Professional Adjustment in Nursing Handout

Contents

Introduction to Professional Adjustment in Nursing

Professional adjustment in nursing refers to the process by which nurses adapt to the evolving roles and responsibilities within the healthcare system. It encompasses understanding the history of nursing, the roles of regulatory bodies and professional organizations, ethical and legal issues, and the application of nursing theories in practice. Nurses are expected to comport themselves professionally, adhere to ethical codes, and continuously reflect on their practice to improve patient care.

This handout will cover key concepts related to the professional adjustment of nurses, including the history and development of nursing, ethics, nursing theories, communication skills, hospital etiquette, and reflective practice.


1. Introduction to Nursing

Nursing has evolved significantly over time, from its roots in caregiving to becoming a respected profession that combines science, compassion, and leadership. Understanding the history of nursing is crucial to appreciate its role in healthcare today.

a. History and Development of Nursing in the World and in Ghana

The history of nursing is shaped by many important figures and events that contributed to the development of modern nursing practices.

  • Global Development:
    • Florence Nightingale: Known as the founder of modern nursing, Florence Nightingale’s efforts during the Crimean War (1853–1856) led to significant improvements in hospital sanitation and patient care. Her emphasis on cleanliness, nutrition, and record-keeping laid the foundation for evidence-based nursing practice.
      • Example: Nightingale’s work in organizing hospital wards and reducing infection rates is still relevant in today’s nursing practices, particularly in infection control protocols.
    • Mary Seacole: A pioneering Jamaican-British nurse and contemporary of Florence Nightingale, Mary Seacole contributed to healthcare during the Crimean War by providing care to soldiers on the battlefield. She was an early advocate for holistic care, treating both the physical and emotional needs of patients.
  • Nursing in Ghana:
    • The development of nursing in Ghana began under British colonial rule. The first formal nursing education program in Ghana was established in the early 1940s.
    • Major Players in Ghana: Key figures such as Josephine Akosua Mintah, the first Ghanaian Principal Nursing Officer, contributed to the growth of nursing education in Ghana. The establishment of the Ghana Registered Nurses and Midwives Association (GRNMA) in 1960 further solidified the profession’s structure in the country.
      • Example: The GRNMA plays a crucial role in advocating for nurses’ rights and improving working conditions for healthcare professionals in Ghana.
b. Nursing Associations and Groups

Nursing organizations support the professional development of nurses, set standards of practice, and advocate for healthcare policies.

  • Ghana Registered Nurses and Midwives Association (GRNMA): This organization advocates for the rights and welfare of nurses in Ghana. It also organizes professional development programs and ensures that nurses adhere to ethical standards.
  • International Council of Nurses (ICN): A global federation of national nursing organizations that represents nurses worldwide. The ICN advocates for health policies that strengthen healthcare systems and improve nursing practice.
  • West African College of Nursing (WACN): Focuses on advancing nursing education, practice, and research in West Africa. The WACN also provides certification for nurses in the region.
  • Ghana College of Nurses and Midwives (GCNM): An educational body focused on providing postgraduate training and certification for nurses and midwives in Ghana.

2. Health Professions Regulatory Bodies in Ghana

Regulatory bodies are responsible for setting standards of practice, accrediting nursing programs, and ensuring that nurses are licensed to provide safe and competent care.

  • Nursing and Midwifery Council (NMC) of Ghana: The NMC is the regulatory body for nursing and midwifery practice in Ghana. It ensures that nursing education programs meet national standards and oversees licensure examinations for nurses and midwives.
    • Example: Before practicing, nurses in Ghana must pass the NMC licensure examination to demonstrate their competency.
  • Health Professions Regulatory Bodies Act, 2013 (Act 857): This act provides legal frameworks for the establishment and operations of regulatory bodies overseeing healthcare professionals in Ghana, including nurses and midwives.

3. Educational Programs in Nursing

Nursing education prepares individuals to provide safe, effective care through theoretical knowledge and practical training.

  • Diploma Programs: These are entry-level programs that train nurses in basic nursing skills. In Ghana, many nurses begin their careers through diploma programs before advancing their education.
  • Degree Programs: Bachelor’s degree programs provide a broader and more in-depth understanding of nursing science, healthcare management, and leadership.
  • Postgraduate and Specialist Programs: Programs such as those offered by the Ghana College of Nurses and Midwives provide advanced training in specialties such as pediatrics, mental health, and critical care.
    • Example: Nurses specializing in mental health may pursue further training to work in psychiatric hospitals or provide community-based mental health services.

4. Ethics and Ethical Codes in Nursing

Ethics form the foundation of nursing practice, guiding nurses in making decisions that respect the dignity and rights of patients. Adhering to ethical codes ensures that nurses provide care with integrity and professionalism.

a. Ethical Issues in Nursing
  • Patients’ Charter: Outlines the rights and responsibilities of patients in healthcare settings. Nurses are required to respect these rights, which include the right to informed consent, confidentiality, and respect for personal privacy.
  • Informed Consent: Nurses must ensure that patients understand the treatment options available to them and the risks involved. Consent must be voluntary and based on a clear understanding of the patient’s condition.
    • Example: Before administering medication, a nurse explains its purpose and potential side effects to the patient and ensures they agree to take it.
  • Confidentiality: Nurses are obligated to protect patient information. Any breach of confidentiality can result in disciplinary action or legal consequences.
  • Clinical Trials: When patients participate in clinical trials, nurses must ensure that they fully understand the implications and risks associated with the trial.
b. The Nurse’s Pledge

The nurse’s pledge is an oath that outlines the commitment of nurses to provide compassionate, ethical, and professional care to patients. It emphasizes values such as loyalty, integrity, and dedication to improving patient health outcomes.

c. Qualities of a Nurse

Nurses are expected to display professionalism in all aspects of their work. Key qualities include:

  • Compassion: Nurses should provide care that is kind and sensitive to patients’ needs.
  • Integrity: Nurses must act honestly and uphold the ethical standards of the profession.
  • Adaptability: The ability to adjust to different clinical environments and patient needs is essential in nursing practice.

Adjusting to Clinical Nursing: As students transition from the classroom to clinical settings, they must adapt to the fast-paced environment of hospitals and learn to manage complex patient care situations.


5. Nursing Theories

Nursing theories provide a framework for understanding and guiding nursing practice. They help nurses make decisions about patient care and contribute to the development of nursing as a science.

  • Florence Nightingale’s Environmental Theory: Focuses on how the environment affects patient health. Nightingale believed that a clean, well-ventilated, and quiet environment promotes healing.
    • Example: Nurses should ensure that the patient’s environment is clean, well-lit, and comfortable to promote recovery.
  • Virginia Henderson’s Theory (14 Basic Needs): Henderson outlined 14 basic needs that nurses should address, including the need for nutrition, safety, and social interaction.
    • Example: Nurses assess a patient’s ability to eat, sleep, and move independently, addressing these needs in care planning.
  • Betty Neuman’s Systems Model: Focuses on the patient as an open system interacting with internal and external stressors. The goal of nursing is to stabilize the patient and reduce stress through holistic care.
    • Example: When caring for a patient with chronic illness, nurses manage the physical, emotional, and social aspects of the patient’s health.
  • Dorothea Orem’s Self-Care Model: Emphasizes patient independence by encouraging self-care. Nurses assist patients in performing tasks they cannot do for themselves and promote autonomy whenever possible.
    • Example: Teaching a diabetic patient how to self-administer insulin is an example of promoting self-care.

6. Hospital Etiquette

Hospital etiquette refers to the expected behavior and conduct of healthcare professionals in clinical settings. Nurses are required to follow professional standards in their interactions with patients, families, and other healthcare workers.

  • Respect for Patients: Nurses should always address patients respectfully, listen to their concerns, and explain procedures clearly.
  • Professional Dress Code: Nurses are expected to maintain a clean, neat, and appropriate appearance. This promotes professionalism and reassures patients.
  • Teamwork: Nurses should work collaboratively with other members of the healthcare team, ensuring that patient care is seamless and coordinated.

7. Customer Care and Interpersonal Relationships

Customer care in healthcare focuses on creating positive experiences for patients and their families. Good interpersonal relationships are essential for effective communication, trust, and satisfaction.

  • Active Listening: Nurses must actively listen to patients’ concerns to understand their needs and provide appropriate care.
  • Empathy and Compassion: Providing care with empathy helps build trust and makes patients feel valued.
  • Handling Complaints: Nurses must remain calm and professional when addressing patient complaints. Listening and providing timely solutions are key.

8. The Law, the Nurse, and Society

Nurses are bound by laws and regulations that ensure they provide safe, ethical, and professional care. It is important for nurses to understand the legal implications of their actions and decisions.

a. Nursing Regulations in Ghana
  • Nurses Regulations LI 683 of 1971: Governs the professional practice of nursing in Ghana.
  • Mental Health Act 2012, Act 846: Provides guidelines for caring for patients with mental health conditions, ensuring that they receive humane and ethical treatment.
b. Common Legal Offenses in Nursing
  • Tort: Civil wrongs that cause harm, such as negligence or malpractice.
    • Negligence: Failing to provide the expected standard of care, resulting in patient harm.
    • Assault and Battery: Physically harming a patient or administering treatment without consent.
  • Criminal Offenses: Include serious crimes such as murder, manslaughter, or embezzlement, which may occur in the healthcare setting.

9. Major Religious Denominations and Their Doctrinal Effect on the Client, Patient, and Family

Religion and spirituality play a significant role in patients’ lives, especially in the context of illness and healing. Understanding the religious beliefs of patients can help nurses provide holistic care that respects patients’ spiritual and emotional needs. Different religious denominations have specific practices and beliefs that may affect how patients view healthcare, illness, and treatment options.

a. Spiritual Needs of the Patient

Spirituality is an important aspect of holistic care. Patients may have specific spiritual needs that must be addressed during illness, such as prayer, religious rituals, or emotional support from religious leaders.

  • Assessment of Spiritual Needs: Nurses should assess a patient’s spiritual needs by asking about their religious beliefs, practices, and any spiritual support they may need during their illness. It is important to be respectful and non-judgmental in these discussions.
    • Example: A nurse caring for a devout Christian patient might offer the option of arranging a visit from a pastor or providing a quiet space for prayer.
  • Spiritual Healing: Some patients believe in spiritual healing through prayer or rituals. Nurses should respect these beliefs and, where possible, support the patient’s spiritual practices in addition to medical treatment.
    • Example: A Muslim patient may want to perform prayers five times a day. The nurse can ensure the patient has access to a clean space and the time needed to fulfill this religious obligation.
  • Concepts and Existing Religions in Ghana and the World:
    • Christianity: The largest religion in Ghana, with various denominations (Catholic, Methodist, Pentecostal, etc.), each with specific practices regarding illness and death.
    • Islam: Muslims may have specific dietary restrictions (e.g., halal food) and prefer to be cared for by healthcare providers of the same gender.
    • Traditional African Religions: Some patients may practice traditional beliefs, which could influence their views on illness and healing, such as the use of herbal remedies or ancestral rituals.
b. The Duties and Responsibilities of the Hospital Chaplain

Hospital chaplains provide spiritual support to patients, families, and even healthcare staff. They play an important role in addressing the emotional and spiritual concerns that arise during illness or hospitalization.

  • Chaplains Provide:
    • Spiritual Counseling: Chaplains offer counseling to patients and families struggling with the emotional aspects of illness, death, or loss.
    • End-of-Life Care Support: Chaplains help patients and families navigate the spiritual and emotional challenges of end-of-life care.
    • Multifaith Support: Chaplains often serve patients of all faiths, providing non-denominational spiritual support or arranging visits from specific religious leaders as needed.

10. Psychological and Social Needs of Patients

Illness affects patients not only physically but also psychologically and socially. Nurses need to address these aspects to provide holistic care that promotes overall well-being.

  • Psychological Needs:
    • Emotional Support: Many patients experience anxiety, fear, or depression related to their illness. Nurses should provide reassurance, listen actively, and refer patients to mental health services if needed.
    • Coping with Illness: Nurses can help patients develop coping strategies to deal with the stress and uncertainty of illness. Encouraging relaxation techniques or connecting patients with support groups can be helpful.
  • Social Needs:
    • Family Involvement: Family plays a central role in the patient’s recovery process. Nurses should involve family members in care discussions and decision-making, ensuring they understand the patient’s condition and treatment plan.
    • Support Systems: Nurses should assess a patient’s support system, including family, friends, and community resources. If a patient lacks social support, nurses can connect them with social services or community organizations.

11. Persons with Hearing Impairment

Communicating with patients who have hearing impairments requires special skills and adaptations to ensure they receive the same quality of care as other patients.

  • Effective Communication Strategies:
    • Sign Language: For patients who use sign language, a trained interpreter may be needed to facilitate communication.
    • Written Communication: Nurses can use written notes or whiteboards to communicate important information to patients with hearing impairments.
    • Lip Reading: Some patients may rely on lip reading, so it is important for nurses to speak clearly, face the patient, and ensure good lighting.
  • Patient Advocacy: Nurses must advocate for the needs of hearing-impaired patients, ensuring that they have access to assistive devices (e.g., hearing aids) and appropriate accommodations during their healthcare experience.

12. The Health Care Team

Healthcare is delivered by a multidisciplinary team, and nurses are essential members of this team. Understanding the roles of different team members helps nurses collaborate effectively and provide coordinated patient care.

a. Members of the Health Team

The healthcare team includes a range of professionals, each with specific roles and responsibilities:

  • Nurses: Provide direct patient care, administer medications, and coordinate treatment plans with the rest of the healthcare team.
  • Doctors/Physicians: Diagnose illnesses, prescribe treatments, and perform medical procedures.
  • Pharmacists: Ensure that patients receive the correct medications and provide education on how to take them.
  • Physiotherapists: Help patients regain physical function through exercise and rehabilitation techniques.
  • Dietitians/Nutritionists: Advise on proper nutrition and create dietary plans tailored to the patient’s health needs.
  • Social Workers: Assist patients with psychosocial challenges, including access to resources, financial aid, and counseling services.
  • Medical Technologists: Perform diagnostic tests, such as blood work, X-rays, and MRIs, to support the diagnosis and treatment of patients.
b. Factors Promoting Effective Teamwork
  • Clear Communication: Effective communication is essential for ensuring that all team members are aware of the patient’s condition, treatment plan, and progress.
  • Respect and Collaboration: Team members must respect each other’s expertise and work collaboratively to ensure that the patient receives comprehensive care.
  • Role Clarity: Each team member must understand their role and the roles of others to avoid duplication of efforts or gaps in care.

13. Quality Assurance and Improvement

Quality assurance in healthcare focuses on maintaining and improving the quality of care provided to patients. Nurses play a crucial role in monitoring and improving the standards of care.

a. Concepts of Quality Assurance

Quality assurance involves the systematic monitoring and evaluation of healthcare services to ensure that patients receive safe, effective, and high-quality care.

b. Importance of Quality Health Care
  • Patient Safety: Quality care ensures that patients are protected from harm, including medical errors, infections, and injuries.
  • Patient Satisfaction: High-quality care leads to better patient outcomes and satisfaction, which is important for both patient well-being and the reputation of the healthcare facility.
c. Dimensions of Quality Assurance
  • Effectiveness: Ensuring that care provided is evidence-based and achieves the desired health outcomes.
  • Efficiency: Delivering care in a timely and cost-effective manner.
  • Equity: Ensuring that all patients receive the same level of care regardless of their background or circumstances.
d. Evaluating Quality of Care

Quality of care is evaluated through patient outcomes, feedback, and performance metrics.

  • Patients’ Point of View: Patient satisfaction surveys and feedback provide insight into how well healthcare services are meeting patients’ needs.
  • Medical Providers’ Point of View: Healthcare providers assess the effectiveness of care based on clinical outcomes, treatment success rates, and adherence to best practices.
  • Hospital Manager’s Point of View: Hospital managers focus on the overall quality of services, patient safety, and operational efficiency.

14. Conceptual and Theoretical Principles in Nursing

Nursing practice is guided by conceptual frameworks and theories that provide a foundation for understanding patient care and developing nursing interventions.

a. Selected Nursing Principles
  • Fuerst and Wolfe’s Principles: These principles emphasize the importance of the nurse-patient relationship and the nurse’s role in providing personalized care based on the patient’s unique needs.
  • Myra Levine’s Conservation Model: This model focuses on promoting patient healing through conservation of energy, structural integrity, personal integrity, and social integrity.
  • Maslow’s Hierarchy of Needs: Nurses use Maslow’s framework to prioritize patient care based on the hierarchy of human needs, from basic physiological needs to self-actualization.
b. Selected Nursing Theorists
  • Florence Nightingale (Environmental Theory): Emphasizes the impact of a clean, well-ventilated, and quiet environment on patient health.
  • Virginia Henderson (14 Basic Needs): Henderson outlined 14 fundamental needs that nurses should address, such as breathing, eating, and maintaining hygiene.
  • Betty Neuman (Systems Model): Focuses on the patient as an open system interacting with internal and external stressors.
  • Dorothea Orem (Self-Care Model): Encourages patient independence and self-care.

15. Job Description and Scope of Practice

Nurses must understand their roles, responsibilities, and the scope of their practice to ensure they provide safe and effective care.

a. Registered General Nurse (RGN)

RGNs are responsible for providing direct patient care, administering medications, coordinating treatment plans, and educating patients on health management.

b. Nurse Assistant (Clinical)

Nurse Assistants provide basic nursing care under the supervision of registered nurses. Their tasks include assisting with daily activities, monitoring vital signs, and providing comfort to patients.

c. Expected Behavior and Attitude of the RGN
  • Effective Communication: Nurses must communicate clearly with patients, families, and the healthcare team to ensure coordinated and effective care.
  • Assertive Behavior: Nurses should advocate for their patients while maintaining professional relationships with colleagues.
  • Managing Challenging Behaviors: Nurses need to manage difficult behaviors from patients or families while maintaining composure and professionalism.
  • Handling Complaints: Nurses should address patient complaints calmly, listen to concerns, and take appropriate actions to resolve issues.

16. Reflective Practice in Nursing

Reflective practice allows nurses to learn from their experiences, improve their practice, and provide better patient care.

a. The Concept of Reflective Practice

Reflective practice involves thinking critically about one’s actions and experiences to continuously improve skills and knowledge. It encourages self-awareness and professional growth.

b. Importance of Reflective Practice
  • Continuous Improvement: Reflection helps nurses identify areas where they can improve their practice.
  • Patient Safety: By reflecting on previous experiences, nurses can avoid repeating mistakes and improve patient outcomes.
c. Types of Reflection
  • Reflection-in-Action: Reflecting during a situation or experience.
  • Reflection-on-Action: Reflecting after a situation has occurred to analyze what went well and what could have been done differently.
d. Reflective Models (Gibbs)

Gibbs’ Reflective Cycle provides a structured approach to reflection, including six stages: description, feelings, evaluation, analysis, conclusion, and action plan.

e. Application of Gibbs’ Principles in Nursing

Nurses can apply Gibbs’ cycle to clinical situations to better understand their decision-making processes and identify areas for improvement in patient care.

Professional adjustment in nursing encompasses understanding the historical, ethical, legal, and professional aspects of nursing. By mastering the principles outlined in this course—such as ethics, nursing theories, hospital etiquette, and reflective practice—nurses can deliver high-quality, compassionate, and effective care. Continuous professional development and reflection are essential for staying current in nursing practice and ensuring that patients receive the best possible care.

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