How to be a Great Nurse – the Heart of Nursing

Dr Julie Santy-Tomlinson, Dr Carolyn Mackintosh-Franklin

• Publisher: M Publishing
• Year: 2020
• ISBN:
  9781910451625
• Topic: Medicine
• Subtopic: Nursing

How to be a great nurse focuses on fundamental issues that are relevant to all nurses, across all countries, fields and areas of practice. It is essential reading for student nurses, qualified nurses, supervisors, assessors, managers and nurse academics, who all want the nursing profession to invest in the highest-quality care, firmly rooted in the real heart of nursing practice.Each chapter focuses on a particular aspect of great nursing, illustrated by case studies, self-assessment tools and exercises, and supported by suggestions for further reading and self-development. Chapter 1 explores the 'head, heart and hands principles' of nursing care. Chapter 2 focuses on the core values of nursing practice from a professional perspective, with an emphasis on personal integrity. Chapters 3 and 4 enable readers to reflect on the skills and emotional intelligence needed to be an effective nurse, highlighting the importance of communication and individual learning needs.Career progression, resilience and the support of other nurses are discussed in Chapters 5 and 6. Chapter 7 then draws many of these ideas together by looking at nursing practice from the perspective of those receiving care. This enables readers to deepen their learning and reflect on their own practice. The final chapter considers the future of nursing, and the new nursing roles that may be needed, to ensure that great nurses meet the varied demands of future practice scenarios.

Chapter 1

The meaning of great nursing

Introduction

Deciding to become a nurse means choosing to join a challenging profession that holds an important and unique position within society, with high public expectations. Great nurses see nursing as a privilege, and they place the patient’s experience at the centre of everything they do. They set out to be great nurses and strive to achieve that goal. This chapter aims to help the reader understand what great nursing means and how nurses should conduct themselves in their professional role.

The nature of great nursing – head, heart and hand

Becoming a great nurse begins with understanding what nursing is and what its values are. To fully appreciate the broad and complex activity that is nursing, it is important to recognise the meaning of nursing and to be able to explain it to patients and families so that they know what to expect from nurses. The International Council of Nursing (ICN) (2002) defines both ‘nursing’ and ‘a nurse’ (see Box 1.1), highlighting the breadth of what nurses do for people with diverse healthcare needs, for all age groups and within all communities. This helps nursing practitioners to describe what they do: how care is given; what knowledge, skills and education are needed; and what makes nursing a profession; as well as the professional and personal values that guide everything nurses do.

Box 1.1 International Council of Nursing (ICN) definitions of nursing and a nurse (2002)

Definition of nursing (short version)

‘Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.’

Definition of a nurse

‘The nurse is a person who has completed a program of basic, generalized nursing education and is authorized by the appropriate regulatory authority to practice nursing in his/her country. Basic nursing education is a formally recognized program of study providing a broad and sound foundation in the behavioural, life, and nursing sciences for the general practice of nursing, for a leadership role, and for post-basic education for specialty or advanced nursing practice. The nurse is prepared and authorized (1) to engage in the general scope of nursing practice, including the promotion of health, prevention of illness, and care of physically ill, mentally ill, and disabled people of all ages and in all healthcare and other community settings; (2) to carry out healthcare teaching; (3) to participate fully as a member of the healthcare team; (4) to supervise and train nursing and healthcare auxiliaries; and (5) to be involved in research.’

To understand what nurses need to know, and how they need to behave, in order to be effective care-givers, it is useful to explore nursing from three angles : the head, the heart and the hand. This framework, first discussed by Galvin and Todres (2011), can help us define effective nursing practice.

The hand

Nursing is, first and foremost, a practical activity involving specific activities and interventions that aim to improve the health and/or wellbeing of those receiving care. The range of practical tasks nurses undertake varies in complexity, from helping a patient to drink or wash themselves, to taking observations or being part of a team following a cardiac arrest or caring for someone who is dying – activities that often involve intimate contact with individuals who are experiencing distress. Such intimacy involves a holistic ‘body, mind and social approach’. To carry out practical tasks and develop a meaningful relationship with the patient, the nurse’s hands are often in physical contact with the patient’s body as they provide physical care: hence, ‘nursing with the hand’ (Galvin & Todres 2011). Even seemingly simple interventions, such as helping someone to walk to the bathroom, can have a positive impact on health and recovery, depending on the way the task is carried out by the nurse.

Being in a person’s personal space and touching their clothing or body is a natural part of the nursing role, but may be a source of fear, anxiety or embarrassment for the patient. Touch itself can be a way to bring comfort to people in distressing situations, depending on cultural norms. Offering a hand to hold, touching someone briefly to indicate closeness or empathy, for example. These are actions that are often reserved for close family members, and it may not be acceptable to the patient to be touched by someone they do not know. Nurses need a highly developed sense of when and how to touch someone. The nurse’s hands are central to such activities. They are the tools used to carry out care and, although they can be used to provide comfort, they can also place the patient at risk of, for example, infection. It is important, therefore, that knowledge of how to carry out physical tasks safely and effectively is incorporated into each nurse’s education and professional development throughout their careers.

The heart

Nursing is much more than simply ‘doing’ practical things for people. The way in which actions are carried out is what sets nursing apart from tasks performed by those who are not members of the caring professions. Physical nursing actions cannot be conducted in isolation from the emotional elements of the process of caring for people. Practical nursing care needs to be carried out in ways that least distress patients and reap the most therapeutic benefits. Nurses therefore need to engage with the people in their care with regard for them as individuals, considering the need for a humanistic approach that involves acting with compassion and treating the patient with dignity. Galvin and Todres (2011) call this ‘nursing with the heart’, signifying an approach to the patient that incorporates emotional engagement with their needs and experiences. It is argued that nursing with the heart is the most important aspect of being a great nurse – that it is possible to learn the skills and knowledge needed to provide acceptable nursing care, but that being able to engage with those in need in a heartfelt way is a more difficult talent to develop (unless the nurse has the right characteristics in the first place).

Nursing with the heart must include an appreciation of the rights of individuals to be cared for by nurses who make every attempt to empathise – to understand and engage with the experience of the person receiving care. This involvement of emotion and understanding is sometimes referred to as the ‘art’ of nursing. It is something that requires talent and cannot always be taught, and it requires someone who possesses the right personality or disposition in the first place. Recruiting the right kind of person to the nursing profession is an important part of ensuring that nurses have the right attitude towards others.

The head

Nursing is often described as both an ‘art’ and a ‘science’. Along with interventions, and the emotional aspects of care, being a nurse involves having a distinct body of knowledge that is sometimes separate from, and sometimes aligned with, that of medical or allied health professional colleagues. Increasingly, nursing actions are based on what is known as ‘evidence’ – knowledge generated through rigorous research. Evidence helps professionals identify the best ways to do things and ensure that the actions they take are of maximum benefit to the patient. The notion of evidence-based practice will be considered in more detail in Chapter 3

Nursing can be viewed as a science because there are physical, psychological and social sciences that enable nurses to carry out their role in a manner that can improve health and wellbeing. Having a knowledge of biological sciences (such as anatomy, physiology and pathology) gives nurses an understanding of health and disease. This enables them to assess individuals and to select and carry out interventions with the aim of improving health and wellbeing, facilitating recovery and rehabilitation, and educating and empowering people and their families to take control of their own health.

However, the biological sciences alone are not a sufficient basis for good nursing practice. Nurses also need an understanding of the impact of social sciences and applied sciences (such as public health) to gain a full appreciation of how human beings work and how they interact with the world around them. Basing practice on the best available evidence ensures that nurses have the knowledge required to provide the best possible care in a way that directly meets their patients’ needs. Great nurses apply this scientific understanding to the decisions they make when they provide care for patients. See Box 1.2 for an example of the application of the ‘head, heart, hand’ framework.

Box 1.2 An example of how the ‘head, heart and hand’ approach can facilitate good nursing

In an earlier paper discussing ‘openheartedness’ and its application to nursing, Galvin and Todres (2009) give some examples of care situations where great nursing is needed. Here is one example:

‘A man of 45 is laid on his back in a hospital bed on an open ward with seven other patients. It is the middle of the day and meals are about to be served. He is lying in his faeces and he is in pain. He cannot move and is aware of the stench of his faeces and the presence of other patients. He has been like this for 5 minutes, but he knows the nurse is on his way; he has gone to get a bowl, cloths, and water. He feels a degree of self-disgust, even selfloathing; an overpowering anxiety, a deep worry that everyone around is also extremely averse to this situation and is bearing this smell resentfully. He wants to be invisible, not noticed.’

Thinking about this situation can be distressing – we can imagine how we might feel if we were this man, or a member of his family. Sadly, nurses become socialised to this kind of situation; because it is an event they commonly have to deal with, they may not engage with the patient’s emotional distress at the time – simply undertaking the practical task of fetching the bowl and water and cleaning up the patient.

If we consider this vignette from the ‘head, heart and hand’ perspective, we can see how ...

Table of contents

• Cover Page
• Title Page
• Copyright
• Contents
• Preface
• 1. The meaning of great nursing
• 2. Core values for nursing
• 3. Learning to be a great nurse
• 4. Effective nursing
• 5. Making a successful career of nursing
• 6. Supporting and influencing others to be great nurses
• 7. Patient perceptions of great nursing care
• 8. Embracing the future of nursing
• Appendix 1. Honey and Mumford learning styles – questionnaire
• Appendix 2. Learning styles – general descriptions
• Appendix 3. Learning styles – a further perspective
• Index