody, 2006). Health as Expanding Consciousness theory is another holistic nursing theory that demonstrates the importance of every person in world regardless of their situation (Cody, 2006). The Human Becoming Theory emphasizes the fact that man is a unitary being and gives a clear guidance for nurses to always value the quality of life as it is (Cody, 2006). Watson’s theory of nursing emphasizes caring as the main focus of nursing (Cody, 2006). A holistic nurse needs to make accurate decisions and without the necessary expertise, this can not be possible. The other very important element of holistic nursing is creativity (Cody, 2006). Creativity helps the nurse to come up with new ways of attending to patients and the same use it for solving problems that arise in the course of practice. In order for the holistic nurse to understand the experience of clients, he or she needs to have an element of intuition. Intuition helps the nurse in interpreting the meaning of a client’s experience to healing. The minimum competencies of nursing practice have been developed from the standards of holistic nursing. The professional identity of a holistic nurse is embedded in their daily way of life (Cody, 2006). Holistic nursing embraces all domains in the nursing practice a fact that makes holistic nurses to be classified under the advanced nursing practice because of their extended scope.
One of the major objectives of advanced nursing practice is to improve the satisfaction of both patients and employees in the emergency department (Chiarella, 2006). This objective can only be achieved when all the staff and the physicians who work in the department have clear standards of operation. Enhanced communication with a professional staff helps a great deal in improving the standard of services given to patients at the emergency department (Sullivan-Marx, 2005). Enhancing communication and service delivery in the emergency department requires strategic planning. To begin with, all the performance standards and job standards need to be clarified to avoid confusion in the department (Cody, 2006). Communication with employees should be enhanced by clearly outlining the communication message points. All the staff in the emergency department should constantly be engaged in workshops and seminars as a way of helping them to improve their service delivery and be in a position to handle clients with a caring attitude (Butts & Karen, 2010). The service given to clients in the emergency department should grow from good to great each and everyday (Furlong, 2005). Extended nursing practice aims at improving patient satisfaction skills by physicians through improved communication skills. The role of a nurse is to make sure the patients and their families are totally satisfied. Some of the best practices in handling clients should be put in place as a way of satisfying both patients and employees (Furlong, 2005).
Competency building for employees in the emergency department should also include training in service performance conversations as a way of enhancing communication in the department (Chiarella, 2006). Nurses and employees in the emergency department should learn how to communicate with empathy in the process of dealing with patients. Performance scripts and examples are essential in restoring order in the emergency department and reduce the chance of medical errors. Long emergency waiting times is one of the major challenges facing the emergency department in many hospitals like the Boston Medical Center and Massachusetts General Hospital in the United States (Wilson & Giddens, 2004). Recent studies have shown that many deaths that occur in hospital are mostly associated with the long waiting times in the emergency departments. Patients in the emergency department need quick attention and delaying can lead to many deaths. One of the major causes is the absence of clinical justification in most hospitals. Unclear role definition has caused delays in the emergency department and in the process increasing the risk of deaths and admissions (Sullivan-Marx, 2010). The efficiency of service delivery in the emergency department can be enhanced by integrating the department with other hospital departments like the ambulatory care department (Chiarella, 2006).
Legal and regulatory guidelines of extended nursing practice are strictly followed in the process of credentialing and certification of qualified nurses for extended practice (Wilson & Giddens, 2004). The marking of the real quality of a nursing practitioner is reflected in the approval certification and endorsements by the regulatory body (Joel, 2009). The government grants the nurses permission to legally practice their profession and regulates the scope of their practice. The use of titles is only granted by the government and anyone found bearing a title without the approval of the government is liable for prosecution in the court of law (Butts & Karen, 2010). The emergence of advanced nursing practice has made it difficult for government regulation bodies to clearly define the scope of advanced nursing practice. This has made many nursing practitioners to be reluctant to carry out some very fundamental tasks because of the fear of breaking the laid down procedures (Kleinpell, 2009).
Licensing and certification is only done when an individual is well qualified in their area of specialization. There are special cases where practitioners are given privileges to perform some activities as they get monitored in the process. A health care professional is only granted privileges by the government based on their training, experience, competence, license and agency regulations (Masters, 2005). This privilege system has helped in promoting advanced nursing practice in health facilities. Good judgment is another basic requirement for a practitioner to be granted a privilege to perform some extended roles. The health care provider operating under a privilege are urged to follow all the orders and instructions incase they are performing certain diagnostics (Mc Cormack, 2004). Privileges are essential tools used by the government and other regulatory bodies in establishing the exact roles of a nurse in extended practice (Masters, 2005). Regulations governing extended nursing practice in different countries across the world should be similar to allow nurses to freely practice in a foreign country without being barred by regulations of the host country (Mc Cormack, 2004). The government and regulatory bodies should adjust and restructure their regulation systems to be consistent with the current demand for health care services (Mc Gee, 2003).
Advanced nursing introduces new knowledge in the nursing profession as it improves the delivery of services in our health care facilities (Dreher, 2010). The development of advanced practice nursing is meant to streamline the nursing profession to meet client demands (Joel, 2009). The misuse of terms and inconsistent titling clearly demonstrates that there is a great confusion about the exact roles of advanced practice nursing. There have been varied interpretations of the exact role of advanced practice nursing by various health experts (Joel, 2009). Evidence-based approaches have been effectively used to design advanced practice guidelines leading to constant underutilization of the actual scope of advanced practice nursing (Mc Gee, 2009). The advanced nursing goals and expectations should be clearly stipulated in the guidelines to develop the roles of extended practice nursing.
The advanced practice role domains should be effectively utilized for tangible benefits ton be seen (Richardson, 2002). Specialization and advancement in roles is a major characteristic of advanced practice nursing as it shifts from the traditional basic practice. Through advanced practice, health care providers are able to fully utilize their nursing knowledge to improve the nursing profession (Mezey & Mc Girvern, 2003). Advanced nursing practice is viewed as a change agent that brings together all the experts in the health fraternity to reason together and come up with new ideas to transform the health care industry.
Apart from clinical practice, advanced nursing plays other roles that are completely different from clinical practice (Richardson, 2002). The other role domains that advanced nursing practice deals with are educational and training, leadership and professional development together with extensive research on all the issues affecting the health care industry (Jansen, 2009). Advanced nursing practice has got different models with different definition of role domains. An example of advanced nursing practice models is the Synergy model. According to the synergy model, clinical nursing specialists have got eight domains of practice (Jansen, 2009). The eight roles defined by this model include systems thinking, moral agency, collaboration, clinical judgment, training, collaboration, caring practices, clinical inquiry and response to a crisis (Nursing Council of Australia, 2006). These domains of practice are very crucial for any professional healthcare to deliver quality services in their areas of specialization. There are other models that have different role domains all aimed at improving service delivery at health facilities and developing the role of nursing (Joel, 2009).
Extended nursing practice gives the healthcare provider some autonomy to practice beyond the traditional scope (Joel, 2009). The practitioner is in a better position to specialize in their favorite areas and at the end of the day render quality services to clients (Richardson, 2002). Advanced nursing practice entails innovation using research based findings in synthesizing and developing new knowledge and skills. Advanced nursing practice can only be successful if there is a full commitment to professional and ethical standards. The fundamental values require advanced nursing practice to strictly focus on health maters and the practice should be patient-centered (Ramirez, 1998). Advanced practice lays much emphasis on the integration of clinical knowledge and skills to improve the health of patients (Snyder, 2005).
Conclusion
In conclusion, the concept of advanced practice nursing has improved service delivery in the health care industry. The implementation of advanced practice nursing programs has been greatly hindered by inadequate regulation by the government and other nursing regulatory bodies. Role development has been proven to offer solutions to problems affecting the heath care industry like long waiting lines for patients and accountability issues affecting the nursing profession. Services in the emergency department can only be improved through extended nursing practice.
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