The Complexity of Critical Care Nursing

Dsicuss about the Critical Lens On Culture In Nursing Practice.

Culture is the mode of conduct or how things get to be done. Individuals make up a culture based on the role they play in a society and their routine, and daily practices make up the culture. It is crucial for every individual to be aware that their ideas can bring about change in their various communities. (Salman and Zoucha 2010) In organizational cultures, each organization is made up of different cultures for instance in departments, unit levels and words. In such a workplace culture has a larger influence on individuals in the specialty area such as the staff, family or the patients. Caring culture in healthcare is a workplace engaging mostly the patients and their families, staff members, service users and the residents around. In this report, the area of specialty chosen was is the critical care nursing whose main aim is to explore and explain the culture of critical care nurses.

Intensive care units (ICUs) are the most intricate and exclusive department in all healthcare’s. the complexity of the organization makes its structuring of care an aim of performance enhancement strategies. Assigning intensivists in the management of the ICU patients instead of nurses from referral departments is one of the improvement made. The proportional percentage of the hospitalized patient’s admission is expected to rise due to the aging population as well as an increase of acuity of illness (Beek and Gerritsen 2010). Beside the mortality rate reducing after assigning of the intensivists, mortality rate is still significantly high in the ICU department. For this reason, several changes have been initiated in the ICU which have impacted on quality of the patient care and the general cost as discussed below;

There before in the early days, patients were under the care of physicians. The caring culture was low considering the fact that there was lack of enough knowledge of the intensive care needed by the patients. The physicians were not offering continued care for the did not give daily care services. The introduction of the intensivist who operate for 24 hours in a day and are not assigned any other duties at these hours other than offering the care needed by the patients. These changes have led to a reduction in mortality rate in the intensive care department (André, Sjøvold, Rannestad and Ringdal 2014).

There has been a change in the nurse to bed ratio in that, the ratio of nurses to patient is currently 1:1 or 1:2 in the intensive unit. Mortality rate has therefore decreased especially to the patients suffering from hypertension and asthma reason being the immediate care of the nurses in times of attacks (Lillis, LeMone, LeBon and Lynn 2010).

Changes to Improve Quality of Patient Care

Since the intensive unit is admitted those patients who are critically ill, outreach teams are installed to reach out to patients before deuteriation period starts. The introduction of the service was mainly aimed on education help and practical support of the ward stuff. The service led to the reduced mortality rate and patients could have a lengthy stay (Morton, Fontaine, Hudak and Gallo 2017).

The introduction of patient digital management (PDMS) has made the services easier by giving the intensivist with a summary of the patient’s data. The management also has an ability to predict on risks that may affect the patients in the intensive care unit. With the new management, manual data collection is not in use hence reducing chances of error in the data. The overall changes have led to a better patient outcome and a decrease in intensivist work load (Bourque 2011).

Evidence of analyses of the findings from observation, the stories from people receiving care and their carers in this context the intensivists, the families and patients in the ICU. There was a tremendous awareness of the necessity to address the culture and background in project groups using the approaches of the research activity. There was the identification of a focus on empowering staffs in the project. A recognition that for culture to be sustained and be improved, a change needed in the social system instead of being dependent on persons (Lehne and Rosenthal 2014).

After visiting one the findings on the safety of the patient could discuss the occurrence that takes place when health care services provided to the patient. Errors detected while offering the services which lead to harmful effects. This error could be error of omissions, error of commissions as well as faults of the care processes that involves equipment’s or drugs administered. In avoiding such harmful effects to the patients, some practices were observed to be kept in place (Leininger 2011). Infection control is one of the methods found that because that most of the patients admitted to the hospitals tend to acquire the nosocomial infection, a reorganizing of infection control concepts made. Antibiotics are administered to the patients to control and avoid diseases. An observation was made on the manner in which the nurses handled patients in intensive care unit. In this ward, it is known that patients in this room hardly even recognize themselves. The patients need close checkup for their lives are normally at a higher risk compared to other wards. Unlike other wards, an intensive care unit ward always has a nurse in the room. The patients can never be left in the room all alone. Mostly these patients rely on machines for survival meaning in case of lights shutdown, there is always a carer to immediately apply the already set alternative plan. This care is seen to be very positive because patients fall in rare risks of dying in circumstances that are avoidable.

Empowering Staff and Person-Centeredness

Evidence on findings from the patients were that, nurses are the most important people in healthcare. The reason behind this was because the patients spend more hours with the carers more than even the doctors. These carers are trained people on how to deal and handle various patients according to the disease they are ailing.  Carers have developed some skills and values that enable them to understand the many problems facing the patients while at the hospital. This values also help the carers with the ability to show love and concern as well as to instill hope in the patients and also to their families during the period at the hospital. The patients also confirmed that the health care provides enough food and the required diet to their patients. Those with lifestyle diseases receive the correct meals and guidelines of what to use to avoid complications (Rehnsfeldt et al 2010).

During those moments when patients are in hospitals, carers change their identity to being best friends, comforter, parents, sibling and most of all their all-time hope.  Various healthcare’s have programs in their timetable. The carers use this time to give volunteer counseling to the patients on ways to overcome and accept their current situations. The findings from the people receiving care were impressing and confirmed to most families who had worries about the idea of total attention to their ailing family members.

An analysis conducted on the carers or nurses in healthcare and findings drafted. Nursing role is the fundamental pivot to patients’ safety in a hospital. Findings from the nurses that they receive support from the doctors and the institution at large. The carers enjoy better communication and are also allowed to take part in decision making. These nurses take part in healthcare to establish various nursing practices which ensure patients safety. The duties of a nurse are to entirely ensure that the patients are in their comfort while in hospitals. The carers identified the various roles they take part in patients’ life. They must monitor how the person receiving care respond to their medications (Van and Gerritsen 2010). They ensure that the patient’s medication is in the progress book, his or her medical history as well as the examination sheets. It is also the role of the nurse to ensure understanding of medications prescriptions to the patients to avoid misunderstanding of instructions on the label of the medications. Despite the major and complex duties nurses have, they admitted that they are proud of themselves since they have the ability to save lives. They also have change the patient’s attitudes to life since many are the patients who visit the hospitals loss of hope and that urge to live but after the treatment and major counselling from the nurse, the patients live changes and comes out of the hospital having a positive view of life. These cares also have their toughest moments when a patient whom they were taking care of succumb death. They are fellow humans with feelings. The carers are responsible to know which method is safer to inform the families if the bereaved to avoid shock and other diseases resulting from shock such as high blood pressure. Were it not for the nurses who gives guidance and counselling to the families, many negative issues could have emerged (Fei and Vlasses 2008).

Leadership and Communication in the ICU

These findings clearly showed that the nursing role is pivotal of the patients’ safety while admitted in the hospital.

Analysis of the current caring culture regarding the attributes, enabling factors and consequences.

For an efficient workplace culture, there exist some consideration; the attributes, enabling factors and the consequences as explained below.

There are five attributes to be considered for effective workplace culture.

1. A shared vision and mission with collective as well as individual responsibility.

For a firm culture to exist, people ought to practice the values. A sense of mission and vision achieved where there is collaboration of the staffs who are motivated and have self-direction and who take responsibility personally and are accountable to them with the aim of making the shared goals. (Brendan 2009)

1. Specific values shared in the workforce

There is need to have principles as well as the set of values that are consistent to be shared and the same in healthcare working places. There are values believed to be essential and influential to the benefits. Person-centeredness is a concept based on the involvement of valuing of staff and the patients. The concept instills skills mutual trust as well as understanding and knowledge sharing. Person-centeredness enables empowering culture, and it nurtures an unceasing method to development practice. Lifelong learning. In this concept there exist active learning and response is pervasive. people Learn from their own mistakes rather than from blames. People commit themselves to education and later sharing of the knowledge learned is done. Practitioners need to learn in their practice, and the skills acquired help them to nurture their efficiency and that of others (Blais 2015).

1. High support and challenge are the main factors in achieving the potential increase in productivity as well as the potential. The workforce ought to be in favor of its stuff for that stuff to have the ability to support others.
2. Leadership development refers to developing those skills a leader ought to have. A leader should have the ability to lead others into positive change. The leadership skills include the ability to make others useful and finding solutions to problems. The leadership skills involve even the leader to lead as a good example. He or she ought to instill positive ideas to his people. Any change in the organization should be addresses to the employees with the reasons behind the changes. It is the role of the leader to be innovative as well as t creative. He or she ought to come up with ideas of change that will bring change of the norm and use other new and more effective in achieving the goals and objectives of an organization (Chassin and Loeb 2011).
3. Evidence use and development valued in facilitating leadership as well as expertise. Evidence being implemented into practice is necessary for the international movement whose aim is using the correct evidence in support of effectiveness in the clinic. Teamwork is an aspect valued and known in the collaboration of interdisciplinary and in the development of the team.

In the health cares, the relationship between the directors and the nurses in the ICU is affected by the type of leadership between the two. Communication from the high authority to the rest of the stuffs sometimes it’s not clear. Despite the positive changes that have improved in the caring culture, it is also evident that nurses and the intensivists have not fully been favored by the leadership in their work placed. The poor leadership has led to nurses being neglected despite the fact that they are the backbone of every hospital and most especially in the ICU where patients are critically at risks. Poor leadership has led also to nurses receiving small wages and salaries despite their hard duties. Many systems of health care have developed the idea of nurses working all hours in every day of their week with no increment in salaries. Nurses have less or no time to spend time with their families all because of poor governance. With poor leadership, nurses have counted many challenges facing their day to day duties (You et al. 2010).

These are the factors enabling the development of an effective working place as well as sustaining it. Those factor’s classification as an individual or organizational enabler.

Individual enablers comprise of transformational leadership. Under poor leadership, achieving a similar vision by involving the minds and hearts will remain a desired goal but cannot be met. Poor leaders do not use learning skills and intelligence to lead and thus lack of enabling teams and persons to change themselves for the better. (Koren 2010) In the individual enablers, participative culture should be enhanced. Mostly in various organization, employees tend to be secluded from decision making or going against their director’s decisions. Nurses are not given a chance to express their views towards the already made decisions. They demand a chance to be listened to and also to be heard but under poor leadership, nurses are not allowed to give their own views especially when they disagree with their bosses thus an effective workplace culture is not achieved. ICU nurses and intensivists are regarded as the backbone of every organization but organizations are used to overlooking them forgetting that they are the enabling factor in each and every organization for the achievement of the set objectives.  The organizations emphasize on the goal of the firm forgetting on the means to achieve it which are the nurse. Successful organization focuses on creating a good environment to its employees and involving them in the growth policies as well as keeping them fully motivated to achieve the visions and missions of the organization (Fasoli  2010).

Organizational enablers are an approach that enables making of decision, leadership, readiness of an organization as well as the supportive department of human resource. The department is greatly influential as they have the responsibility of enabling administrative growth and learning as well as maintaining performance. It is also important for a firm to ensure the availability of career development strategy. This strategy should critically look into the performance of employees as well as allowing them planning for their career growth and change. For example, the millennials are known to be very loyal to themselves than to the organizations where they have been employed. In order for a hospital to earn total loyalty of their nurses, it is crucial for them to have a chance in decision making and that those decision mutually benefit both their directors as well as them nurses (Hall, Goddard, Stewart and Higginson 2011).

Working with the enabling factors as well as the attributes increases the chances of attaining an effective working place. Once the enabling factors are not achieved under such as poor leadership, the consequences of attaining an effective working place will negatively affect the nurses as well as the patients. The members show empowerment as well as a commitment as seen in recruitment and job satisfaction. when the nurses and the intensivist are under bad leadership, the caring culture in that hospital will not achieve its main objective. with a poor management from the poor leadership, the potential of the nurses is ignored and only their performance matters (Pillitteri 2010). The environment surrounding the ICU nurses is not conducive under bad management. The required tools and equipment’s necessary to the work done are not provided. Directors lacks the required skills in every docket because of corruption in such health carers. Unskilled intensivists and the ICU nurses in professional jobs will only produce little or no service of what is essential for an effective workplace culture (Hockenberry and Wilson 2014). Mentoring of the workers about the changes in an organization and how to excel in their roles is important but mostly is ignored under poor leadership. Most organizations are flexible to changes and in case there is a change on the plan, then the affected employee in the docket will also need to change his or her previous way of handling the work, hence mentoring them on such changes will avoid confusion and repeat of previous mistakes (Hines, Luna, Lofthus and Marquardt 2008).

Specific person and teams gain the stated goals, objectives and national as well as the standards locally. Members’ empowerment and the associated inspiration may be an appearance of human flourishing but under poor leadership all becomes in vain (Ray 2012).

Conclusion

The caring person-centered is developed by the important values to work with, the development processes as well as the contribution practices (Kaplan et al. 2010). The work of research action viewed as the practice linked to the approaches of research which can successfully achieve change in culture with an individual as well as collective development that adds to the key aspect of knowledge. Using the methods based on values which are comprehensive for all shareholders, organized with approval empowering methods that are original, and attach chances to study from the practice work station culture in which it is person-centered, harmless and operative. The method is of specific consequence as this is the culture provides utmost attention and practices (Pronovost et al. 2013).

For teams in the wish to develop safe, effective cultures and careful attention needs to exercise on:

• Evolving relations with patients and facility users to guarantee the focus on what specifically
• matters to them and the stuff, so that the activity around what matters is at the core of team action
• Rising leadership and enabling skills that pay consideration to establish and supporting
• Effective workstation cultures, reflection as well as learning.
• Entrenching values and opinions in workplace schemes such as communal governance and systems for erudition and assessment
• Shared vision and mission with collective as well as individual responsibility.

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