Custom Competency Assessment Supplement (CAS)

Custom Competency Assessment Supplement (CAS)
Professional Responsibility and Accountability
Professional nurses are supposed to demonstrate professional responsibility and accountability reflected through actions, beliefs, opinions, and attitudes. Demonstration of knowledge about patient care using the nursing process is also an act of professionalism by nurses. I remember walking in the emergency unit in our clinic when I came across an old patient in a wheelchair. The lady was accompanied by her family but had not received attention for some time. I knew as a leader I needed to find out what was happening in the department that led to delays in patient care (Competency #13).

I walked around the department to assess the situation and find out what was the actual cause of delay in patient care. I realized that the ER was busy that day and all healthcare providers were occupied with various tasks including emergency care for a patient who needed resuscitation. At this moment I knew that priority was given to very sick patients first (C. #8) and multitasking in a such a busy environment could only lead to errors and possible adverse outcomes. On assessment, I realized that there was a slight shortage of staffing that day and I decided to step in and help the old lady that I felt needed immediate attention.

To begin with, I introduced myself to the patient and the family. I understood that creating a rapport with the patient and the family was a very important step in establishing communication. Secondly, it was necessary to involve the family members in the process because the patient could not communicate effectively (C. #12). Nurses are supposed to communicate therapeutically which involves a face-to-face interaction with the patient while connecting to the physical and emotional well-being of the patient.

The provision of nursing care to patients in a professional manner requires the nurse to observe the patients’ rights all the time. For example, the patient has the right to privacy, confidentiality, and refusal of medication. These were among the first thoughts that crossed my mind before attending to the patient. I was fully aware that I needed a separate room that could allow the patient and the family to communicate easily (C. #7b). Secondly, the room could allow for assessment and examination of the patient without involving other parties. Prior to the beginning of my assessment, I explained to the patient and the family the need to give consent for any procedures and treatment that were likely to be received during patient care (C. #7a).

The next step involved gathering information about the patient’s complaints and the reason for seeking healthcare. I realized that the patient had difficulty expressing herself because she was weak and had challenges with speaking well. I learned from her daughter that she had recently been diagnosed with oesophageal cancer and had developed weakness at home which led to her hospitalization. I was very keen to note how the family was expressing their concerns about the condition of their patient. I reassured them that they were in the right place and they could expect the best from the healthcare providers in the institution (C. #1). Through active listening and using my clinical observation skills, I was able to realize that a few interventions were required before the patient could have an opportunity to be reviewed by the doctor.

Oesophageal cancer is among the common chronic conditions in the elderly population that has a significant effect on mortality and morbidity. On examination of the patient, I realized that she was weak, had difficulty in expressing herself, and appeared restless. From the patient’s history, I had also noticed that she had refused to eat for two days. At the back of my mind, I could relate the observed signs with the expectations of a patient with oesophageal cancer. The pain during swallowing could have contributed to the inability to eat. Consequently, I could relate the general body weakness observed due to insufficient intake (C. #6). I went ahead to collect more data to inform my decisions including checking vital signs. The patient’s blood pressure was low, cannot recall the readings, and the respiratory rate was a little bit fast. I did a quick head to toe assessment and examination whereby I realized the patient was dehydrated probably related to inadequate fluid intake. There was a need to administer fluids before any other interventions (C. #2), but I had to inform the medical doctor in charge first.

Interprofessional collaboration in healthcare today is key to the improvement of quality. It involves different members of the healthcare workforce working together towards a common goal. For example, while attending to the above patient, I realized she needed immediate attention. I also knew the importance of consulting with the doctor before initiation of fluids as she awaited the ER team to be free (C. #10). Upon initiation of care, I was now comfortable that the patient could await further review by the doctor and the nurse in charge. I also knew that I could not leave the patient alone after the initiation of IV fluids. Therefore, I delegated monitoring of the patient to an unregulated care provider until the nurse in the department was free. The main task for the UCP was to monitor the IV fluid and make the patient comfortable while awaiting further care (C. #9).

Collaboration in healthcare does not only involve staff but also patients and families to meet set goals. It involves working together and assuming roles and responsibilities while carrying out plans for patient care. For example, I managed a patient who wanted to quit smoking but was unable due to peer influence. The major concern for the patient was that if he had a nearby healthcare facility, it would have made it easy to seek medical care and perhaps manage his smoking habit. I understood very well that the environment and access to healthcare had a huge influence on the healthcare status of individuals (C. #15). Therefore I had to look for ways to ensure this patient returned to the healthcare facility or had access to a primary care provider.

The first step towards the management of the patient involved working closely with the mental health nurse in the institution. I introduced the patient to the psychiatric unit and helped develop a plan for regular visiting and follow-up to ensure the goal could be achieved. Additionally, it was necessary to involve the family of the patient to monitor the smoking habit and provide the necessary support (C. #3). Upon collaboration with the family, I realized that they were ready to accompany the patient to the facility weekly for sessions and provided financial support. I realized that collaboration with the patient and family is a powerful tool towards meeting the goals of care.

The healthcare environment consists of different individuals with different personalities working together to provide quality care to patients. When there is a large group of people, conflict always exists because of different perspectives and methods of doing things. For example, I received complaints from staff about differences in the organization of tasks in the medical unit. The morning or rather a day shift staff argued that the night duty staff always left the nursing table disorganized and they found it difficult to start the day’s work upon receiving the morning report. This issue made it difficult for communication between the two parties and sometimes the report was incompletely given due to the interpersonal differences. I understood that conflict was common between staff and people who responded to conflict through aggression (C. #5).

As a leader, I had to think of ways to solve the conflict that could otherwise affect patient care. I knew that the best approach was to do an investigation about the issue and determine the root cause. The following morning, I was up early to visit the unit and take the morning report while noting the differences in communication and interaction between the two teams. I realized that the two parties did not relate well and indeed the night shift staff had left the nursing table disorganized alongside other things. I planned to involve each team to explain the cause of the problem separately before coming to conclusion (C. #4). Upon collecting data on the causes of the problem, I planned to involve the two teams in a talk to settle the issue.

In the morning before the beginning of the report, I involved the parties in a small meeting where they presented their claims. The night duty staff argued that they were few and it was difficult to keep things organized as required due to the amount of work that was needed to be done. On the other hand, the day shift staff claimed that it was difficult to start the busy morning shifts with the disorganization. I realized that the two teams had an opportunity to make things work, only that they both wanted one party to be blamed. There was a lack of respect for the duties and responsibilities of each other’s shit (C. #11). Knowing that the problem could be solved, I planned to brief the staff on their respective duties.

Conflict resolution requires an approach that leaves both parties satisfied with the solution. I was strongly convinced that the night duty staff had time to organize the nursing station and tidy the working area before morning staff arrived. Therefore, I explained to the staff that it was their responsibility to keep the nursing working area clean and tidy before the beginning of the next shift. It was also their responsibility to organize patient’s files and deliver a comprehensive report despite the intensity of work available (C. #22). Using this approach made the night duty staff realize that it was not all about numbers when providing care, but the completion of one’s task for continuity of care.

The second approach involved defining the roles of the day shift staff and explaining how flexibility in their roles could work to improve patient care. For example, I asked them to empathize with the two-night shift staff who worked for long hours to provide care to patients. It was not good to hold them accountable for failing to organize the nursing station if indeed they had busy nights. Perhaps, the morning duty staff could make it a routine to check on the organization of the nursing station before beginning the day’s work (C. #46). However, I made it clear that it was entirely the responsibility of each shift’s staff to leave the working area organized.

To ensure the two parties resolved the issue, I informed them that I would be present the following day to observe how the shift handover was given. The following day, I realized that the night shift staff had managed to tidy and arrange the working area halfway before the morning duty staff arrived. Because of this effort, I observed that the two teams worked collaboratively to organize the working area before receiving the report. I realized that both parties were happy with the approach and promised to work together because at one point the shift would be interchanged. One week later, I visited the unit and I was pleased that the conflict resolution approach had yielded results (C. #59). There were no more delays in giving reports because the nursing station and working area were always prepared on time.

Nurses are involved in the provision of health education during care delivery to promote health and positive patient outcomes. It is my duty as a nurse to provide evidence-based education to patients and families at all times. For example, I had an encounter with a diabetic patient who wanted to learn more about self-monitoring and weight management strategies. On assessment. I realized that the patient had added weight and his blood pressure was increasing gradually. I knew I had to develop a health education plan that utilized technology to monitor his weight and perhaps his diet (C. #14). I managed to demonstrate weight management and monitoring of blood sugar levels using an application on his phone and how to keep in contact with his primary care health provider.

The nursing code of ethics promotes advocacy for the patient’s rights during care delivery. Nurses are supposed to be on the watch to ensure the patient is protected at all costs. For example, there was an issue with medication administration in the clinic I work where complaints about medication errors were reported. The main issue was in the emergency department where an influx of patients and under-staffing contributed to errors among the healthcare providers. I knew that the patient’s health status was at stake due to the numerous errors and something had to be done (C. #16). Therefore, I analyzed the staffing issue in the unit and wrote a recommendation to the administration to consider adding more staff in the ER. Eventually, medication errors decreased gradually as more staff were deployed in the unit.

Healthcare delivery to patients extends up to the community level to ensure patients are able to manage their health and utilize community resources. Community health nurses ensure patients have easy access to community resources that can change the health status of populations. I remember a colleague who came to me sometime back and explained how she felt she lacked enough social support. I asked her to meet me on a weekend so that we could discuss the way forward. I realized that she was so much into work that she did not find time to socialize. I advised her not to work overtime as before unless it was necessary. Secondly, I recommended her to join local women groups to promote sharing. She actually identified a group that met over the weekends for running and exercise and said that she felt comfortable with that group (C. #17). Later on, the nurse greatly appreciated my effort of talking her into utilizing community resources to build upon her weaknesses.

Nursing care delivery is characterized by an encounter of different patients with different medical conditions that necessitate the use of critical thinking and problem-solving approaches. I can recall taking care of a patient in the clinic who required a blood transfusion. The physician wanted the patient to have two units of blood before considering a possible transfer for surgery in a different healthcare facility. After 30 minutes of transfusion, I noticed that the oxygen saturation started going down to 95% then 90%. Immediately I thought the solution was to start oxygen and probably everything will be okay (C. #19). I put 2L of oxygen but the saturation levels still remained at 91%.

The physician was not around and so I had to step up. I thought, maybe I should listen to his lungs. His lungs were not as clear as before, I could hear crackles bilaterally (C. #20). Then I thought, what must be wrong with the patient? I knew there was something with fluid overload in the patient. Immediately I checked on the history and realized he had a history of CCF. The fluid intake according to the chart was +1.5 L and probably this made it difficult for the lungs to expand. I consulted with the physician and upon administration of Lasix positive results were achieved (C. # 18). Were it not for critical thinking, the patient’s condition could have worsened.

Nursing can be sometimes busy due to overwhelming tasks and organizing one’s tasks could be the solution to the management of tasks. I have been faced with various situations that required the organization of tasks to meet the daily objectives. For example, I had a busy schedule sometime back where I was part of the team performing quality improvement assessment in the unit. At the same time, I had to organize for patient transfers and compile reports about healthcare worker assessment. I thought, what could be the most appropriate approach to these tasks? I realized that setting goals for the completion of the tasks were necessary. Secondly, I had to delegate some tasks like an assessment of QI to a colleague who joined the team to ensure the day’s work was completed (C. #21). At the end of the day, I managed to achieve all the tasks perfectly through approaches of goal setting and delegation.

Communication is an important aspect of nursing care that ensures the building of relationships and channels for care delivery. The nurse should choose communication techniques that suit the patient given the circumstances of care. While providing care to patients, I always have these three approaches to communication: listen actively, allow asking of questions, and give feedback appropriately (C. #23). For example, I always give patients the time to express their thoughts and explain deeply how they are feeling. I have the ability to show empathy and stay enthusiastic to ensure I provide the most accurate care to solve the patient’s problems. I have found these techniques to be effective in promoting the opening up of patients and the establishment of a therapeutic relationship with my clients.

Unregulated care providers make up a significant portion of healthcare providers in Canada. They regularly assist healthcare providers to perform routine tasks according to their areas of designation. Providing education and guidance for healthcare assistants is important to ensure quality care delivery. I have not worked with UCPs before but I have participated in educating subordinate staff in my unit. For example, There was a time the patients complained about their bathrooms being dirty because they were not cleaned on time. As a leader, I took the initiative to educate the cleaning staffing how important a clean environment was to the healing of patients (C. #24). There was a positive response from the staff because subsequent cleaning was done on time and patients reported satisfaction with the level of cleanliness in their bathrooms.

Leadership in healthcare is important because it helps propel the organization forward through the realization of set goals. There are various types of leadership styles that nurse leaders can use including autocratic, democratic, transactional, transformational, and laissez-faire. For example, there were challenges with the use of resources in the clinic whereby most healthcare professionals did not assume the responsibility of appropriately using gloves. I observed that most people put a lot of gloves in their pocket and when the shift was over they would dispose of them. As a leader, I knew I needed to take action. I remembered how autocratic leadership was most suited to counter challenges and prevent waste of resources (C. #25). I made it mandatory for every staff who was found to misuse resources to face disciplinary action that could also include purchasing the supply.

Challenges in healthcare delivery exist each day and it is the nurses’ role to identify potential health problems and step up to solve the issues. Nurse leaders particularly have an obligation of identifying risk behavior in the healthcare environment and take action. For example, I was doing routine rounding in the clinic when I noticed that the staff doing the cleaning of the floor did not have any caution signs to avoid slips. I noted that patients were passing through without any knowledge that they might fall. I also knew that there was an increased risk of falls that could affect the health of patients, families, and other healthcare providers (C. #26). Preventing this risk was necessary by informing staff to use wet floor signs when cleaning.

Providing care to patients requires the healthcare provider to have full knowledge of the patient gained thorough history taking. Upon completion of history taking, general and focused assessments are used to gain more insight into the patient’s condition. For example, I had an encounter with a patient who came to the facility with complaints of fatigue, difficulty in breathing, and slight headache. On observation, the patient had a slightly puffy face and her lower limbs were swelled. Based on these findings, I decided to perform a focused assessment to gain more understanding of the patient’s condition (C. #27a). I started with vital signs which indicated an elevated blood pressure and heart rate. On further inquiry, I realized that the patient was a known hypertensive and was on medication until a few days ago when he started feeling unwell.

Due to the patient’s condition and history, I consulted with the physician on the most probable approach to treatment including further examination. The swelling on the lower limbs was a sign of fluid overload secondary to hypertension (C. #27b). Because the patient was on medication for a long and had not experienced any complications, I suggested an analysis of kidney functioning which could be a potential cause of fluid retention (C. #28a). I also had time to review my literature on the probable causes of fluid overload in hypertensive patients. The doctor also was into the idea of kidney problems because the patient’s medications included antidiuretics that could have worked (C. # 28b).

Further investigations from the patient revealed acute kidney failure which was probably caused by prolonged periods of hypertension. To ensure the patient received good care, he was put on antidiuretics to clear the fluid overload. Unfortunately, the response was not good as the patient became more restless and the blood pressure was shooting. Further assessment revealed that the patient had bilateral crackles that indicated fluid overload in the lungs. The priority care now was to maintain normal breathing through oxygen supplementation and other nursing interventions like propping up the patient (C. #28c).

As the patient continued to receive care, the doctors noted that his kidneys were slowly shutting down and the only intervention left was to start the patient on dialysis. Our facility did not have a dialysis center and this meant the patient was to be transferred for further management (C. #29). The expected outcome was that upon dialysis normal fluid balance could be restored and the patient’s condition could improve (C. #28e). At the facility, we worked to monitor the input and output of the patient while maintaining a continuous oxygen supply (C. #28d). While processing the transfer, I informed the patient on the new approach to the management of his condition that involved dialysis, and health education on dietary intake was given (C. #28f). The family was also notified of the changing plan of care for the patient. The collaborative practice demonstrated ensured that the patient left the facility in a stable condition ready for further management.

Health is influenced by many factors including genetics, individual behavior, physical influences, the environment, and access to medical care services. Nurses should take into consideration these factors and how they influence the health of individuals for effective planning of care. I once managed a patient who was about to be discharged home on medication and required a routine checkup. While providing discharge information and instructions I realized that the patient could not understand the instructions. I went back to the patient’s file to confirm the educational background where I realized a low level of education that probably hindered understanding. Therefore, I planned to involve the family in education before discharge to ensure instructions were well-understood (C. #30).

Nursing care delivery involves the performance of a wide range of tasks that include preventive, promotive, curative, rehabilitative, and palliative care services. In my experience, I believe I have worked to provide care to patients based on the five domains of nursing care. For example, I have ensured the promotion of health by giving health education to patients concerning their health issues. One example I can remember was education given to pregnant mothers in the MCH clinic concerning the importance of attending the routine visits to the clinic during pregnancy (C. #31a). The second aspect involved providing care to prevent disease and injury through the administration of medication. An example I provided earlier was the administration of Lasix to a patient who had CCF (C. #31b).

I have worked with a wide range of patients with mental health problems in the clinic especially those that come for monthly shots of medication. I once provided treatment to a patient diagnosed with a bipolar mood disorder who used to come for a regular checkup and monthly shots of modecate. During care delivery, I always tried to understand the patient while explaining the importance of seeking medical care. There were complaints from the family that the patient did not want to take his medications and sometimes had to be forced to come to the facility. Through socialization and interaction, I realized that the patient lacked someone to trust during the treatment period (C. #31c). Subsequently, the patient tried to maintain regular seeking of medical care that led to greater improvement of his health.

Rehabilitative and palliative care service provision is important to nurses because it demonstrates care to restore normal health. In my institution, several patients who have had accidents seek medical care. I observed that most care was provided to these patients while in wheelchairs. I realized that these patients needed walking aids to at least restore normal walking. I proposed to the administration to build walking rails in the exercise field where nurses and family members could help patients stand and walk (C. #31d). Regarding palliative care, I have numerously provided treatment to patients with terminal illnesses like cancer. Additionally, I have participated in training staff and colleagues on the administration of opioid analgesics to these patients including policies guiding the use of pain medication to cancer patients in the institution (C. #31e).

Collaborative care occurs between healthcare providers and patients to ensure the delivery of quality and patient-centered care. For example, I once collaborated with the physician to provide discharge health education to a patient who was about to go home with a suprapubic catheter. I knew that the physician could provide more knowledge to the patient on the importance of the catheter and when to come back for a checkup (C. #32). On the other hand, my role was to emphasize the cleanliness of the surgical area and how to empty and change the urine bag. The patient was cooperative and demonstrated understanding of the procedure and any precautions while at home.

Administration of medication is among the core functions or rather roles of nurses in any healthcare organization. While administering medication the nurse should take into account the five rights that include the right patient, right drug, right dose, right route, and administration at the right time. There was a time I noticed nurses in the medical wing did not observe appropriate medication administration techniques including giving drugs at the right time (C. #33). I collaborated with the nurse educator and practically demonstrated how to give drugs to patients including aspects of seeking consent before giving medication.

The rate of hospital-acquired conditions has increased in the recent past due to failure to observed hygiene and the use of aseptic techniques when necessary. For example, the wound dressing is among the procedures that require the use of an aseptic technique to prevent infection. When I was working in the outpatient department, I encountered several patients who required wound care. While providing wound care, I ensured the use of sterile gloves and a sterile pack for the dressing of wounds (C. #34). I also demonstrated to staff and students how to handle the sterile field including wearing masks during wound dressing.

Nurses are obliged to prepare patients for diagnostic and surgical procedures during care delivery. In the area I work, we do not have an operating theatre and all patients requiring such attention are referred. However, I remember when I was a student I used to prepare patients for surgical procedures such as cesarean section. The initial approach involved explaining to the patient about the procedure and seeking consent. I always ensured the patient signed the consent before the operation. Other preparations included shaving the operation area, gowning the patient, and putting labels for easy identification. Post-surgical care involved checking the surgical area for bleeding and administration of medication (C. #35).

I earlier explained how the nurse uses critical thinking and problem-solving approaches while providing care to patients. Another example that I remember was when I provided care to a patient who had undergone amputation. The patient was on home care and routine follow-up in another facility. Upon arrival, the patient complained of intense pain in the amputated leg. The doctor’s notes gave directions for the administration of morphine to ease the pain. However, the opioid did not seem to work. Then a thought crosses my mind, what if it is nerve compression that led to the pain? I had observed how patients with diabetic neuropathy struggled with nerve pain that did not respond to analgesics (C. #36). Therefore I suggested to the physician if we could try to use gabapentin and see if the pain could reduce. The physician agreed and shockingly upon administration of gabapentin the patient’s pain eased. This intervention made the doctor think from another perspective and eventually the patient was effectively managed (C. #52).

While providing care to patients, the nurse should critically analyze the aspects f patient care and make necessary decisions that suit the patient. When I was working in the medical wing, the physician I was working with wanted to perform the relocation of the hip for a patient who had an accident. He ordered the use of IV diazepam 10mg for sedation before the beginning of the procedure. However, I was not convinced with the decision because I thought a dose of 5mg was enough before using a higher dose (C. #37). Additionally, I noted that the patient was on hydromorphone which was used to manage his pain at home. I thought using a high dose of diazepam could lead to respiratory depression. I consulted with the doctor and we amicably decided to use 5mg of IV diazepam which worked perfectly.

The patient’s rights should be respected all the time while providing care. Involving the patient’s family into the patient’s care is also important but the patient should consent to the information shared with the family. I remember I had a difficult encounter with an elderly patient diagnosed with ESRD. The patient did not want the information to be shared with the family because he thought they would be scared. I had to explain to the patient the importance of involving the family in such situations and how they could feel if they found out he did not want to share. The patient eventually agreed to share the information but only with the elderly son. I knew it was my duty to respect the patient’s decision only to involve part of the family in his care (C. #38).

Healthcare delivery today is characterized by the use of technology to influence decisions about patient care. The use of technology evidently improves the quality of patient care. I remember using the electronic health record (EHR) system to influence patient care in the outpatient department. The system helped me gather history about a patient who was seeking subsequent medical care but we could not trace the file (C. #39). It was easy having the patient’s information in the EHR system and it saved me the time of taking a full history and confirming medications for the patient.

Health refers to the state of physical, emotional, and social well-being of an individual, but not merely the absence of disease. While providing care to patients, it is critical to understand the different determinants of health and how to help individuals make the right choices about their health. I remember when I attended to a 25-year-old patient who was having pre-diabetes and hypertension. On assessment, I realized that these conditions were related to the individual’s lifestyle and family history. I understood that having a family history of diabetes was a predisposing factor for the development of the condition. However, there was a need for the patient to work on weight management and practice exercise to keep healthy (C. #40). Therefore, I advised the patient to engage in daily exercise and practice healthy eating habits (C. #50).

Diversity in healthcare is important because it allows for interaction and dealing with patients from different backgrounds. The healthcare provider should understand that diversity affects how people perceive health and also how they receive care. For example, I realized that sometimes we had challenges in the clinic while providing care to patients who were non-English or Arabic speakers. In collaboration with the administration, we managed to bring interpreter services to provide assistance to those that had communication problems (C. #41). Secondly, the facility incorporated signs that could provide directions from the gate to different departments.

I work as the head of the nursing department in my clinic and one of my roles is to assign care to nurses and nursing assistants. Because the clinic always has a busy emergency unit, nursing assistants are available to provide care to patients under supervision. Among the care that I have assigned this personnel includes guiding patients to physician rooms, retrieving files, and records when required, and helping patients move around the busy unit. I understand that this personnel do not have special training and therefore can only perform basic tasks (C. #43).

Apart from assigning duties to this personnel, I regularly evaluate their duties to ensure they practice within the set guidelines and in accordance with the hospital policies (C. #58). I remember an incident when the ER was very busy and a patient required monitoring of fluids while awaiting review by the doctor. After assessing the patient’s condition, I was convinced that the nursing assistant could effectively monitor fluids for the patient and disconnect when fluid was over (C. #44). Eventually, the assistant helped in the monitoring of the patient as the nurses in the unit finished with other emergencies.

Nursing practice is guided by a code of ethics and professional practice guidelines that should be followed. I can proudly say that I practice diligently to accomplish my tasks according to the job description. For example, it is my role to assess patient care requirements for each department in the facility. I perform routine rounding to note any problems in the nursing departments and complaints from the patient (C. #45a). Secondly, I am obligated to promote the mission, values, and vision of the organization. I always ensure the enforcement of policies in the institution to ensure the attainment of quality care. For example, I recently wrote an internal memo to nurses reminding them about the importance of keeping time while stressing on the minimum working hours according to shifts (C. #54b).

Nurses use therapeutic communication techniques to provide support and information to patients. These techniques include active listening, acknowledgment, reflection, and clarification among many others. During routine rounding, I always encounter many patients with variable complaints. Sometimes I have to take time and listen to each patient and provide the most appropriate feedback or follow-up (C. #48). I understand that leaders should interact and socialize with staff and patients to identify challenges and address them appropriately. For example, three weeks ago I was doing evening rounds when I came across a patient complaining of lack of attention by the healthcare providers. The patient insisted that he had not been given medication and did not think he was receiving the most appropriate care in the institution. As a leader, I inquired with the nurse to determine the cause of the problem (C. #47). I later realized that the patient’s medication was not available in the pharmacy and that the patient’s relative had been informed to come with the drug. I explained the same to the patient and I observed a high degree of calmness upon receiving the news.

Health education is crucial in healthcare today because it informs one’s healthcare status and allows for the making of good choices. Different strategies such as training, role-playing, and concept mapping are available to provide education to providers and patients. While educating patients is important, I always make sure I use different strategies in the client’s learning. For example, I provided health education about the danger signs for babies that might make the mother seek medical care immediately in the MCH. After finishing the lesson, I asked the mother to teach-back what she had understood (C. #49). It was an effective step towards ensuring the client retained what was taught.

Nurses have an obligation to support health affairs by influencing policies and making decisions that lead to healthier populations. Such moves by nurses include attending seminars, conferences, and writing reports to influence decisions at the topmost levels. For example, I attended a meeting comprised of nurse leaders from private practitioner groups with the aim of improving private practice for nurses (C. #51). The meeting discussed aspects such as licensing for private practice and the formation of a union that could represent private nurse practitioners nationally. I felt that I was part of the team working to promote health and make nursing a better profession in the country.

Additionally, the meeting had agendas on the promotion of nursing activities and making nursing a better profession. One idea that I liked was a discussion on how to minimize nursing strikes in the country (C. #53). I believed there was room for improvement of nursing and our leaders had to step up and represent nurses at their hour of need. As a proposal, it was observed that regular evaluation of contracts and pending agreements was the best solution instead of waiting until strikes happened. I believed this idea could help change the nursing profession at large.

Nursing care delivery to patients is guided by a plan of care that is drawn before beginning the process of patient care. Sometimes it is difficult to follow the steps outlined depending on the patient’s condition especially during an emergency. For example, the routine nursing care for inpatients in the clinic includes taking the report, making patients comfortable through bed making and providing a bath, administering medication, and then doing investigations as per the patient’s needs. I remember there was a time I had to forgo the routine procedure and take the patient for an abdominal ultrasound early in the morning because I felt there was something wrong (C. #54). The patient was involved in an accident previously but kept complaining of stomach pain. I consulted with the doctor to incorporate the investigation that could perhaps identify something they had missed (C. #55). Later we realized that the patient was bleeding internally and this led to a change of care. I was glad that I used my clinical judgment to inform the new patient care approach that helped save the patient’s life.

Healthcare delivery is sometimes characterized by rapid changing events in the patient’s condition or the general patient environment. For instance, accidents can rapidly change how care is provided in an institution especially when there is a mass casualty. I remember several years back I was on duty during the weekend in the ER when an accident happened nearby. Almost all the patients had to be rushed to our facility before planning for transfer for those that needed advanced care. Because most of our staff take-offs during the weekend, I had to activate the backup plan calling for nurses to help in the critical situation (C. #56). Additionally, there was a need to mobilize resources such as IV lines, fluids, and medications from the other departments to help with the situation.

Organizational culture matters in healthcare today because it is an indicator of effective quality service delivery to patients. Organizational culture can be observed in aspects of patient care, the involvement of families in patient care, conflict resolution, and the recruitment of employees. For example, I observed that my healthcare institution has failed to maintain adequate staffing for long periods. It has become a norm that every department has to complain before new staff is added. As a leader, I believe this culture has a negative impact on quality service delivery to patients (C. #57). Future changes should be made to have a regular recruitment plan because the patient population is increasing every day.

Earlier I explained the importance of therapeutic communication to patients and what it entails. While communicating with patients, I always ensure I give them an ear by listening actively and providing feedback. For example, the encounter with the patient who complained that nurses did not give him attention made me realize the importance of giving feedback (C. #60). The nurses had done well to request medication from relatives but they did not inform the patient. However, after I told the patient what had happened, he was satisfied with the response.

Leadership styles commonly used in today’s healthcare system include transformational leadership, democratic, and transactional leadership. I believe I am a transformational leader because I always motivate colleagues to take ownership of their roles and perform beyond expectations. For example, I regularly organize meetings with nurses outside working hours to discuss their challenges and how best they can be improved. I approach problems from a positive perspective by using those experiences to build on new changes in the organization. These approaches to leadership have greatly made me a good leader that is loved in place of work (C. #61).

Evaluation is an important aspect of nursing care that helps nurses determine the effectiveness of their care delivery process. For example, I was providing discharge information to a diabetic patient including necessary education about the self-injection of insulin and dietary modification. After finishing the education, I realized that the patient understood more about the meal plan than the self-injection process. I had to change the teaching strategy to include online videos on self-injection where I realized that the patient understood more (C. #62). The evaluation process helped me understand the importance of using diverse education and teaching methods.

Ethical Practice

Diversity in healthcare means having patients from different ethnic, socioeconomic, and cultural backgrounds. This means that nurses should respect where patients come from and how they want to receive their care. For example, I remember I had an encounter with a patient who refused treatment and wanted to be discharged home. I was called as the head nurse to try and explain to the patient the importance of staying at the hospital and persuade the patient. However, the patient argued that she had small kids at home and did not feel comfortable to be admitted. As a nurse, I understood that patients had the right to refuse medical care unless it was life-threatening (C. #63). I eventually allowed the patient to sign the ‘against medical advice’ form before discharging the patient.

Nurses relate with different types of patients every day and one’s personal values, beliefs, and experiences greatly affect how they relate with patients. For example, I had this patient who was involved in an accident and unfortunately developed complications while receiving care in the facility. The patient had developed pressure ulcers that were unresponsive to treatment. It was so sad that the patient had given up, including the family members who did not visit regularly. The patient’s health status deteriorated because he could not eat well and he just wanted to die. On my side, believed the patient was going to recover if the most appropriate care could be given to the patient (C. #64). I consulted with the administration and we had a separate room for the patient where a high degree of cleanliness, hygiene, and sterility was observed when necessary. Eventually, subsequent care yielded results because of the interventions made and faith I had in healing.

I observed that this situation had a huge impact on care delivery in the organization. First, the nurses became more confident that their care can lead to positive change even during difficult situations. I also realized the importance of interprofessional collaboration during healthcare delivery to patients (C. #65). For instance, nurses and doctors worked closely during the management of the patient leading to faster recovery.

Ethical practice is acknowledged as an essential feature of good nursing care in today’s healthcare environment. Nurses ought to understand how to act morally and ethically when providing care to patients. For example, I understand that confidentiality is an important factor when providing care to patients (C. #66). When communicating with patients, I have always managed to establish a good therapeutic relationship that allows the sharing of information easily. I also understand that the information shared should be kept confidential unless the patient wants it to be shared. A good example is a patient I described earlier with ESRD who stressed that only the elderly son should be informed about his condition.

Ethical responsibility is the ability to act according to the standards of a professional body like the one governing nurses in a country. Legal rights on the other hand exist within a country or system to guide how individuals behave and access services. For example, I understand that every patient has the right to medical care regardless of their ethnicity, religion, or cultural background. At the same time, I understand that the nurse should provide medical care to patients using the ethical principles of beneficence, non-maleficence, and justice (C. #67). For instance, a patient has the right to medical care but also has the right to refuse medication.

While providing care to patients, nurses always ensure the patients are informed about the care including the risks and benefits associated with the care. The patient then is able to provide consent on whether to continue with care or use another approach in care delivery. For example, There was a patient who came to the ER with a dislocated hip after sustaining a fall. Upon examination and investigation, manipulation and alignment under sedation were required. I had to inform the patient about the use of sedatives and the potential risk like respiratory depression that could follow the procedure (C. #68). I understood that the patient had the right to refuse the use of sedatives based on the side effects.

The nursing standards of care require the nurse to provide safe, compassionate, and competent care to patients. For example, there was a patient who came for a routine medical checkup in the outpatient department accompanied by her mother. For confidentiality and privacy, I asked the mother to wait outside while conducting the physical examination and assessment. I focused on obstetrics which included things like LMP and the regular flow of menses. I realized that the lady had an abdominal mass and upon further investigation, she told me that she had not received her periods for the past two months. I probably knew she was pregnant, but she did not want me to tell her mother. However, she was 17 years old which gave me a go-ahead to share the information with the mother because she was a minor (C. #69). I talked the patient down and asked the mother to provide support because she was afraid of the reaction from the parent. Eventually, this demonstrated situations when confidentiality could go beyond the patient and the healthcare provider.

Interprofessional collaboration in healthcare exists to ensure the most appropriate care is provided to patients. During the collaboration with healthcare teams, the nurse must ensure the patient’s information is protected and shared only when necessary (C. #70). For example, I had a client in the MCH clinic who came with complaints of abdominal pain and occasional foul smell discharge from the vagina. She had used medication prescribed for possible UTIs but had not worked. There was a need to conduct a speculum examination to observe any problems. Upon examination, I realized that the patient had abnormal growths around the cervix that I was not sure of. I asked the client if I would consult so that we could establish the most appropriate diagnosis. I consulted the physician who observed and determined that they were cervical polyps.

The establishment of a good relationship with patients is crucial to treatment. However, the nurse should be able to differentiate between social and therapeutic patient relationships. For example, It is my responsibility to solve patient problems and fulfill their requirements. There is this patient that I used to interact with in the surgical wing because she had stayed in the facility for long. I noticed that our relationship got deep and she started asking for favors. At first, I thought it was good to give her some special treatment like giving her extra sheets and allowing her to use my phone to contact family members. However, in my reflection, I noted that our relationship was becoming more social than therapeutic (C. #71). I even started to avoid that ward because I knew she could take most of my time. I eventually had to explain to her about the situation and how maintaining a therapeutic relationship could be of benefit to us.

Nursing care delivery is strongly related to the environment where the care is delivered. A good environment promotes recovery and healing of patients including the promotion of peaceful death for those with terminal illnesses. As the head of the nursing department in my healthcare institution, I have managed to ensure that all patient rooms are kept clean. I understand that cleanliness of the environment is crucial to the prevention of the spread of microbes that could otherwise hinder faster healing. Secondly, a caring environment involves a nursing team that is focused to provide patient-centered care with the patient’s needs being put first. Through education, training, and motivation, I believe my nursing team is ready to provide a conducive healing environment for diverse patient populations (C. #72).

A therapeutic nurse-patient relationship is a helping relationship that is based on trust, respect, and natured in faith and hope. It is the type of relationship that allows sharing with the patient freely to achieve positive outcomes. For example, when I meet a patient in the wards or in the ER, I always start by greeting the patient and introducing myself (C. #73). Then I ensure the patient or the family introduces themselves before I ask for the patient’s complaints. These approaches always give me an upper hand at interacting with patients across all age groups. Other strategies that I use include active listening, maintaining eye contact, and interrupting when it is appropriate. I have realized that these approaches make patients gain confidence that they are expressing their feelings to a concerned healthcare provider.

Caring in nursing is an aspect that enables nurses to focus on the patient and provide assistance without feeling that they are being forced. It is manifested through actions either done to the patient or observed during communication. For example, There was this patient that had stayed in the institution for long due to the inability to clear his bills. While doing my duties, I could observe that the patient was ready to help other patients to eat and walk around because he was stable. Sometimes the nurses could call him to help when the day was busy and he had a good heart. I was so touched with the services of the patient to others and I thought I should do something to help him clear his bills (C. #74). I talked to the administration about the same and organized small fundraising within the facility to boost the patient’s finances. I was surprised that we managed to raise a lot of capital that enabled the patient to clear his bills.

Nurses are advocates of patients that ensure appropriate care is given to patients all the time. Sometimes ethical challenges arise while providing care to patients and it requires critical thinking to make the right choice. For example, when I was working with psychiatric patients, I encountered a patient who totally refused to take medication. At the back of my mind, I understood that failure to take medication could only worsen the patient’s condition (C. #75). I also knew that forceful medication can be administered to psychiatric patients if actions leading to refusal for medication can cause self-harm or harm the health of others. I consulted with the physician and eventually managed to forcefully administer medication against his will.

Diversity in healthcare involves providing care to patients from different communities, age groups, races, and ethnic backgrounds. Nurses should ensure the provision of care that respects and incorporates diversity. For example, I have had to solve issues in the inpatient regarding the wearing of hospital gowns or uniform for Muslim patients. The healthcare institution policy states that every patient seeking inpatient care should be on the right hospital uniform for identification. However, I understand that some communities are strongly rooted in their tradition that should be respected even during healthcare delivery (C. #76). Therefore, any patient claiming that their culture prevents wearing of different attire is assessed and proper decisions are made towards care for the patient.

Nurses have an obligation to ensure patients make informed choices all the time. This involves explaining to the patient the risks and benefits involved with undertaking certain procedures or medications. For example, I once encountered a patient in the ER who had a deep cut wound in the head sustained during an injury. On assessment, the wound would heal faster when stitched than when only dressed. The patient refused to stitch claiming that he had seen much bigger wounds that healed without stitching. I explained how stitching could enable faster healing and prevention of infection (C. #77). However, the patient stuck to his decision. I had no other option than to dress the patient and recommend routine dressing.

Every patient is affected by the environment in which their care is provided including individuals providing that care. Nurses have an obligation of advocating for the patient’s rights. For example, there was a time I experienced difficulties in planning for the patient’s care due to the involvement of the family members. The patient had a fractured femur that required reduction and casting alongside limb elevation and close monitoring. According to my experience, our facility did not stand a good chance of effectively managing the patient including complications that could arise. Upon advising the patient to seek referral services, I realized that the relatives did not want the transfer because they knew our facility was cheaper. I knew that the health of the patient came first than money and I was only doing what was best for the patient (C. #78).

I consulted with the medical department about the issue and they were also in support of the decision. I talked with the medical officers who indicated the need for the patient transfer. Secondly, I asked the medical team to try and explain to the patient’s family the importance of making the move before it was late. The medical team was cooperative because they managed to demonstrate to the patient and the family the importance of seeking special care in a more advanced institution (C. #80). Through collaborative practice and advocacy, I managed to help the patient receive the most appropriate care according to his condition.

Self-awareness is important for the personal and professional development of nurses. It involves the recognition of one’s emotions, potentials, strengths, limitations, and temperament which affects relationships in the healthcare environment. For example, I always find it within my reach to help new nurses and trainees to adapt to the organizational culture and the new healthcare environment (C. #81). I understand how difficult it is for new staff to fit into the organization as they try to provide quality care. During my free time, you will find me in the wards guiding trainees to perform patient assessments and ensuring their complaints are addressed to the latter. Additionally, I always make a follow-up for new employees and provide mentorship to ensure they are prepared to provide compassionate care.

I earlier described the importance of maintaining professional boundaries with patients. The encounter I had with the patient made me realize how social relationships can affect nursing care delivery. For example, I realized that maintaining professional boundaries with patients allowed the demonstration of equality while handling patients. Secondly, the practice has helped me to avoid issues with patients that could otherwise affect my job or even lead to the inability to deliver quality care (C. #82). An example is when I could avoid visiting the surgical ward because I did not want to come across the patient with who we had developed deep social attachments.

The healthcare environment can potentially promote healing or greatly affect the healing process when appropriate care and management is not in place. A good example is when there are safety issues that can lead to patient falls or patient harm. For example, I noticed during my routine rounding that some of the patient’s beds were not in optimum conditions. I had received a few incidence reports about patient falls related to poor functionality of the patient beds. In my monthly report to the administration, I included recommendations to consider purchasing new beds to replace the faulty ones that could potentially aggravate patient falls (C. #83).

Another incident I observed was the failure of some staff to maintain confidentiality. I heard staff sharing critical information about a patient to a colleague, information I thought was only meant to be between the patient and the client. I knew that this behavior could put the two in trouble if the patient fund out and it was against the nursing code of ethics (C. #79). I did not want to take action at this stage because I knew I had to warn them first and demonstrate how their actions could potentially affect their work and relationship with patients.

Service to the Public

The healthcare industry has evolved today to incorporate different aspects of care and service delivery to patients. Today, the use of technology in delivering healthcare as well as the use of evidence-based practices dominates the healthcare industry. For example, I attended a seminar six months ago which broadly discussed the impact of technology in delivering care and how the healthcare practitioners needed to adapt to the current changes (C. #84). I realized that the use of mobile applications to inform patients about their care was helping providers in the management of chronic conditions such as hypertension, diabetes, and obesity. This information helped me realize how easy it would make to deliver discharge information and health education to patients with the aid of these mobile app technologies.

While providing services to the community, nurses work with different healthcare team members that assume different roles. I remember when the institution organized a cancer awareness program, different members of the healthcare team were involved. Because of the diverse population, the nursing team was responsible for providing health education on breast and cervical cancer. I also ensured that senior nurses participated in cervical cancer screening in partnership with the physician team (C. #85). Additionally, the physician team was responsible for interpreting laboratory findings and prescribing appropriate medications for clients who had issues.

Different populations have different healthcare needs that nurses need to consider when allocating resources. For example, My healthcare organization provides care to patients of all categories except those that require intensive care and operation services. When I reflect back on the community needs in the practice environment, most people seeking medical care are faced with challenges of 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 importance of physical exercises.

Nursing knowledge and the incorporation of new methods to deal with conditions is increasing daily as technology takes over the healthcare world. It is imperative that nurse leaders develop plans to incorporate nursing research and technology into daily patient care. For example, I observed that that most interventions towards the management of chronic illnesses like diabetes today use mobile apps. These apps help patients monitor their weight, diet, and even foster communication between patients and healthcare providers. I already have a plan to include these technologies in the management of a selected disease with approval from the hospital administration (C. #88).

Every individual has strengths and weaknesses that define how one works to provide quality care to patients. I believe each individual has an opportunity to work upon their weaknesses when necessary to ensure efficient service delivery in healthcare. For example, one of my limitations is that I do not like delegating work. I always find myself doing every task to perfection and sometimes I am convinced that the only person who can accomplish the tasks better is me. Last year, I realized that I always left work late because I had to finish all my tasks. I consulted with my colleagues who I observed managed to finish their work earlier and they advised me to have a work schedule and delegate duties that I felt could be done by other people (C. #89). Although this solution did not work, I still believe I haven’t explored all avenues to find solutions to my weakness.

The problems commonly faced by individuals in my practice environment include chronic conditions like diabetes and hypertension. These diseases are a result of lifestyle choices that the community can probably work upon. For example, I proposed a plan last month to the administration to consider having a separate department that is in charge of discharging patients and providing health education (C. #92). I realized this plan could be important to ensure that every patient leaving the healthcare facility gets to be educated on the common problems in the community and possible solutions to the issue (C. #90). Secondly, the facility has managed to put posters on different corners stressing the importance of diet and exercise in controlling the two common burden diseases in the region: hypertension and diabetes.

The observed trends in nursing research include the use of evidence-based practices to improve quality and the use of mobile application technology to manage chronic diseases. My healthcare organization has plans to incorporate the technology aspect into patient care. Regarding the use of the evidence-based practice, the organization already has a collaborative team approach strategy in place to minimize errors in the medical unit (C. #91).

Interprofessional collaboration is recognized as an aspect of pf care that improves quality service delivery to patients. In the earlier example, I explained how nurses and doctors in the facility worked to ensure the success of the cancer education and screening program organized in the institution. To ensure the development of such collaborative efforts, the institution always has monthly meetings between heads of different departments to discuss ways that the teams work together and how to solve common healthcare issues (C. #93). For example, last month we discussed the increasing burden of healthcare-associated conditions. Plans are underway to demonstrate collaborative care between nurses and physicians to decrease HIAs.

Nurses work to protect the interests of the public and to protect the public from harm. Activities such as health education and increasing awareness of diseases in the community are among the actions that demonstrate the nurses’ responsibility towards maintaining and promoting public health (C. #94). For example, it was the initiative of the nursing team to have posters in the institution highlighting the importance of maintaining a healthy lifestyle through exercise and dietary modification. Secondly, as the head of the nursing department, I have organized several outreach programs for community health nurses and students to educate the public about common diseases like hypertension and obesity.

The management of resources in healthcare is a managerial function that ensures continuity of care and sustainability of the organization. Common resources to be managed include land, labor, capital, and entrepreneurship. For example, I work in an institution where a high level of accountability for one’s actions is practiced. Additionally, the management of resources while providing care to the patients is crucial to ensure that healthcare workers are responsible. I remember there was a time I realized that most departments did not have glucometers for monitoring blood sugar levels. Upon inquiry, I realized that the unit incharge failed to keep an inventory of the important equipment regularly used during patient care (C. #95). Today, every departmental head must submit a complete record of all stationery and be accountable for any lost equipment when necessary.

The healthcare environment can be unpredictable sometimes due to a rapid change of events. Nurses should utilize critical thinking and decision making skills when situations change. For example, I have severally consulted with nurses and physicians concerning emergency situations in the wards and the ER. There was a time when the nurses in the institution organized a go-slow because they felt they were not actively involved in making decisions concerning patient care and those that affected their well-being. I remember it was during the initial stages of my nursing leadership role and I was confused about what to do to calm down my people. I consulted the director of medical services concerning the most appropriate approach to the situation (C. #96). Eventually, his advice worked because I was able to contain the situation within a short period by summoning the nursing team and promising to air their grievances immediately.

Interprofessional collaboration is built upon trust and hearing of one’s views to determine whether they inform the current practice. Most of the collaborative approaches are observed in the ward s during mutual care for patients. For example, I was part of the multidisciplinary team during routine rounding in the medical ward. The team was discussing the management of patients with catheters and the probable causes of CAUTIs in the department. The nursing team argued that doctors did not perform a routine assessment for the need of the catheters and only recommended their removal upon the patient’s request (C. #97).

I was in the front run to explain to the consultant how his team failed to involve patients in their care and proposed solutions to solve the CAUTI problem in the unit. I was pleased to learn that subsequent care to the patients by the doctors involved checking for the need to have the catheters. Additionally, the collaboration between the nursing and the medical team increased while providing care to patients under catherization. I congratulated the consultant for ensuring his team worked collaboratively with patients and nurses because positive results could be observed (C. #98).

Evaluation of nursing care provided to patients is an important step towards determining the effectiveness of care provided. One of the trends I identified earlier in nursing research includes the use of EBP practice to inform patient care. Some time back we implemented the use of a multidisciplinary approach towards minimizing medical errors in the ER and the inpatient units. The basic concept behind the approach was that healthcare teams could work closely to provide care to patients at all times. Aspects of timely consultation and timely response to other teams were incorporated. Today, I can proudly say that the incidences of errors in the emergency department have decreased and more positive outcomes have been realized in other departments (C. #99).

Providing feedback in healthcare is crucial because it ensures future decisions on patient care improve upon past experiences. For instance, the collaboration between professional teams should be strengthened by giving feedback and acknowledging areas that are done well and recommending a change in poorly performed areas. For example, I provided feedback to the medical team about the improvement in CAUTI prevention after the establishment of a collaborative approach with patients and nurses (C. #100). I believe the approach to providing feedback was appropriate because it was well-appreciated by the consultant and other members of the medical team.

The second aspect of evaluation involves evaluation of self-awareness to the primary aims of the nurse towards maintaining and protecting the health of the public. I was involved in increasing awareness to the patients seeking healthcare in the facility on the burden of chronic diseases including diabetes and hypertension. I believe using the posters in the institution is one way of increasing awareness to the public. However, I am certain the message cannot reach several members of the public because the clinic does not provide care to a large population (C. #101). Perhaps, in the future, I should consider involving the public health sector through the public health nurse to ensure posters are available all over the area to address the issue of chronic conditions in the region.

The third aspect of evaluating service to the public involves the evaluation of physical resource use. These resources include capital, infrastructure, equipment, information technology, and healthcare professionals. In my healthcare organization, I discussed how I found gaps in the management of physical resources which led to a loss of equipment such as glucometers. Upon introduction of keeping an inventory on all medical equipment, I believe employees will be more active towards keeping an eye on equipment use and storage (C. 102). The approach will also increase accountability among staff ensuring that every member recognizes the importance of managing resources in healthcare.


There are various qualities that professional nurses should seek to emulate and maintain professionalism. These qualities include interaction, teamwork, integrity, compassion, and demonstrating a positive attitude towards others. For example, I was introducing students to their new clinical practice areas in the institution some time back. I observed that the students became more engaged when a friendly approach was used at the beginning of the process. I could create time thereafter to ask the students questions and respond to their issues including debriefing during critical events (C. #103). I believe I demonstrated mentorship because I was available for questioning and guiding the learners in their clinical areas.

Professionalism in nursing entails many things including aspects of style, communication, self-control, and confidence that define one’s professional presence. I believe acting professionally even changes how people perceive you the first time you meet. For example, If you met me at work during your first day, you will probably score me above 90% in terms of my professional presence. I deeply value my physical appearance and I always maintain a positive smile when interacting with clients (C. #104). In the workplace, I know the names of every nurse and several other physicians and colleagues because I am attentive and have a good memory. I always mentor students and advise them to dress well, use etiquette, and act in a professional manner.

Healthcare organizations are constantly changing as a result of technological advancements and nurses ought to adjust appropriately to fit in the dynamic healthcare environment. The nurse should identify changes in the nursing environment and act appropriately. For example, in 2014 when our organization implemented the use of EHR technology, it took me time to adjust to the new method of documenting patient data (C. #105, C. #116). I was traditionally used to that approach of gathering information from the patient, performing an assessment, and then going back to document when done with the provision of nursing care. I had to change my approach to the documentation of data because most of the EHR documentation is done simultaneously unless in areas of medication administration.

Professional standards of nursing practice are available to guide nursing care delivery including identification of areas of weakness in one’s practice. This requires the evaluation of one’s practice through reflection or using evaluation tools to gauge how competent care delivery is done. For example, during an emergency situation in the ER, I felt I was not calm and quick enough to provide resuscitation to a patient who had CCF. Later, I reflected on the events leading to the undesirable outcome and realized I needed to replenish my CPR skills and the use of resuscitation medication (C. #106a).

Later on during the holiday, I created time and attended a three weeks course on emergency care that I believe helped boost my skills on resuscitation and the administration of emergency drugs to patients (C. #106b). In another situation, I was able to collaborate effectively with the pediatric team to resuscitate a baby who had aspirated meconium. I realized I had improved my mastery of providing CPR and reassessment of the patient before beginning subsequent cycles of compression (C. #106c). Eventually, we were able to save the life of the baby through teamwork.

The use of nursing research has taken root today as researchers look for evidence-based practices to inform nursing care. EBP use enables nurses to understand the effectiveness or risks associated with treatment or diagnostic tests. For example, there is increasing evidence supporting the importance of communication and collaborative practice towards improving patient outcomes. I acknowledge this strategy because I understand how care delivered by different healthcare teams without proper communication affects patients and resource use in the organization (C. #107). Research functions to demonstrate how new approaches to patient care can promote healing, patient-centered care, and minimize waste in the healthcare environment.

Nursing is a profession governed by professional bodies in different countries. In Canada, the College of Nurses of Ontario (CNO) is the governing body for registered nurses, registered practical nurses, and nurse practitioners. I understand that the college enforces the standards of practice and conduct for nurses, establishes the requirements for entry to practice, and administers a quality assurance program to ensure nurses practice according to the set standards (C. #108a). Additionally, the body engages in the legislative process to set laws governing nursing practice in the country. Registered practical nurses in Canada belong to different professional organizations such as RPNAO. This organization is the voice of registered nurses that works to listen to the needs of nurses and advocate on their behalf (C. #108b). Membership is only allowed to licensed practical nurses but other memberships are available for students and non-practicing members. Nursing unions such as CFNU are available to advocate for key health priorities and the future of public healthcare in Canada (C. #108c).

Nursing informatics involves the use of technology to communicate and inform patient care. Technology use has greatly impacted care delivery today and has led to positive patient outcomes. For example, I remember before the introduction of computer systems in our organization we used to keep a lot of files containing patient information. Today, we usually document patient information in the computer system and the files are only available to guide patient care at the bedside (C. #109). This means that nurses must be computer literate to provide care in hospitals and should sharpen their skills while learning the legal implications of using technology in healthcare today (C. #113f).

Electronic health records have made it easy to document and retrieve patient information today. For example, while attending to a patient in the outpatient department, the physician ordered a stat dose of 10mg morphine to reduce the pain sustained during an accident. After checking for the availability of the drug in our stores I realized I needed to place an order from the pharmacy. The EHR system was the easiest method to make the request. I keyed in the patient information and prescribed the drug (C. #110a, C. 3117a). Secondly, I sent the request directly from the computer to the pharmacy indicating the urgency for the drug (C. #117b). I knew that the EHR system in the ER was compatible with that in the pharmacy department allowing for easy communication of data. I then went to collect the drug and administered it to the patient (C. #110b). Administration of opioid medication in our unit requires keeping records for the drug use to avoid overdose and ensure it was used for the intended purpose. In the EHR system, I accurately documented the time of drug administration, dosage, and reason for the medication (C. #42).

Computer technology can also be used to share information outside the organization especially to regulatory bodies or when making orders for supplies. For example, I am responsible for maintaining records on communicable diseases and communication of the same to the public health ministry. Monthly reports on communicable diseases are sent via email to the ministry of health (C. #110c, C. #117c). Lastly, I do use computer technology for learning purposes including validation of EBP use in nursing. For instance, I recently reviewed the WHO guidelines on hand hygiene and research evidence supporting the practice to reduce HAIs (C. #110d). I intend to propose education on hand hygiene using the guidelines both to nurses and physicians in the surgical department (C. #117d).

Professional growth and development for nurses are important for those seeking to elevate their positions and responsibilities. While many professionals are advancing their profession through continuing education, professional growth can be achieved through training (C. #111). For example, Three months ago I attended a training for nurse leaders that focused on conflict resolution in healthcare. I managed to learn different causes of conflict, how to identify conflict, and strategies to handle conflicting parties. I believe such training is an advancement in my career as a nurse leader.

Nursing practice is guided by a set of standards that regulate the individual’s behavior and how care is provided to patients. Sometimes a violation of these standards can be of consequence to the nurse and can lead to legal action. For example, a few years ago I had a case of a male nurse who reported to work on the weekend while drunk. Professional standards for nursing practice are against such behaviors that can put the lives of patients at risk due to impaired judgment (C. #113a). Because I was not on duty, I waited until the following Monday when I summoned the nurse to find out what had happened. I explained how drinking at work could have caused problems that could have led to actions like fights or assault to colleagues (C. #113c). I asked the nurse to write an apology letter to explain the reason and to state how he would like to deal with the issue. Secondly, I gave a last warning for the unprofessional behavior and he signed down any action of the same could automatically lead to disciplinary action (C. #113b, C. #113d).

Quality assurance represents an ongoing evaluation of services and the impact of these services on patient care. The process helps determine processes that are working and any changes that might be required. For example, the quality assurance committee conducts monthly audits on the effectiveness of follow-up programs for patients after discharge. For the past six months, the institution has recorded a higher response rate for patients coming back for subsequent appoints due to the follow-up program (C. #113e). Additionally, the program has demonstrated how the use of follow-up using phone calls can yield positive results.

Continuing development for nurses is crucial to ensure nurses get to influence policies and stand a chance to represent others at the topmost levels. For example, I am a nurse administrator in my institution and I am part of the administration committee that ensures the setting of goals for the organization. I have attended meetings to analyze hospital policies and those that involve the implementation of the new change in the organization (C. #114).

Organizational policies and procedures are available to guide healthcare professionals in making the most appropriate choices during patient care. For example, the institution has a strong policy on accepting patients coming in as referrals from other facilities. A phone call should be made first to confirm the availability of space and to ascertain if the medical condition can be managed better in our facility. I remember there was a time a patient was brought in an ambulance from another institution without prior information. Upon assessing the situation, I realized that it was against the hospital policy to receive the patient (C. #115). I had to inform the nurse to go back with the patient and make further inquiries later if space was available to take in their patient.

Informatics in healthcare has significantly improved how care is delivered through the various technological approaches used. First, I believe informatics has helped in reducing medical errors through improved communication. For example, the nurses and the physicians are able to document medications in the EHR system which makes it easy to retrieve the data (C. #118). Another example is that informatics has helped save time during patient care leading to lower costs of healthcare delivery.

Evaluation is an important step because it helps establish how well a process is working after implementation. For example, I described earlier how the introduction of the electronic health record system impacted my delivery of nursing care to patients. I believe the EHRs have improved documentation of patient data compared to the traditional paper system (C. #120). Minimal errors are made when documenting and the information can easily be retrieved when required. Secondly, informatics and technology have reduced costs of care delivery in the hospital. For example, patients used to take several hours in the ER before they could see a physician. Today, patients spend as less than 30 minutes on a busy day to be seen (C. #121). In my organization, the maximum waiting time in the ER is 45 minutes compared to two hours before the introduction and incorporation of informatics into patient care.

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