Discuss: Contemporary Nursing Practice

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Nursing practice has changed over the decades from when nurses had minimal education to having complex nursing training programs and when nurses provided basic care to performing complex medical and nursing procedures. Nursing was initially a woman’s work where women cared for the sick at home in the era where there were no hospitals (Egenes, 2017). Modern nursing is attributed to Florence Nightingale, who developed nursing practices that created new standards for nursing practice.  In this regard, this paper will discuss the evolution of nursing practice, the differences between ADN and BSN nurses, and the significance of evidence-based practice in nursing.

Evolution of Nursing Practice

Nurses were formerly not provided formal nursing education but were instead given on-job training on how to provide basic care such as clean and dress wounds. They did not have autonomy and received instructions from physicians. As the nursing practice evolved and more hospitals were established, women began receiving nursing training in small to medium-size hospital systems (Egenes, 2017). However, the training was observation-based, taking two to three years, and the scientific rationale for interventions was not emphasized.

Advances in medicine and technology created a need for complex and specialized nursing education. As a result, nursing training shifted from hospital observation to the classroom.  Certification programs have been created, changing the scope of nursing practice (Egenes, 2017). Nurses also have Master’s and Doctorate levels, which increase a nurse’s scope of practice to include duties similar to physicians such as taking history and physical exams, making diagnoses, interpreting diagnostic results, and initiating treatment plans.  Furthermore, standards of nursing practice have been created to ensure quality nursing care, and nurses are educated on ethical practice and providing culturally sensitive care.

Practice Competencies between an Associate and Baccalaureate Education in Nursing

Nurses with an Associate Degree in Nursing (ADN) and with a Baccalaureate Degree (BSN) are both registered nurses (RNs). Both BSN and ADN programs prepare nursing students to deliver patient care that meets the set standards. Besides, both programs equip the future RN with nursing skills and ensure they attain the clinical practice competencies necessary for nursing practice (Northrup-Snyder et al., 2017). However, the BSN program emphasizes more on areas of informatics and research. It also has courses not offered in the ADN program, such as nursing theories, social sciences, public health, leadership, and management. The differences in the ADN and BSN training result in differences in the scope of practice. ADN RNs are generally more focused on technical, clinical duties and everyday direct patient care, including monitoring patients, administering treatment, performing basic nursing procedures, and updating charts (Ghaffari, 2017). On the other hand, the scope of BSN nurses includes nursing educator, research, public health, administrative, leadership, management roles, and direct patient care.

Approaches to Decision-Making in a Patient Care Situation of a BSN vs.ADN

Approaches to decision‐making would differ in a BSN and ADN nurse caring for a diabetic patient with uncontrolled sugars and a worsening foot ulcer.  An ADN nurse will care for the patient by providing basic care such as dressing the wound, administering insulin or hypoglycemics, and monitoring blood sugar levels. Conversely, the BSN nurse will perform these tasks but get concerned about the uncontrolled sugars and delayed wound healing. As a result, the BSN will assess the patient’s diet and exercise patterns and educate the patient on the needed changes to promote optimal glycemic levels. Besides, the nurse will apply evidence-based interventions to promote healing of the ulcer and educate the patient on foot care.

Applying Evidence‐Based Practice to Nursing Care

In the past decades, evidence-based practice (EBP) has become a key element of excellent patient care. EBP is applied in various aspects of nursing as it offers valuable insight into clinical care approaches backed by evidence to address issues in direct patient care, infection control, and patient workflow (Mackey & Bassendowski, 2017). It enables nurses to apply the latest research methods in the patient care setting, including direct patient care. It focuses on established outcomes, thus promoting enhanced patient care. The BSN program equips students with knowledge and skills on EBP, which helps to analyze patient care approaches that can improve health outcomes (Mackey & Bassendowski, 2017). Students are trained on scientific research, gathering, and analyzing evidence, which they apply to establish the best patient care interventions.

Interdisciplinary Communication and Collaboration in Nursing Practice

Nurses today are part of the interdisciplinary teams and play a major role in developing patients’ care plans. Nurses communicate with the interdisciplinary teams using CUS and SBAR protocols. CUS is an acronym for Concerned, Uncomfortable, and Safety. It is a communication tool used by nurses to express concerns to the interdisciplinary team about changes in a patient’s health status respectfully and professionally. The SBAR protocol representing situation, background, assessment, and recommendations is used by nurses when having a clinical problem that needs to be conveyed to the team (Müller et al., 2018). Communication using the SBAR protocol is usually purposive, straight, and prepared and promotes information exchange between the nurse and the team. The CUS and SBAR protocols foster quality and safe patient care since patient information is communicated through an efficient and well-organized format.

Conclusion

Unlike in the past, where nurses conducted similar tasks, nurses’ scope today is determined by their level of education and the specialized courses they have undertaken. Both BSN and ADN nurses have the same licensing level; however, some of their roles are different. ADNs focus on technical, clinical duties, while BSNs focuses on research, management, leadership, and informatics.  Nurses need to communicate accurately, succinctly, and purposeful with the interdisciplinary teams to promote collaborative care.

 

 

References

Egenes, K. J. (2017). History of nursing. Issues and trends in nursing: Essential knowledge for today and tomorrow, 1-26.

Ghaffari, M. (2017). Preparing Nurses for Community Health Care: A Comparative Study of the ADN and BSN Programs. International Journal, 5(2), 32-45. https://doi.org/10.18488/journal.9.2018.52.32.45

Mackey, A., & Bassendowski, S. (2017). The history of evidence-based practice in nursing education and practice. Journal of Professional Nursing, 33(1), 51-55. https://doi.org/10.1016/j.profnurs.2016.05.009

Northrup-Snyder, K., Menkens, R. M., & Dean, M. (2017). Student competency perceptions from associate degree to bachelor degree completion. Journal of Nursing Education, 56(10), 581-590. https://doi.org/10.3928/01484834-20170918-02

Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W. E., & Stock, S. (2018). Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review. BMJ open, 8(8), e022202. https://doi.org/10.1136/bmjopen-2018-022202

The field of nursing has changed over time. In a 750-1,000 word paper, discuss nursing practice today by addressing the following:

Explain how nursing practice has changed over time and how this evolution has changed the scope of practice and the approach to treating the individual.
Compare and contrast the differentiated practice competencies between an associate and baccalaureate education in nursing. Explain how scope of practice changes between an associate and baccalaureate nurse.
Identify a patient care situation and describe how nursing care, or approaches to decision-making, differ between the BSN-prepared nurse and the ADN nurse.
Discuss the significance of applying evidence-based practice to nursing care and explain how the academic preparation of the RN-BSN nurse supports its application.
Discuss how nurses today communicate and collaborate with interdisciplinary teams and how this supports safer and more effective patient outcomes.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.c

Assessment Description

Attachments

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Contemporary Nursing Practice – Rubric