Changes In The Roles And Responsibilities Of Nurses

Changes In The Roles And Responsibilities Of Nurses Nursing staff have seen their roles and responsibilities change considerably within the modernisation of the NHS, but is this a good thing? There are some big changes in the nursing field in the last 50 years such as, uniform, salaries, job demand, the roles of nurses, the different roles for men and women nurses, the technology used, Litigation and Documentation, Holistic Care and patient load. Nurses are becoming more popular and demanding in all sorts of different working environments such as, working in nursing homes, hospitals, home help, travel nurse, school nurse and more. Years ago, nurses were seen just as little more than helpers or assistants for doctors. Today in 2010, nurses are health care professionals in their own right. They are bright, capable, and often have a clearer picture of the overall situation than the doctors they work alongside with. Nursing has not only changed on the face of it but the background work of a nurse has changed to, for example the education given to nurses, the scope of policies and practice, the structures of nurses and the principles of the care of the patient. People are lead to believe that the modernisation of the NHS will be beneficial to the care of the patient, but is this really the case? Due to the increasingly shortage of nurses, they have learned to be more independent which is an outstanding way to increase skills and keep up to date with the new trends in health care. As well as nursing changing, health care in general has changed too. Within the modernisation of the NHS and nursing the care of the patients is still the everlasting goal. This means that there is more work for the nurses, which then has a knock on affect leading to less satisfaction of patient care. Although the NHS and government are doing their best to modernize nursing with the patients interests are heart, it seems like there is less time for care due to time, but more time for paperwork. The Department of Health has laid down certain policy initiatives, targets and structural and organizational changes that can improve the quality of care received by patients through the NHS. These changes are emphasized along with the need for multi-agency and multi-organizational collaborative working acros s disciplinary boundaries. The four key interfaces for which collaboration and coordination measures are being suggested are health and social care; general medical and community health services; primary and secondary care; and interface with carers (DoH, 1996). The education of nurses now days are a lot more intense and harder than it was 10 years ago. Over the last 10 years, there has been a gradual shift for the education and training of nurses. Currently all nurses have to be trained to a degree university level before they can practice as a fully qualified nurse. Opportunities for nurses have increased by large, with one training opportunity being through the internet although this method of training has to be approved by the NHS. On the other hand, years ago nurses only had to have a diploma or LPNS. Now days all nurses have to attend and complete continuing education courses to keep up to date with the new trends and information used in the current day. In addition to the higher and more advanced education, which nurses now have to have, there comes an increases scope of practice. In the current worlds, nurses are doing more and going places that in the past they would not be allowed to have done. The scope of practice is an expression used for various professions that define the procedures, actions, and processes that are allowed to be used and practiced. In the health care profession, there are many different jobs with very different defined scope of practice laws and regulations. These include nursing, social workers, speech and language pathology,  audiologists,  training, radiography,  nuclear medicine, dentists, surgeons, paramedics, physicians and many more. In the interest of the patients, it is a good thing that nurses are allowed to do more and more as there are more doctors than nurses, so the patients may be seen quicker, but on the other hand, it is not a good thing as nurses are doing more and maybe caring for th e patient need and wished less. Nowadays in hospitals, the wards are not gender mixed although the nurses are gender mixed between wards. The stereotypical roles of a nurse have change a lot since the 1990s. There are more male nurses but still not enough. However although there are still not enough male nurses, the female domination of nurses is slowly decreasing and now more men are entering the caring profession. For patients the more male nurses is a good thing because some patients i.e. men prefer to be treated by a man. For example, a man may like to be washed by a man and not a woman for dignity reasons. In addition, for years, the majority of nursing was thought of as a female profession but every year more and more males are joining the nursing profession. Nowadays being a male nurse does not have a stigma attached to it and is now seen as a very good career. The demand of nurses now in 2010 is by large massive. The NHS is always asking for more nurses. When the baby boom started there was a very large need for nurses but as the baby boom is decreasing now there is time and money for improvement of standards of living and disease control, our citizens are living longer. As the general population increases, so too does the demand for nurses. Now more than ever nurses are overworked but with the increasingly shortage of nurses they have to work harder and longer hours, which again is not benefiting the patients. Because of the nursing demand and staff shortage, staffs are taking more sick days due to excessive stress and lack of sleep and self-time. This is because nursing is very demanding on a person not just mentally but physically too. This is seriously compromising the NHS. In 2010 compared to 1980, there is a lot more technology for nurses to use and to be trained to use. Nurses today have to keep up to date with a lot more technology than a nurse 50 years would have had to. Technology can be seen as a good gadget and as a bad gadget, because not only do nurses have to provide basic and skilled care, they also have to learn how to work with many types of equipment that are specific to their area of expertise. The more popular piece of technology used every day by a nurse is a computer. Nurses use them every day as a way to document the care given to a patient. Although new technology is a good advantage for health care, it has its negatives, for example training the staff to use it costs a lot of money, but on the other hand, it can save lifes. Other important technology that is used every day that benefits a patient is, air mattresses as they help to prevent DVTs and assistance with IV insertion which has made things a lot simpler. All of the new high tech equipment being simplified is for user- friendliness, which means that the new methods are speeding things up. Lastly, infection control plays a big part in the NHS every day, so new technology is being developed all the time, although the basic hand washing procedures remain very much the same. There are many different approaches to nursing care, one being the holistic care. This type of care has become more and more popular. The commutations between the Health and Allied Health services improving, a total Patient Care Model has come about. Resulting in decreased in-patient times and better health outcomes. The holistic care has been seen more popular within the complementary therapies and concepts. The patient load that a nursed has is massive. In America, there was a debate about the amount of patients under care of nurses. In 1999, the debate was won and there was a cap of the amount of patients allowed under care of one nurse. The results have been very effective from happier staff and better care for patients. There should be a cap in the UK. The changes of nursing over the last 10 years have been welcomed with open arms, but there are still teething problems and views that need to be heard. Optimal patient care is in a constant battle with budget and we can expect to see new policy reforms, new technology, and new demands created in the decade to come. It remains the responsibility of not only the nurses, but also the patients of the future, to voice their opinions in order to guide the Industry in the right direction. Nurses are now expected to come with a bigger patents load but more paper work as well. The importance of the paper work has increases over the last 10 years. This is due to the society that we now live in as it has been raised to need someone to blame for everything. As a nurse or doctor there are many emotional people around you every day as people are dying all the time. Therefore, sometimes people sue the nurses and doctors as they are upset and think the person died due to the NHSs fault. Following this, nurses and doctors keep finding themselves in court. Even if they have not done anything, all allegations have to be investigated. This is the reason for paperwork there is to write up. Paperwork is the only solid setting stone and proof/ backup of a nurses care. A nurse is required to document every blood pressure reading, every medication, every incident, and every day. They have to  account  for every action, and put it all in writing. The problem with documentation is th at it takes time. More time for documentation means less time for patients. Plain and simple. The polices that nurses have to follow are very similar across the whole world. In Australia, the no-lift policy was introduced in the late 1990s. To date the policy is still used and the nurses are trained using this policy. No-Lift means using Lifting Machines to mobilise patients, using slide sheets to manoeuvre them around the bed and promoting back care in general. Although this concept is yet to be adopted in the UK, the benefits are becoming obvious and discussions have begun on the implementation of a similar policy in the UK. There are many different types of nurses that work in the community and in the hospitals. These can range from, Adult nurses, mental health nurses, Childrens nurses, Learning disability nurses, District nurses, Neonatal nursing, Health visitors, Practice nurses, Prison nurses, School nurses and Healthcare assistants. There are also many different levels to being a nurse. A health care assistant is under a nurse, and then you have staff nurses, then sisters and ward sisters and then nurse manager/ matron. All in all these all make up our NHS and work as a team to provide the best possible care for the patient. There is a large scale of pay, which starts at around  £13,000 to  £67,000. The above table shows how the NHS works. The last 40 years nurses uniform has changed but not that much. In the 1960s nurses still wore dresses and stocking .In the 1970†²s more changes came to the way nurses dressed. Dresses were a little shorter and the white caps were beginning to lose importance in some hospitals across the country. In the 1980†²s there was an end of the nursing caps altogether. Nurses also began wearing disposable aprons at this point rather than cloth aprons and medical facilities became much less militant in regards to restrictions on jewellery and cosmetics. During the 1990†²s and today, nursing dresses have been replaced with much more user-friendly scrub suits. Scrub suits can be found in a wide variety of colours and styles. Some hospitals have specific scrub suit colours for different types of hospital staff and others allow nurses and other staff to choose colours and styles that appeal to them. Todays nursing uniforms are designed more for function than form but are also conside red much more comfortable than those worn throughout history are. There are many different theories towards nursing. The three main ones are needs based theories. The main point being that the focus of nursing is the assessment and care of the patients / clients needs, which they are unable to meet for themselves. The second theory is interactions theories. The main point of this being the focus of nursing is the relationship between the nurse and the patient / client. Lastly, the other theory is the goal-based theories. The main point again being that the focus of nursing is the outcome and emphasis is placed on facilitating the ability of the patient / client to adapt to changes in their health and regain stability and harmony. Today in the NHS nursing takes on a role of the biomedical model. The biomedical model has been around since the mid- nineteenth century as the most common model used to diagnose diseases. The biomedical model states that All illness and symptoms arise from underlying abnormality in the body, all diseases give rise to symptoms and that health is absence of disease. The model overlooks the fact that the diagnosis is a result of commutation between doctor and patient. Biomedical model has no doubt led to huge medical advances although the patient has little responsibility for presence /cause of illness. In conclusion, the changes in roles and responsibilities of nurses in the modernisation of the NHS can beneficial towards the patients but can also be damaging towards the patients. This is due to lack of staff and increased working hours, more paperwork, and more tasks that a nurse has to do and there are generally more patients now than 10 years ago. Therefore, a nurse has less time caring for the patients needs. On the other hand, the modernisation is seen as a good thing because there is more technology nowadays to make the nurses life easier, which also get a more persist result. Within the context of policies and procedures there are no many more rules than year ago, which does make a nurses life maybe easier but maybe harder. With all of these changes to nurses and the NHS in general, is the modernization is good thing, does it have the patients interests are heart or is it about saving money?

Exam Malpractice

Abstract Show/Hide This study considers the remote causes of examination malpractice in the Nigerian education system with a view to suggest new ways of combating the problem. Three research hypotheses were formulated to guide the study. Using the multistage stratified sampling technique, 200 students were selected for the study from 20 secondary schools in Akwa Ibom State. An Examination Malpractice Questionnaire (EMQUE) was used for data collection. The three research hypotheses were tested statistically using the Chi square statistical technique.The results indicate that poor study habits, paucity of educational facilities, and inability of schools to cover prescribed syllabuses are significant remote causes of examination malpractice in the country. Based on these findings, methods of tackling the menace are proffered and counselling implications are suggested. Introduction The issue of examination malpractice is a national emergency situation. Before the advent of western type e ducation, traditional Nigerian education was based mainly on experience and practice.Its mode of instruction was simple as knowledge was passed on orally and through practical tests. Students then only had to commit to memory, learn by rote, or through observation (Ibia, 2006). Because traditional Nigerian education placed little or no emphasis on certification, students had the proper view of education, seeing it as a means to an end not an end in itself. Besides, the Nigerian culture then frowned at dishonesty and would not hesitate to sanction offenders (Agogo, 2006).According to Ejiogu (2001), general moral decadence and the high premium placed on achievement and certificates by Nigerians has in recent times spawned examination fraud. The general overdependence on educational certificates as a measure of one’s knowledge and competence has led to a mad rush by most people for educational certificates (Sofola, 2004). In a bid to acquire such certificates, many have resorted to unethical means—foremost among which are examination malpractices—just to acquire the certificates at all cost.Without doubt, the persistent occurrence of examination malpractice in Nigeria has spawned heinous problems such as: 1. Lack of credibility of academic certificates acquired in Nigeria by the international community. 2. Declining standard of education in the country. Onyechere (2004) asserted that unless we are able to stop examination malpractice, the standard of education in Nigeria will continue to fall. 3. The problem of turning out into the society half-baked—if not unbaked—graduates who are virtually good for nothing and functional illiterates. 4.Inability to secure competitive and challenging jobs which require practical test of proficiency and skills. 5. The existing correlation between examination malpractice and corruption in public offices. As noted by Thomas Derry of the West African Examinations Council (WAEC) and quoted in the E xaminations Ethics Project (EEP) survey (2004) report, students who steal their ways to higher offices through examination malpractice would not find it difficult to engage in corrupt practices when they are employed. 6. Finally, examination malpractice has economic implications.According to EEP (2003) report, Nigeria loses more than one billion naira annually to examination malpractice. Thus examination malpractice could equally be seen as an economic crime. Mention-worthy at this juncture is the fact that Nigerians have not been sleeping since the wake of this mischief in the mid 1970s. It is on recorded history that the first serious case of examination malpractice in independent Nigeria was the leakage in 1977 of the West African Examination Council (WAEC) question paper for the West African School Examination (Onyechere, 1996).The outcry by WAEC in the wake of this incidence led to the setting up of a tribunal by the Federal government of Nigeria to investigate the mass leakage and to suggest possible measure to forestall future occurrence. The tribunal recommended severe punitive measures. The federal government followed this up by promulgating Degree No. 20 of 1984 and later, Degree No. 33 of 1999 in which severe punishments against perpetrators of examination malpractice were clearly enshrined.Further measures which have been taken in recent times to eradicate examination malpractice include that taken by the Obasanjo Administration which embedded in the National Economic Empowerment and Development Strategy (NEEDS) policy document a target of 40% reduction in examination malpractice annually; the existing legislation on examination malpractice, Degree No. 33 of the 1999 Constitution which is still in force—though not enforced; and the move by the Federal Ministry of Education to introduce the study of ethics in the school curricula with a view to forestalling examination malpractice.It is a truism that even though much has been done, it is eith er grossly inadequate or ineffectual at curbing the menace as we day-in-day-out see examination malpractices take newer, dynamic and appealing forms especially with the advances in Information and Communications Technology (ICT) coupled with the general falling standards of societal norms. It is also true that examination malpractice would not have attained its present endemic state but for the fact that the major stake holders in education are at the forefront aiding and abetting the crime.Orhungur (2003) decried the general opinion which tends to indict the students and exonerate the teachers and other examination agents. Quoting a tentative report by Usman, he maintained that if the staff, that is, all who have to do with examinations—examiners, typists, custodians, staff of examination bodies, printers, transporters, and security agents—put their house in order, students would not have access to examination materials before examinations. Umar (2003) indicted head m asters and principals as the biggest perpetrators of examination malpractice in the country.He asserted that headmasters in connivance with their teachers initiate primary school pupils into examination malpractice during common entrance examinations by giving answers to the students so that they would record high number of passes in their schools. In the case of secondary school principals, Umar (2003) stated emphatically that they are the worst perpetrators of the crime as they, in a bid to have the names of their schools praised and recognized, manipulate and aid the crime.In the same vein, Ike (2004) of the EEP held that principals have gone to the extent of building into the National Examinations Council (NECO) and the West African Examinations Council (WAEC) registration fees, an examination malpractice fee variously referred to as cooperation fees, understanding fees, examination welfare fees, and miscellaneous fees with the sole aim of bribing supervisors and invigilators an d whoever sent them so that they might ‘cooperate’ during examinations.Another group of master-minders who have rather taken centre stage in recent times are operators of private study centres also known as extramural classes. These study centres are veritable fronts for examination fraud operated by organized syndicate who charge outrageously high fees for examinations. Funnily enough, students are, more often than not, willing to pay because in the end it pays off very well (Thisday, 2004). The last group which is also a strong force behind the perpetration of examination malpractice is the parents. Many parents would not want their children to repeat any class no matter their level of performance.Thus, they pressure school authorities to give their children automatic promotion even when they fail their examinations. Parents are also in the forefront of hiring mercenaries to write examinations for their wards. They thus collude with principals to issue fake but favour able examination results to their children. Looking beyond the contribution of education stakeholders to examination crimes, other important causes of examination malpractice revolve around the students and their attitude towards their studies as influenced by the general socio-economic situation in the country.In recent times, students prepare—if at all they do—lackadaisically for examinations. The reason for this lacklustre attitude as opined by Thomas Derry of WAEC is that the youths have prioritized entertainment and pleasure at the expense of their books (myspacefm. com, 2004). Furthermore, Anger (2004) pointed out that the high fees associated with especially the Senior School Certificate Examination (SSCE) makes malpractice unavoidable as poor students cannot afford to repeat a given examination and would in the first instance do anything to pass it at all cost.A comprehensive submission by Anyiin (1998) identified the fundamental causes of examination malpracti ce to include: 1. Lack of necessary facilities for teaching/learning 2. Non-coverage of prescribed syllabuses due to their extensiveness and the general nonchalant attitude of teachers towards teaching. 3. Industrial actions by teachers. 4. Mass promotion of students in internal examinations. 5. The general misconception of good performance by some principals and the society as a means of enhancing the status of societal rating of the principals and their schools. . Faulty or lack of proper administration of examinations. 7. Imposition of school subjects on candidates by parents. 8. Poverty and greed on the part of the teachers who constitute the bulk of invigilators and examiners. 9. Constant increase in examination fees, among others. Statement of the Problem In the fight against examination malpractice, it appears that no one is exonerated. As exposed in the preceding section, education stakeholders, the students, as well as the national economy could rightly be apportioned blame s for the preponderance of this menace.In sum, these variables tend to operate interdependently such that there is a cumulative influence, with one variable buttressing the others. This could be seen in the fact that the poor economic situation in the country has compelled most poor parents to resort to unethical means in order that their wards may pass their examinations at one sitting. Therefore, this research investigates remote causes of examination malpractice in Nigeria with a view to proffering effective methods for curbing the menace.

Intramuscular Injection Essay

The clinical skill I have chosen to reflect on is the administration of Intramuscular (IM) injections. I will use a reflective model to guide me in my reflection. The Gibbs reflection cycle features, description, feelings, evaluation, description, conclusion and an action plan (Gibbs 1988). The first stage of Gibbs (1988) is description of events. On my clinical placement I had the opportunity to administer a drug to a patient via IM injection under the supervision of my mentor. I had already observed this skill on various occasions and previously had the opportunity to administer IM injections in previous placements. My mentor was talking me through the process as this was the first time I have performed the skill with her supervision. When the mentor got to the step of using an alcohol wipe to cleanse the area of the injection site the patient said he did not usually get that done. He continued to say that an alcohol wipe had been used once before and had caused him an unpleasant stinging sensation and he would rather it was not used. The previous times I had administered IM injections, I had cleansed the site with alcohol wipe, and therefore I asked my mentor for some guidance in this situation. My mentor confirmed that it was acceptable to administer the injection without using the alcohol wipe and I continued with the injection. Feelings are the next stage of Gibbs (1988) cycle. My thoughts and feelings about this situation was that I felt a little nervous as I was under the supervision of my mentor for the first time doing this skill. However as I had already had the opportunity to administer IM injections before, I felt I was competent to carry out that skill. When the patient had said he did not usually have the alcohol wipe used, I began to doubt my practice. I knew I had previously used this in my practice, but began to question myself if it was correct. As the patient continued to say he had previously had an unpleasant stinging sensation when the alcohol wipe had been used I began to think that the person who had administered that injection did not allow skin to dry properly before administering the injection. If the skin is not dry the cleaning is ineffective and the antiseptic may cause the irritation by being injected into the tissue (Downie et al. 2000). The patient requested that the alcohol wipe not be used on this occasion and this left me feeling confused. I knew he has the right to patient autonomy and without his consent I could not carry out this procedure. As a nurse you are accountable for gaining consent and maintaining the patients right to be autonomous . Hawley (2007) states that autonomy means a persons right to make their own decisions in life, as long as they do not harm anyone else. I was unsure of the risks of not using the alcohol wipe and had to seek guidance from my mentor. Evaluating this situation made me realise that questioning your own practice is a good way of keeping up to date with evidenced based practice. The Royal Marsden manual of clinical nursing procedures (Dougherty & Lister 2004) advocate the use of skin cleansing wipes, it is however stated within their guidelines that they adopt this for patients who are immunosuppressed, and also give evidence of previous studies which indicate that skin cleansing is not normally necessary. Research by Workman (1999) suggests that the use of skin cleansing wipes is inconsistent and not necessary in IM injections if the patient appears to be physically clean and the nurse has adopted an aseptic technique as well as stringent hand hygiene. The fourth stage of Gibbs cycle (1988) has made me become more aware of different practices concerning the use of alcohol wipes in skin cleansing. I understand that both practices have been researched, and as I develop professionally I will not cleanse the skin in future unless the local policy states to do so or the patient requests me to. The evidence in this area is not clear therefore I will use any literature which is available to allow me to justify my actions, and deliver safe evidence based care. In conclusion, I have learned that not all nurses use evidence in the same way and may use different methods. I understand that as long as my practice is safe and evidence based then I can practice safely. My action plan would be to continue to keep updated with any new research and evidence of using alcohol wipes in the administration of IM injections. This will help me to keep my practice safe and up to date.

Individual Education Plans (IEP)