Nursing Role Communication Lecture 4 (Oct 6, 2024) PDF

NURSING ROLE COMMUNICATION Discuss professional role relationships among nurses in health care Distinguish among the professional nursing role opportunities Describe the components of professional role socialization in nursing Construct a model of safe, supportive work environments...

NURSING ROLE COMMUNICATION Discuss professional role relationships among nurses in health care Distinguish among the professional nursing role opportunities Describe the components of professional role socialization in nursing Construct a model of safe, supportive work environments they would work in Discuss the advocacy role in nurse–person relationships Apply evidence-informed role research to clinical practice situations. Understanding & Communicating Nursing Role(s) Role –a multidimensional psychosocial concept defined as a traditional pattern of behaviour and self-expression performed by or expected of an individual within a given society Your role is: A job title- your position, authority or power in the healthcare organization. - E.g. RPN, RN, CNS/CNE, NP Set of expectations: working with other members to provide care to the public Responsibilities: Use holistic approaches to health promotion & education, disease management and enhance access to care Behaviours: creating an environment where patients feel safe, respected and cared for. - E.g. imagine a nurse rolling their eyes after a patient complains of pain, or talking about a patient to a colleague in front of the patient (but not engaging them) Self-expression: conveying thoughts, feelings and identity through communication. Physical- using your body language - E.g. warm smile, open posture, eye contact, conveying interest Intellectual- expressing thoughts and ideas - E.g. nursing knowledge, curiosity/ life-long learning, advocating, conversations with peers/ colleagues Creative- through art or music Emotional- authentic expression of emotions - E.g. vulnerability, showing empathy/ compassion Relational- showing who we are in relationships. - E.g. relationships (recall the what is going in within, between, and around people) https://www.cna-aiic.ca/en/nursing/nursing-tools-and-resources/primary-care-toolkit/pct-role- description Structures that Shape Nursing Role(s) Communication Professional Nursing Role CNO Entry-to Practice competencies 101 competencies 9 roles Chapter 23 for additional details on nursing roles https://www.cno.org/globalassets/docs/reg/41037-entry-to-practice-competencies-2020.pdf Nursing Roles (CNO, 2019) Clinician Professional Communicator Collaborator Coordinator Leader Advocate Educator Scholar CNO Requisite Skills & Abilities CNO recognizes that meeting the entry-to-practice competencies requires certain skills and abilities. Seven categories have been identified by CNO as capturing the components necessary for nursing practice. Cognitive Communication Interpersonal Behavioral Psycho-motor Sensory Environmental https://cno.org/Assets/CNO/Documents/Standard-and-Learning/Practice-Standards/41078- skillabilities-4pager-final.pdf Advocating for Nursing Nurse-patient ratios (safe staffing) Safe work conditions Violence against healthcare workers Bullying Clarifying or amplifying nursing image or role Professionalism: Characteristics Specialized knowledge that is theoretical, practical and clinical Accountability Autonomy Advocacy Inquiry Collegiality & Collaboration Innovation Ethics and values Attributes, Antecedents, and Consequences of Identity Formation (Halverson et al., 2022) describe the attributes, antecedents and consequences of professional identity formation in nursing Orientation Phase – Case Study Professional Self-Introduction Create a comfortable setting Maintain eye contact Introduce self as a professional nurse or student nurse using first & last names Time frame you will be working with the person Your role in caring for them Expectation in the relationship :treatment plans & goals How would you prefer to be addressed? *Introduction affect nurses' professional standing, patient empowerment & patient safety* NOD Professional Role Socialization “Is a complex continuous interactive educational process through which student nurses acquire the knowledge, skills attitudes, norms, values and behaviours associated with the nursing profession” Autonomy Competency: Novice to expert (Table 23.1) Communication skills Collaborative skills Continuing education Strategic career planning Role relationships within nursing Peers Supervisors Supervision of staff Unlicensed assistive personnel (UAPs) Licensed nurses Self-awareness Nurses have rights Transformational leadership Structural empowerment Acquiring the profession’s culture: internalize the values, standards and role behaviours of nursing Academic role models as socializing agents Clinical nurses as socializing agents Clinical preceptors Mentors Orientation Employment transition ▶ Novice ▶ Advanced beginner ▶ Competent ▶ Proficient ▶ Expert (Benner, 1984; Benner, 2001 BENNER (2001) FROM NOVICE TO EXPERT - The Dreyfus Model of Skill Acquisition Applied to Nursing Benner (2001) From Novice to Expert - WHAT DO NEW GRADUATES THINK OF THIS? “[Thinking about Benner and expertise], I’m not at the expert level yet, but I think maybe her terms are not necessarily the right terms to be using. In my opinion, I don’t believe in “expertise”. I believe you could be very well experienced and have a really good knowledge of what you’re doing. So I really just take her model as an example and apply it, but there’s always learning to be done. So I don’t think anyone’s an expert.” (Participant “Henry”) If Benner has stuck with Henry almost 2 years into his nursing practice, maybe this model is worth discussing and thinking about… FROM NOVICE TO EXPERT Patricia Benner is a nursing theorist who suggested nurses develop their skills gradually over time based on education and experience The Dreyfus Model of Skill Acquisition was originally developed by a mathematician and a philosopher (Dreyfus & Dreyfus) based on the study of chess players and airplane pilots This model was later applied to nursing by Patricia Benner after she studied a wide range of nurses in their practice From Novice to Expert was originally published in 1984 STAGE 1: NOVICE “Beginners have had no experience of the situations in which they are expected to perform” (Benner, 2001, p. 20) - This will be you when start to learn skills in lab and in clinical “To give them entry to these situations and allow them to gain the experience so necessary for skill development, they are taught about the situations in terms of objective attributes such as weight, intake and output, temperature, blood pressure, pulse, and other such objectifiable, measurable parameters of a patients condition- features of the task world that can be recognized without situational experience” (Benner, 2001, pp. 20-21) - This is where your learning will begin - This is the more “black and white” learning - Reference points You enter the clinical area as novices; with little understanding of the contextual meaning, or how to identify the most relevant tasks to perform in an actual situation  - Move between what we know and what we don’t know, expect uncertainty, and become comfortable asking questions Dependent on procedural lists and objective/measurable findings WHAT DO NEW GRADUATES THINK OF THIS? STAGE 2: ADVANCED BEGINNER “Advanced beginners are ones who can demonstrate marginally acceptable performance, ones who have coped with enough real situations to note (or to have pointed out to them by a mentor) the recurring meaningful situational components that are termed ‘aspects of the situation’ in the Dreyfus model” (Benner, 2001, p. 22) The ’aspects of the situation’ are similar to reference points and require prior experience in actual situations for recognition We only see what we know STAGE 3: COMPETENT “Competence, typified by the nurse who has been on the job in the same or similar situations two to three years” (Benner, 2001, p. 25). What factors contribute to how long it takes to reach this stage? Clinical experiences, new environment/ setting, work experiences before graduation, number of patients and experience gained in a short period of time, passion/interest, reflection ++? The nurse can sort which attributes and aspects of the current and projected/ future situation are most important/ relevant and which can be ignored (Benner, 2001) Prioritization, critical thinking “The competent nurse lacks the speed and flexibility of the proficient nurse, but does have a feeling of mastery and the ability to cope with and manage the many contingencies of clinical nursing. The conscious, deliberate planning that is characteristic of this skill level helps achieve efficiency and organization” (Benner, 2001, p. 27) What does ‘conscious, deliberate planning’ look like? How might you have already adopted such approaches to achieve efficiency and organization in your life, perhaps as a student? WHAT DO NEW GRADUATES THINK OF THIS? “I think where I am now with my nursing career, with how I’ve grown… being a good listener is one thing that I value, but I also think I really appreciate my problem solving… typical time management, and so on. Same with my critical thinking. …I guess confidence is a word to describe it, but I don’t want to sound like I’m overconfident, because I know I still have lots of learning to go. But I’m proud with how confident I feel with lots of things. Like I’m not nervous anymore to talk to a doctor. I don’t care if they think it’s a silly issue. I have a concern, and I will speak up about that because the way I see it is I’d rather speak up about something that’s insignificant than miss something. And that’s something that I really, really have been trying to work on.” (Participant “Kelly”) Notice how Kelly says she feels confident with “lots of things”, so not all things (still ”lots of learning to go”), suggesting this is gradual, and you don’t suddenly become “competent”. You become competent with some things, then many things, then most things… STAGE 4: PROFICIENT “Proficient nurses understand a situation as a whole because they perceive its meaning in terms of longterm goals” (Benner, 2001, p. 27) “Ok, here’s this baby, this is where this baby is at, and here’s where I want this baby to be in six weeks. What can I do today to make this baby go along the road to end up being better” (Benner, 2001, p. 28) Starting to see the big picture and not just a list of tasks to do Learning from experience what typical events to expect in a given situation and how plans need to be modified in response to these events What should happen next (ability to anticipate and predict), what to do if it doesn’t (troubleshooting, ‘think again’), how to react/respond to a turn of events (e.g. ask for help, re- assess, try something different, call the doctor, call a medical emergency team) WHAT DO NEW GRADUATES THINK OF THIS? “I could talk a little bit about my ambulatory care experience as a practical nurse. That made me very passionate and involved in wound care, because we had a wound care clinic. We would treat maybe 40 wounds a day. Forty people. Right away, I saw that some people would treat the wound and not the person. The way I approached things is I would treat the whole person, and not just the wound. I’d have a conversation with them, how their day was going, everything, while I was doing wound care. Then we would float around… But I always was pulled to surgical or wound care. I loved those. I ended up working with RNAO due to my passion. I still have that passion, but right now I’m working in harm reduction. There are wounds in harm reduction, it’s just not the specialty. So, I still get to practice wound care. I do feel like one day, I’ll go and specialize in wound care.” (Participant “Henry”) Is passion a catalyst for skill acquisition? Does working in a speciality area (e.g. a wound care clinic vs. a surgical floor) fast-track your skill acquisition in wound care specifically? Does seeing the whole person aid in job satisfaction? Do we go back to an earlier stage when we change practice settings/ environments and require new knowledge and skills? STAGE 5: EXPERT The expert nurse no longer relies on rules, guidelines, or maxims (think of a general ‘rule of thumb’) to connect their understanding of the situation to an appropriate action The nurse inherently knows what is happening and what to do next based on keen intuition, experience ++, and an ability to focus in on the priority issue Deep understanding of the total situation, or the big picture Can be hard for them to explain or convey in words, but they know what they see, they feel what they feel, and they do what feels right WHAT DO NEW GRADUATES THINK OF THIS? “Yeah, the big thing I’ve noticed is either there’s overconfidence or underconfidence, probably a little bit of both. That’s probably for any nurse, but it’s more evident in new nurses because they’re trying to prove themselves as practitioners. Even myself, I think there were times where I was overconfident and probably gave information that wasn’t completely accurate or was false. And you don’t realize it because you’re trying to give the patient an answer and make sure that they know that you’re competent. But I think part of being competent is admitting that you’re wrong, or that you don’t know as well. And even now, I’m still a new nurse in my opinion. Two years isn’t enough experience to know anything.” (Participant “Jay”) SELF-REFLECTION