Role of nurse in

health care

Fundamentals of Nursing
Year-I, Semester-I
KHALID HUSSAIN
Senior Nursing lecturer
jcn / su
 Profession
 A calling requiring specialized knowledge and often long and intensive academic
preparation

 “A vocation requiring extensive education in science or the liberal arts and often
specialized training”

 Relating to or belonging to a profession. or A person engaged or qualified in a

profession.
 THE FUNDAMENTAL CHARACTERISTICS OF A PROFESSION

 Great responsibility
Professionals deal in matters of vital importance to their
clients and are therefore entrusted with grave
responsibilities and obligations.
 Given these inherent obligations, professional work
typically involves circumstances where carelessness,
inadequate skill, or breach of ethics would be significantly
damaging to the client and/or his fortunes.
THE FUNDAMENTAL CHARACTERISTICS OF A
PROFESSION

 Accountability
Professionals hold themselves ultimately accountable for the
quality of their work with the client.
 The profession may or may not have mechanisms in place to
reinforce and ensure adherence to this principle among its
members.
 If not, the individual professional will (e.g. guarantees and/or
contractual provisions).
THE FUNDAMENTAL CHARACTERISTICS OF A
PROFESSION

 Based on specialized, theoretical knowledge

Professionals render specialized services based on theory,
knowledge, and skills that are most often peculiar to their
profession and generally beyond the understanding and/or
capability of those outside of the profession.
 Sometimes, this specialization will extend to access to the
tools and technologies used in the profession (e.g. medical
equipment).
THE FUNDAMENTAL CHARACTERISTICS OF A
PROFESSION

 Institutional preparation
Professions typically require a significant period of hands-on,
practical experience in the protected company of senior
members before aspirants are recognized as professionals.
 This provisional period, ongoing education toward
professional development is compulsory.
 A profession may or may not require formal credentials and/or
other standards for admission.
THE FUNDAMENTAL CHARACTERISTICS OF A
PROFESSION

 Autonomy
Professionals have control over and, correspondingly, ultimate
responsibility for their own work.

 Professionals tend to define the terms, processes, and

conditions of work to be performed for clients (either directly
or as preconditions for their ongoing agency employment).
THE FUNDAMENTAL CHARACTERISTICS OF A
PROFESSION

 Ethical constraints
Due to the other characteristics on this list, there is a clear
requirement for ethical constraints in the professions.
Professionals are bound to a code of conduct or
ethics specific to the distinct profession (and sometimes the
individual).
 Professionals also aspire toward a general body of core
values, which are centered upon an uncompromising and
unconflicted regard for the client's benefit and best interests
 Roles of a Professional Nurse

 Caregiver: The care afforded depends on the needs and requirements of a patient. This
might include total care which entails doing everything for the patient. The care might also
entail helping a patient with the prevention of an illness; nurses have an obligation to care
for a patient holistically. This means that care ought to address cultural, spiritual, and
mental needs.

 Decision maker: A nurse is a decision maker for the client and is ought to use his/her
critical thinking skills to come up with the most significant outcomes for the patient. Some
of these critical thinking skills entail evaluating a patient, recognizing the problem, and
implementing interventions that promote the health of a patient.

 Communicator: Effective communication in the healthcare system can improve outcomes

in the healthcare environment. If the communication is not effective, the healing process
will be inhibited. A nurse has the responsibility of devising the best strategies for
communicating to the patient as well as family members.
 Roles of a Professional Nurse

 Patient advocate: This role has been described as the most

important of the nursing roles. This role entails protecting the rights
of the patient. For instance, when a patient is sick, they are unable
to act as they normally would. Thus, it is the responsibility of the
nurse to determine what a patient wants.
 Teacher: Nurses must also act as a teacher. Being a teacher to the
patient entails assisting patients in gaining knowledge about their
health and medications. More often than not, patients will be
confused about certain steps and procedures.
 Manager: Being a manager means that you have the responsibility
to give directions, organize, plan and implements things out. A
nurse manager has been given the power to facilitate the unit or
case
 Nurse as a Nursing Educator

 A nurse educator is a nurse who teaches and prepares licensed practical

nurses (LPN) and registered nurses (RN) for entry into practice
positions.
 They can also teach in various patient care settings to provide
continuing education to licensed nursing staff.

 Skills needed for Nursing Educator:

 Enjoy communicating your understanding to others: There is
definitely a performance element to most teaching. Our section on
interpersonal skills, including effective speaking, covers this in more
detail, and there is a great deal of overlap with presentation skills.
 Have confidence: Nurses will need the confidence to look calm and
 Nurse as a Nursing Educator

 Have great organizational skills:

 Have you prepared for the session and done any marking in
time?
 Have you kept what is needed for anyone in the group who
was away?
 If you are part of a teaching organization, have you fed back
results to any interested colleagues?
 Work effectively in groups
 Be able to deal with conflict.
 Motivate your students to do their best
 Empathize with your Students
 Give feedback.
 Nurse as a Counselor
 Counseling is:
 The process that occurs when a client and counselor set
aside time in order to explore difficulties which may include
the stressful or emotional feelings of the client.
 The act of helping the client to see things more clearly,
possibly from a different view-point. This can enable the
client to focus on feelings, experiences or behavior, with a
goal to facilitating positive change.
 Nurse as a Counselor
 Benefits of Counseling
 Improve communication
 Enhance relationships
 Peace of mind
 Improve self-esteem
 More satisfaction out of life
 Personal growth
 Improve job performance
 Also helpful in following areas
 Adult relationships
 Career change
 Dealing with loss of a loved one
 Anxiety
 Depression
 Adjustment to family changes
 Parent-child relationships
 Sibling relationships
 Divorce
 Cooperative parenting between divorced parents
 Qualities of a Counselor
 Empathy (the ability to understand the view of
another person)
 Respectful
 Confidential
 Honest
 Attentive/listening
 Unbiased
 Understandable/clear
 Unhurried
 Effective Communication skills

 It is essential that nurses have skills that keep the focus of

communication on the patient, that demonstrate active listening
and assist with information giving. Examples of communication
skills that are integral to nursing.
 It is important that these skills are developed in pre-registration
training and further developed during preceptorship, clinical
supervision and mentorship throughout a nursing career to
promote confidence and competence in this area.

 Skills that assist in keeping the focus on the patient and/or career:
 Looking and listening for cues.
 Effective Communication skills

 Asking open questions. For example: ‘How are you?’

 Asking open directive questions. For example: ‘How are you since I last saw
you?’
 Asking open questions about feelings.
 Exploring cues. For example: ‘You said you are not with it, can you tell me
more about that?’
 Using pauses and silence.
 Using minimal prompts.
 Screening. For example: asking the question ‘Is there something else?’ before
continuing with the discussion.
 Clarifying. For example: asking the question ‘You said you are not with it, from
what you say, it sounds like it is hard to concentrate?’
 Effective Communication skills

 Skills that demonstrate listening:

 Reflecting.
 Acknowledging.
 Summarizing.
 Empathizing.
 Making educated guesses.
 Paraphrasing.
 Checking
 Effective Communication skills

 Skills that assist with information giving:

 Checking what information the person knows already.
 Giving small amounts of information at a time, using clear terms and avoiding
jargon.
 Avoiding detail unless it is requested – do not assume people want to know.
 Checking understanding using an open question. For example: ‘I’ve gone
through some difficult information, what sense have you made of it?’
 Pausing and waiting for a response to what you have said before moving on.
 Checking, with sensitivity, the effect of the information you have given on the
patient. For example: ‘There has been a lot of information to take in today,
how are you feeling?’
 Barriers to effective communication
 Patient and carer barriers:
 Environment – noise, lack of privacy, no control over who is
present or not present (staff or relatives).
 Fear and anxiety – related to being judged, being weak, or
breaking down and crying.
 Other barriers – difficulty explaining feelings (no emotional
language to explain feelings), being strong for someone else, or
communication cues being blocked by healthcare professionals.
 Barriers to effective communication
 Healthcare professional barriers:
 Environment – high workload, lack of time, lack of support, staff
conflict, lack of privacy or lack of referral pathway.
 Fear and anxiety: related to making the patient more distressed by
talking and/or asking difficult questions.
 Other barriers: not having the skills or strategies to cope with
difficult reactions, questions and/or emotions. Thinking ‘it is not
my role’, and ‘the patient is bound to be upset’.
 Career Roles in Nursing

 Indirect Nursing Care

 Physician Offices
 Educational Services
 Clinics
 Professor/ Associate Professor/ Assistant
Professor  Insurance Companies
 Lecturer/ Nursing Instructor/ Clinical Nursing  Government
Instructor
 Community Health
 Telephone Trial Nurse / Nurse Writer
 Research
 Elementary or High Schools

 Infection Control  Correctional Healthcare Facilities

 Quality Control  Public Health Nurse
 Case Management  Home Health Nurse
 Healthcare Informatics  Home Health Nurse
 Nurse Manager
 Travel Nurse
 Forensic Nurse
 Direct Nursing Care
 Nurse Advocate
 Hospitals
 Hospice Nurse
 Skilled Nursing Facilities
 Outpatient Settings
 References
 Booth K, Maguire PM, Butterworth T, Hillier VF (1996) Perceived professional support
and the use of blocking behaviours by hospice nurses. Journal of Advanced Nursing. 24,
3, 522-527
 Fletcher I (2006) Patterns of verbal interaction between health professionals and cancer
patients. Unpublished PhD thesis, University of Manchester, Manchester
 Heaven CM, Maguire P (1998) The relationship between patients’ concerns and
psychological distress in a hospice setting. Psychooncology. 7, 6, 502-507
 Standards of Clinical Nursing Practice, American Nurses Association (1991).
Kearneysville, WV: American Nurses' Publishing
 Walters, S. T., Ogle, R., & Martin, J. E. (2002). Perils and possibilities of group-based
motivational interviewing. In W. R. Miller & S. Rollnick (Eds.), Motivational
interviewing: Preparing people for change (2nd ed., pp. 377–390). New York, NY:
Guilford.