CPD
Prepare for revalidation: read this CPD article and write a reflective account http://revalidation.zone
CONTINUING PROFESSIONAL DEVELOPMENT
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Practice skills multiple choice questionnaire
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Professional practice skills for nurses NS759 Groves W (2014) Professional practice skills for nurses. Nursing Standard. 29, 1, 51-59. Date of submission: March 6 2014; date of acceptance: June 19 2014.
Aims and intended learning outcomes
Abstract Nurses work in a healthcare system in which different partners in care have different expectations of them. Demands to provide compassionate care that is patient-centred and responsive while adhering to budget constraints are contributing to ‘compassion fatigue’ and adversely affecting nurses’ mood and effectiveness. This article discusses how an understanding of professional practice skills, communication skills and teamwork can help nurses to cope with these conflicting demands and compassion fatigue while performing their professional roles and responsibilities. This approach is discussed in the context of nursing discourse and related professional and government recommendations.
Author Winnifred Groves Public sector researcher, Surbiton, Surrey. Correspondence to: [email protected]
Keywords Code of conduct, communication, compassionate care, compassion fatigue, interpersonal skills, nursing care, nursing practice, professional practice, revalidation, 6Cs of nursing
Review All articles are subject to external double-blind peer review and checked for plagiarism using automated software.
Online For related articles visit the archive and search using the keywords above. To write a CPD article: please email [email protected] Guidelines on writing for publication are available at: rcnpublishing.com/r/author-guidelines
This article examines ways in which developing professional practice skills can help nurses to cope with conflicting demands and ‘compassion fatigue’ in their roles, while remaining responsive and providing targeted measures and high standards of patient care. After reading this article and completing the time out activities you should be able to: Identify the main partners in care that nurses work with and briefly describe their expectations of nurses. Outline the main challenges faced by nurses as a result of the different expectations of them of different partners in care. Identify and describe essential professional practice skills needed by nurses to meet personal, professional and legislative requirements. Explain how professional practice skills can help support nurses faced with the dual demands of providing effective practice and compassionate care.
Introduction One of the main narratives in nursing today is that patients are suffering from serious neglect in the NHS; ‘compassion fatigue’ is also of growing concern. Nursing has been in the spotlight for providing poor care, partly highlighted by events at Mid Staffordshire and Winterbourne View (Department of Health (DH) and NHS Commissioning Board (NHSCB) 2012). The Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis 2013) proposed a way for all those involved in care to provide it in a way that meets expectations and standards. It emphasised the importance of adequate resources, as well as the right
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CPD professional issues
1 Identify the different groups of people and professional bodies that have expectations of the quality of patient care provided by nurses. Briefly describe these expectations.
approach and attitude of the carer, in meeting these expectations. Trust is the basis of the relationship between nurses and their patients. As a result of challenges to and developments in nursing, the nursing profession, the DH and the NHSCB have made several recommendations, including the 6Cs: care, compassion, competence, communication, courage and commitment (DH and NHSCB 2012, Watterson 2013). Nurses are expected to embrace new and smarter ways of working to enable the 6Cs to become a reality. There is also debate about a new revalidation process for nurses and midwifes. The premise of revalidation is that nurses need to demonstrate their continued competence and fitness for practice consistently and regularly (DH 2013, Keogh 2013). Nurses are at the forefront of providing health care. The commitment to provide excellent care that is safe, compassionate and holistic is integral to nursing. It is vital for nurses to develop and maintain professional practice skills that are patient-centred and promote safe and effective care, while being cost-efficient. Applying these skills will enable nurses to achieve the care and compassion that have been under recent scrutiny in the NHS.
FIGURE 1 Main partners in nursing care
The state or healthcare system Organisations Regulatory bodies The general public
Professional bodies, for example: Royal College of Nursing Nursing and Midwifery Council
Nurses to provide good quality care which is cost-efficient
Patients Carers Relatives
Colleagues or nursing managers Medical staff Other members of the multidisciplinary team
Professional practice skills are generic skills that enable nurses to understand the legislative framework, be aware of professional requirements and standards of behaviour, possess the knowledge base and skills for reflection, and communicate effectively (Oku and Reid 2009). Mindfulness of how ethics, morals and values affect the care provided by nurses is also required (Fry and Johnstone 2008). These skills promote a careful assessment of the needs of individual nurses, those of their colleagues in clinical practice and those of professional bodies and relevant legislation, as well as the demands and expectations of individual patients. Knowledge and application of these skills will help nurses to plan, implement and review care that more effectively meets the needs and expectations of all main partners in care. Complete time out activity 1
Expectations of nurses Nurses have a moral and professional responsibility to patients, carers, relatives, colleagues, professional bodies and the state. Together, these groups represent partners in care in nursing (Figure 1). Nursing involves working with different professional groups and families to meet the needs of individuals, promote and maintain health, care for patients when they are ill, assist patients’ recovery and independence, maintain their wellbeing, and improve their quality of life (Royal College of Nursing (RCN) 2003). Public expectations of nurses are at an all-time high and the government’s agenda of consulting and involving service users (DH 2010, 2012) has led to a rise in ‘patient power’ and resulted in care environments where nurses must be accountable for their actions (Ellis 2013). The public trusts nurses to meet patients’ health needs and ensure their safety, involve them in their own care, treat them with respect and dignity, provide timely care, listen to and inform them, and demonstrate empathy (Care Quality Commission (CQC) 2013). In addition, professional bodies require nurses to have the knowledge, skills (Kozier et al 2011) and attitudes necessary to provide and sustain evidence-based and cost-efficient care. Given these competing demands, nurses have to demonstrate through their practice the ability to identify and understand the
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needs of different partners in care while being realistic about available resources. The principal argument is that nurses should balance a commitment to the patient with standards of care that meet the needs of all partners in care. This involves making decisions and prioritising care. Continuing professional development (CPD) is a professional requirement for nurses that involves learning in practice. Training nurses to deliver excellent care throughout their careers is one way of safeguarding the health and wellbeing of the public, thereby achieving the state’s function and responsibility to its citizens. The need to provide a high standard of care is stressed by the Nursing and Midwifery Council (NMC), which requires nurses and midwives to keep their skills and knowledge up to date and uphold the standards of their professional code of conduct (NMC 2008, 2014). Complete time out activity 2 Nurses provide care to patients from diverse backgrounds. An ageing population will have more complex and multiple medical conditions. Furthermore, the public has high expectations of what constitutes health care and support and how these should be provided (DH and NHSCB 2012). However, there is a mismatch between these requirements and the availability of nurses to meet them (Ross et al 2005), which reduces nurses’ capacity to provide individualised care. There is evidence to suggest that staff shortages, poor working conditions and low staff morale result in poor nursing care, and dissatisfaction among patients and other partners in care (Newman et al 2002, Groves 2012). Heavy workloads make nurses focus on technical tasks rather than caring, making patient-centred care an unrealistic expectation. Without the necessary resources, care will become mechanistic, which will become a barrier to compassion. Other barriers to good nursing care include: poor workplace policies and practices, lack of managerial and ward support, and the gap between theory and practice. Lack of time has also been noted as a major source of stress for nurses (Demerouti et al 2000). Nurses feeling unappreciated and inadequate social support have been cited as barriers to effective communication (Reynolds et al 2000, Chant et al 2002), while teamwork and CPD can support nurses (Melnyk et al 2004). From these challenges, it appears that the gap between clinical leadership and management is
an ongoing barrier to providing excellent care. The central question is that with management driven by targets and the 6Cs requiring compassion and sensitive care, what support is there for nurses to achieve this? It remains to be seen whether the 6Cs recommendations will be effective without the resources nurses need to achieve them. These problems call for a multiplicity of solutions from the different partners in care. Effective use of nurses’ knowledge and skills has numerous benefits. So, which core professional practice skills do nurses need to cope with competing demands and avoid the shortfall in standards of nursing care reported in the media? Complete time out activity 3
Essential practice skills for nurses and their relevance to practice Table 2 lists practice skills that are essential to good nursing practice. Learning and developing these skills will enable nurses to provide individualised care and tailor measures to meet patients’ needs. Sometimes it can be difficult to effect professional demands, given the scarcity of resources (Table 1). Nurses need to provide evidence-based care compassionately, sensitively, cost-effectively and efficiently, thereby meeting the needs of different partners in care, combating compassion fatigue and achieving the revalidation requirements of the future. An ability to think critically fosters reflection, self-confidence, inquisitiveness and open-mindedness (Scheffer and Rubenfeld 2000). Critical thinking is a transferable skill that enables nurses to analyse situations from multiple viewpoints (Lloyd and Murphy 2008, du Boulay 2009) and can lead to changes in attitudes. Furthermore, critical thinking involves cognitive flexibility, which allows the nurse to scrutinise the evidence and its usefulness meticulously. By so doing, the nurse is complying with the need to practise evidence-based learning as encouraged by professional bodies (NMC 2008, DH and NHSCB 2012). Good research skills help nurses to access information on legislation and professional requirements. Nurses require information on sources of training and to acquire ‘professional know-how’ to understand what type of care will have an effect, what is practicable, and what is ethical and sensitive. Gaining access to this information helps
2 Describe the main challenges faced by nurses as a result of the different expectations of them by different partners in care. Compare your answers with the challenges listed in Table 1. 3 Identify the core professional practice skills required by nurses to meet different expectations. Describe how such skills can help in achieving the 6Cs in practice.
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CPD professional issues the nurse not only to provide care that meets patients’ needs and uses resources efficiently but also complies with statutory expectations and The Code (NMC 2008). Clauses 40 and 41 of the code require nurses to update their knowledge and skills throughout their working life by participating and engaging in learning activities that promote competence and improve performance (NMC 2008).
The importance of concise, timely and accurate documentation has been noted as a prerequisite for safe and effective nursing practice (Casey and Wallis 2011). Decision making is the basis of professional practice, particularly given the competing demands on nurses and the scarcity of resources, which necessitates the rationing of care. Decision making underpins ethics (doing what is right) and morals (pursuing behaviour
TABLE 1 Barriers and aids to care Challenges and barriers
Assisting factors
Increasing legislative and professional expectations. Increasing paperwork.
Continuing professional development. Research skills. Reading. Decision-making skills. Information and communications technology. Critical thinking. Sharing of information. Report writing.
Workplace policies and practices.
Assistance with interpreting workplace policies. Engaging nurses in all aspects of care initiatives. Seeking nurses’ views and acting on them accordingly. An open culture that is not intimidating. A culture that helps with effective communication.
Lack of managerial support. Unhelpful organisational culture.
Management support. A transparent and fair work environment. An environment that promotes learning and encourages nurses to speak out. Counselling and emotional support.
Lack of resources: Severe staff and/or skill shortages. Heavy workloads. Poor working conditions.
Availability of adequate resources. More nurses with appropriate skills. Opportunities to assist with integrating research evidence into practice. Willingness to share knowledge and skills that only come with experience. Promoting a positive work environment.
Lack of time.
Effective time management. Decision-making and negotiation skills.
Theory-practice gap.
Research skills. Ability to select knowledge and reflect on practice. Critical thinking ability. Learning from each other.
Poor pay and increasing cost of living.
Pay rises for nurses. Other incentives.
Lack of appreciation and recognition for nurses.
Feeling valued, appreciated and supported by: - The ward sister and other leaders. - Management. - The state.
Diversity of nursing, professional relationships with colleagues.
Teamwork. Effective communication skills. Good interpersonal skills. Motivation and respect for each other.
Low staff morale (Royal College of Nursing 2014), low job satisfaction, compassion fatigue.
Increase in wages. Teamwork. Nurses sharing a common vision. Support from colleagues and mentors.
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that society finds acceptable) (Fry and Johnstone 2008). Ethics, morals and values – as well as professional knowledge – are essential components of decision making in practice. Nurses’ duties are set and regulated by legislation and professional bodies; however, when equipped with the right knowledge, skills, resources and attitudes, rather than operating simply as passive observers of the rules, nurses should be able to make decisions that meet the needs of all partners in care by identifying and analysing problems, and performing searches for evidence-based information. Learning in practice fosters competence, which is one of
the 6Cs. ‘People have a right to expect safe, effective, compassionate, high-quality care’ (CQC 2013) – the right knowledge, skills and attitudes are vital to the provision of such care.
Communication skills in compassionate care and effective nursing practice
For the purpose of this article, communication is defined as social interaction through messages (Fiske 2011). Communication is multidimensional. It involves the transmission of information from one person to another. It has a clear purpose. For example, during a consultation between a nurse and a patient, the model developed
TABLE 2 Essential practice skills for nurses and their relevance to practice Essential practice skills
Relevance to practice
Critical thinking and decision making.
Critical thinking enables nurses to be open-minded, see the bigger picture and reflect, so they can make more effective judgements and clinical decisions. Decision making is a significant aspect of clinical practice. Critical thinking and decision making promote ethical practice, since nurses can argue why their organisations’ actions or inaction deprive patients of their rights and wellbeing. By acting as the patient’s advocate and using the right knowledge in the right situations, nurses work towards achieving components of the 6Cs, including competence, commitment, care and courage. Critical thinking and decision making promote a less stressful environment, since nurses are able to critically analyse situations to arrive at a clinical decision that helps achieve desired health outcomes. This promotes effectiveness and ultimately efficiency by maximising the use of limited resources.
Information and communications technology (ICT), writing, reading, note-taking, proofreading.
Knowledge of ICT is relevant to clinical practice because of its increasing use in care. Good knowledge of ICT assists competence and care, by allowing the nurse to access recent research to provide evidence-based care. Legible and concise writing of care plans achieves effective communication and continuity of care. Smart reading and note-taking saves time in busy clinical environments. Proofreading minimises mistakes, improves understanding and promotes competence in practice.
Interpersonal skills, teamwork.
As noted in the 6Cs, communication is central to providing care. Nurses need to communicate with patients, carers, relatives, colleagues and other partners in care, and to work in teams. Good communication and interpersonal skills enable nurses to demonstrate empathy and an ability to listen and provide care, underpinned by respect and dignity.
Presentation skills.
Nurses need good communication skills to conduct presentations. Presenting information in a manner that is convincing and easy to understand is vital.
Consultation and negotiation skills.
Nurses work in consultation with patients to help them feel they are partners in their own care. This results in greater co-operation since nurses and patients agree on care that is acceptable and right for them. Nurses constantly negotiate with patients, colleagues and other healthcare professionals.
Time management and cost management.
Time is a finite resource. There is a need to deal with matters quickly and prioritise them according to their importance. A nurse needs the time and knowledge to assess a patient, process different types of data, and define the problem, its components and its origins. Carefully analysing costs enables the nurse to devise a plan of action and set realistic goals, resulting in resources being used more strategically. Careful use of equipment and disposable items should also be considered.
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CPD professional issues
4 Are your communication skills serving you well? Think of an example in clinical practice where you had a consultation with a patient, carer or relative. Reflect on your performance using the statements shown in Box 1.
by Silverman et al (2004) suggests that effective communication involves moving from developing a rapport to developing a relationship that puts the patient at ease, with the nurse asking questions, using active listening, reflecting on what is heard, rephrasing responses to ensure that the patient and the nurse have the same understanding of events, and agree on a care plan. The importance of effective communication is stressed by NMC (2008), which emphasises that the information that people need or want to know about their health should be shared with them in a way that they can understand. Nursing demands effective verbal and non-verbal communication skills (Debnath 2010), including active and purposeful listening. Listening skills are vital in improving the quality of communication. They show the person with whom you are talking that you respect and value him or her. ‘Good communication is central to working with people. It’s important to be able to communicate both on a one-to-one basis and in a group context. Communication is not just about the words you use but also your manner of speaking, body language and, above all, the effectiveness with which you listen. To communicate effectively it is important to take account of culture and context, for example where English is an additional language’ (Department for Education and Skills 2005). Complete time out activity 4
BOX 1 Assessing your communication skills I am a good listener. I maintain good eye contact when I’m speaking to someone. I don’t know how to maintain eye contact because of my cultural upbringing. I am aware of my body language, posture, tone of voice, pitch and expression. I do not think it is wrong to chew gum when I’m speaking to patients, relatives or colleagues. I give patients my full attention when they speak to me. My voice is naturally loud. My tone of voice is patronising. I come across as aggressive but I am not. My body language is open and receptive. I keep an open mind when communicating with someone. I try not to interrupt when someone is speaking to me. I listen to the unspoken words. I ask for clarification by paraphrasing what the other person says to me. I am emotionally available when someone is speaking to me. I act on feedback to improve my communication skills.
Good communication skills affect the working environment, colleagues, the quality of care, and how patients feel and respond to treatment. Francis (2013) noted a public concern that patients are treated in a dehumanising and impersonal way. In the light of current public complaints about poor nursing care, effective communication is vital. Effective communication requires the nurse to know how best to gather information from a patient and how to explore sensitive issues. To help achieve this, the nurse can offer genuine acceptance, ensure confidentiality and listen with interest. Communication serves different functions. It expresses our state of mind and emotional state. This involves seeing and hearing and, to some extent, feeling (intuition). Nurses therefore need to observe patients’ body language (non-verbal clues), gestures and facial expressions. Nurses should also listen for words that suggest doubt, anxiety, discomfort, anger, denial, acceptance and gratitude, among other emotions. One focused method of communication is to make links between what patients say and their intention to act on it. Does what the nurse sees and hears suggest that the patient could be at risk of self-harm? Does it suggest that the patient has given up hope? If so, how will that affect the patient’s adherence to treatment and the treatment outcome? With this knowledge, the nurse can plan and implement targeted intervention strategies. Empathy entails considering the situation from the patient’s point of view. After listening to patients, nurses should show their understanding of what they have heard by paraphrasing and repeating it back to the patients. Treatment plans should be negotiated in a confident, reassuring manner that suggests that the proposed treatments are patient-centred. This can be done by sitting on a chair next to the patient, perhaps holding the patient’s hand, making eye contact and using an appropriate tone of voice that clearly conveys the message that you care. Nurses should always communicate with patients in a manner that is sensitive and respectful. Trust in nurses is especially important, given the public’s belief that some nurses are uncaring (Francis 2013). Developing trusting relationships with patients and colleagues can enable all parties to feel valued and respected. Listening to and respecting patients fosters and restores
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trust. This assists nurses to provide care that is culturally sensitive, complying with The Code (NMC 2008). As a patient’s advocate, nurses need to learn the skill of negotiation. Enhanced interpersonal and negotiation skills enable nurses to influence decisions that affect patients’ health (Christiansen et al 2014). For example, given the scarcity of resources, nurses have to negotiate with patients about what care can be provided. Having professional practice skills assists nurses in reviewing, co-ordinating and justifying care. Sometimes this will mean advocating patients’ needs and having the courage to speak up about cuts in funding, the government’s drive for targets and the challenges and negative effects these initiatives can have on the provision of compassionate and sensitive care to patients.
Importance of teamwork Teamwork involves individuals working co-operatively to achieve the objectives and goals of the organisation (West 2012). Teamwork is assisted by having clear goals and a shared understanding of how these goals will be achieved, thereby instilling shared responsibility (Thompson 2011). Nursing involves teamwork, interaction and the sharing of information with other team members to ensure the continuity of patient care (CQC 2013). Complete time out activity 5 To promote effective teamwork, nurses should appreciate individual differences, respect each other, and appreciate and value the different skills, knowledge and expertise of each team member. Nurses should trust one another and collaborate to achieve good patient care. Teamwork is challenging. The growing diversity of nurses’ ages and cultural and educational backgrounds could lead to conflict. Team members’ different personalities can give rise to conflict (West 2012). Nurses should be aware of this and use different ways of resolving conflict. In some cases, this may require recognising and managing self-esteem and insecurities, being humble in acknowledging limitations and mistakes, and compromising to promote collaboration. Nurses have a responsibility to treat others with respect and dignity (DH and NHSCB 2012). Diversity enriches workplace
culture. Different skills and knowledge offer greater opportunities for informal learning. However, different views and perspectives require effective management to ensure the organisation maximises opportunities for learning in its teams. According to Lloyd and Murphy (2008), learning to work with others is a vital skill. Peer support for and trust in one another are prerequisites for an effective team. These can be achieved through a shared goal of continuous learning and a culture that encourages nurses to participate actively and maximise their roles and responsibilities in the team. Acceptance and integration of human resources policies and practices (Gratton and Truss 2003) can be achieved through teamwork, through the search for new knowledge and skills, and sharing professional knowledge in achieving organisational goals. Good communication skills enable team members to negotiate tasks, resolve conflicts maturely, promote loyalty and influence, and motivate others. Having the right attitude and willingness to work with others is a starting point. One method of achieving this is to provide a welcoming environment that values and promotes the sharing of ideas and learning among nurses. An appreciation and acceptance of our cultural and individual differences shows respect for and an ability to collaborate and seek advice from each other (NMC 2008). Colleagues serve as a valuable source of ‘social capital’ (Lee et al 2011) for learning, using networks and co-ordinating
5 Reflect on the statements in Box 2. Outline what nurses can do to promote teamwork. Describe the benefits of teamwork to providing effective nursing care.
BOX 2 Assessing your teamworking abilities I am more respectful and courteous when I speak to doctors than to patients and colleagues. I am good at managing conflict with colleagues. I acknowledge individual differences in the team and treat others with respect. I am dismissive of colleagues who can’t speak proper English or who have strong accents. I keep my ideas to myself. I fear that if I share my ideas with others, they will know more and seem cleverer than I do. I am afraid of asking questions in case people think I am stupid. I don’t like to be criticised. I struggle to express myself because English is not my first language. I am not confident about giving presentations because I fear I will make a fool of myself. I worry that people will laugh at my accent. I am a good team player. I can’t stand colleagues who are lazy and don’t do their fair share of the work.
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CPD professional issues to improve efficiency. Acceptance of others and feeling a sense of belonging offers a comfortable, less threatening working environment and improves job satisfaction (Rafferty et al 2001), particularly at a time when morale is low. Nurses are encouraged to learn from positive role models and from each other’s strengths and shortcomings, irrespective of ethnicity, gender, age, grade, and professional discipline or status. Sharing information with colleagues helps with recall, improving understanding. Effective communication can enable nurses to articulate their roles and contributions within the team. Learning to communicate increases confidence. It enables nurses to answer patients’ and relatives’ queries and to allay their anxieties sensitively, inspiring confidence and trust. Good communication skills can help to give nurses confidence to speak in public (McMillan and Weyers 2012) and present
ideas to individuals in small and large groups. In contrast, the inability to communicate properly can be misconstrued and can undermine a nurse’s authority and right to be taken seriously. Nurses use different ways of communicating in a team. The Code (NMC 2008) requires nurses to keep clear and accurate records of assessments, discussions, the treatments offered, and the treatments’ effectiveness, and to keep these records securely. In the course of nurses’ professional lives, nurses will regularly communicate by writing care plans and reports. An ability to take notes and to write in a structured and concise manner will promote ease of reading, prevent ambiguity and promote a logical understanding of this information. This way, continuity of care can be ensured (Kripalani et al 2007). Technical and presentational aspects of writing can be improved by proofreading (Fairbairn and Winch 2011).
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Conclusion Nurses face many challenges as a result of often conflicting demands from different partners in care. Changes in how health care is delivered have resulted in greater powers for patients and, consequently, increased expectations of standards of care. Recommendations by regulatory and professional bodies have resulted in increasing workloads for nurses without a corresponding increase in staff and capital. This can lead to compassion fatigue and stress among nurses. These challenges require a greater commitment from nurses to develop essential professional practice skills, such as effective communication and teamwork. Developing professional practice skills assists nurses by providing a clear strategy to equip nurses with the right knowledge, skills and attitudes, and is one way of enabling nurses to cope with professional
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demands. Effective application of these skills will fulfil the expectations and needs of different partners in care, enable nurses to provide compassionate care, equip them with the knowledge to liberate themselves from accusations of poor care, and enable them to manage personal and work-related stress NS Complete time out activity 6
USEFUL RESOURCES NHS England: Compassion in practice: www.england.nhs.uk/nursingvision/ NHS England Chief Nursing Officer: www.england.nhs.uk/tag/chief-nursingofficer/ Nursing and Midwifery Council: Revalidation: www.nmc-uk.org/Nurses-and-midwives/ Revalidation/ Royal College of Nursing: Defining nursing: tinyurl.com/4yu6jl2 (All websites last accessed: August 19 2014.)
needs regarding evidence-based practice: implications for accelerating the paradigm shift. Worldviews on Evidence-Based Nursing. 1, 3, 185-193. Newman K, Maylor U, Chansarkar B (2002) “The nurse satisfaction, service quality and nurse retention chain”: implications for management of recruitment and retention. Journal of Management in Medicine. 16, 4-5, 271-291. Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. NMC, London. Nursing and Midwifery Council (2014) Code of Conduct. www.nmc-uk.org/Documents/ Consultations/2014/Draftrevised-code.pdf (Last accessed: August 19 2014.) Oku J, Reid J (2009) Study Skills for Health and
Social Care Students. Sage Publications, London. Rafferty AM, Ball J, Aiken LH (2001) Are teamwork and professional autonomy compatible, and do they result in improved hospital care? Quality in Health Care. 10, Suppl 2, ii32-ii37. Reynolds W, Scott PA, Austin W (2000) Nursing, empathy and perception of the moral. Journal of Advanced Nursing. 32, 1, 235-242. Ross SJ, Polsky D, Sochalski J (2005) Nursing shortages and international nurse migration. International Nursing Review. 52, 4, 253-262. Royal College of Nursing (2003) Defining Nursing. tinyurl. com/4yu6jl2 (Last accessed: August 19 2014.) Royal College of Nursing (2014) Nursing Workforce
6 Now that you have completed the article, you may like to write a reflective account. Guidelines to help you are on page 62.
Morale at All-time Low. tinyurl. com/pqasun4 (Last accessed: August 19 2014.) Scheffer BK, Rubenfeld MG (2000) A consensus statement on critical thinking in nursing. Journal of Nursing Education. 39, 8, 352-359. Silverman J, Kurtz S, Draper J (2004) Skills for Communicating With Patients. Second edition. Radcliffe Publishing, Oxford. Thompson N (2011) Effective Communication: A Guide for the People Professions. Second edition. Palgrave Macmillan, Basingstoke. Watterson L (2013) 6Cs + principles = care. Nursing Standard. 27, 46, 24-25. West MA (2012) Effective Teamwork: Practical Lessons From Organizational Research. Third edition. BPS Blackwell, Chichester.
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Prepare for revalidation: read this CPD article and write a reflective account http://revalidation.zone
CONTINUING PROFESSIONAL DEVELOPMENT
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Practice skills multiple choice questionnaire
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Read Adam Davies’s reflective account on fever in children
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Guidelines on how to write a reflective account
Professional practice skills for nurses NS759 Groves W (2014) Professional practice skills for nurses. Nursing Standard. 29, 1, 51-59. Date of submission: March 6 2014; date of acceptance: June 19 2014.
Aims and intended learning outcomes
Abstract Nurses work in a healthcare system in which different partners in care have different expectations of them. Demands to provide compassionate care that is patient-centred and responsive while adhering to budget constraints are contributing to ‘compassion fatigue’ and adversely affecting nurses’ mood and effectiveness. This article discusses how an understanding of professional practice skills, communication skills and teamwork can help nurses to cope with these conflicting demands and compassion fatigue while performing their professional roles and responsibilities. This approach is discussed in the context of nursing discourse and related professional and government recommendations.
Author Winnifred Groves Public sector researcher, Surbiton, Surrey. Correspondence to: [email protected]
Keywords Code of conduct, communication, compassionate care, compassion fatigue, interpersonal skills, nursing care, nursing practice, professional practice, revalidation, 6Cs of nursing
Review All articles are subject to external double-blind peer review and checked for plagiarism using automated software.
Online For related articles visit the archive and search using the keywords above. To write a CPD article: please email [email protected] Guidelines on writing for publication are available at: rcnpublishing.com/r/author-guidelines
This article examines ways in which developing professional practice skills can help nurses to cope with conflicting demands and ‘compassion fatigue’ in their roles, while remaining responsive and providing targeted measures and high standards of patient care. After reading this article and completing the time out activities you should be able to: Identify the main partners in care that nurses work with and briefly describe their expectations of nurses. Outline the main challenges faced by nurses as a result of the different expectations of them of different partners in care. Identify and describe essential professional practice skills needed by nurses to meet personal, professional and legislative requirements. Explain how professional practice skills can help support nurses faced with the dual demands of providing effective practice and compassionate care.
Introduction One of the main narratives in nursing today is that patients are suffering from serious neglect in the NHS; ‘compassion fatigue’ is also of growing concern. Nursing has been in the spotlight for providing poor care, partly highlighted by events at Mid Staffordshire and Winterbourne View (Department of Health (DH) and NHS Commissioning Board (NHSCB) 2012). The Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis 2013) proposed a way for all those involved in care to provide it in a way that meets expectations and standards. It emphasised the importance of adequate resources, as well as the right
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CPD professional issues
1 Identify the different groups of people and professional bodies that have expectations of the quality of patient care provided by nurses. Briefly describe these expectations.
approach and attitude of the carer, in meeting these expectations. Trust is the basis of the relationship between nurses and their patients. As a result of challenges to and developments in nursing, the nursing profession, the DH and the NHSCB have made several recommendations, including the 6Cs: care, compassion, competence, communication, courage and commitment (DH and NHSCB 2012, Watterson 2013). Nurses are expected to embrace new and smarter ways of working to enable the 6Cs to become a reality. There is also debate about a new revalidation process for nurses and midwifes. The premise of revalidation is that nurses need to demonstrate their continued competence and fitness for practice consistently and regularly (DH 2013, Keogh 2013). Nurses are at the forefront of providing health care. The commitment to provide excellent care that is safe, compassionate and holistic is integral to nursing. It is vital for nurses to develop and maintain professional practice skills that are patient-centred and promote safe and effective care, while being cost-efficient. Applying these skills will enable nurses to achieve the care and compassion that have been under recent scrutiny in the NHS.
FIGURE 1 Main partners in nursing care
The state or healthcare system Organisations Regulatory bodies The general public
Professional bodies, for example: Royal College of Nursing Nursing and Midwifery Council
Nurses to provide good quality care which is cost-efficient
Patients Carers Relatives
Colleagues or nursing managers Medical staff Other members of the multidisciplinary team
Professional practice skills are generic skills that enable nurses to understand the legislative framework, be aware of professional requirements and standards of behaviour, possess the knowledge base and skills for reflection, and communicate effectively (Oku and Reid 2009). Mindfulness of how ethics, morals and values affect the care provided by nurses is also required (Fry and Johnstone 2008). These skills promote a careful assessment of the needs of individual nurses, those of their colleagues in clinical practice and those of professional bodies and relevant legislation, as well as the demands and expectations of individual patients. Knowledge and application of these skills will help nurses to plan, implement and review care that more effectively meets the needs and expectations of all main partners in care. Complete time out activity 1
Expectations of nurses Nurses have a moral and professional responsibility to patients, carers, relatives, colleagues, professional bodies and the state. Together, these groups represent partners in care in nursing (Figure 1). Nursing involves working with different professional groups and families to meet the needs of individuals, promote and maintain health, care for patients when they are ill, assist patients’ recovery and independence, maintain their wellbeing, and improve their quality of life (Royal College of Nursing (RCN) 2003). Public expectations of nurses are at an all-time high and the government’s agenda of consulting and involving service users (DH 2010, 2012) has led to a rise in ‘patient power’ and resulted in care environments where nurses must be accountable for their actions (Ellis 2013). The public trusts nurses to meet patients’ health needs and ensure their safety, involve them in their own care, treat them with respect and dignity, provide timely care, listen to and inform them, and demonstrate empathy (Care Quality Commission (CQC) 2013). In addition, professional bodies require nurses to have the knowledge, skills (Kozier et al 2011) and attitudes necessary to provide and sustain evidence-based and cost-efficient care. Given these competing demands, nurses have to demonstrate through their practice the ability to identify and understand the
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needs of different partners in care while being realistic about available resources. The principal argument is that nurses should balance a commitment to the patient with standards of care that meet the needs of all partners in care. This involves making decisions and prioritising care. Continuing professional development (CPD) is a professional requirement for nurses that involves learning in practice. Training nurses to deliver excellent care throughout their careers is one way of safeguarding the health and wellbeing of the public, thereby achieving the state’s function and responsibility to its citizens. The need to provide a high standard of care is stressed by the Nursing and Midwifery Council (NMC), which requires nurses and midwives to keep their skills and knowledge up to date and uphold the standards of their professional code of conduct (NMC 2008, 2014). Complete time out activity 2 Nurses provide care to patients from diverse backgrounds. An ageing population will have more complex and multiple medical conditions. Furthermore, the public has high expectations of what constitutes health care and support and how these should be provided (DH and NHSCB 2012). However, there is a mismatch between these requirements and the availability of nurses to meet them (Ross et al 2005), which reduces nurses’ capacity to provide individualised care. There is evidence to suggest that staff shortages, poor working conditions and low staff morale result in poor nursing care, and dissatisfaction among patients and other partners in care (Newman et al 2002, Groves 2012). Heavy workloads make nurses focus on technical tasks rather than caring, making patient-centred care an unrealistic expectation. Without the necessary resources, care will become mechanistic, which will become a barrier to compassion. Other barriers to good nursing care include: poor workplace policies and practices, lack of managerial and ward support, and the gap between theory and practice. Lack of time has also been noted as a major source of stress for nurses (Demerouti et al 2000). Nurses feeling unappreciated and inadequate social support have been cited as barriers to effective communication (Reynolds et al 2000, Chant et al 2002), while teamwork and CPD can support nurses (Melnyk et al 2004). From these challenges, it appears that the gap between clinical leadership and management is
an ongoing barrier to providing excellent care. The central question is that with management driven by targets and the 6Cs requiring compassion and sensitive care, what support is there for nurses to achieve this? It remains to be seen whether the 6Cs recommendations will be effective without the resources nurses need to achieve them. These problems call for a multiplicity of solutions from the different partners in care. Effective use of nurses’ knowledge and skills has numerous benefits. So, which core professional practice skills do nurses need to cope with competing demands and avoid the shortfall in standards of nursing care reported in the media? Complete time out activity 3
Essential practice skills for nurses and their relevance to practice Table 2 lists practice skills that are essential to good nursing practice. Learning and developing these skills will enable nurses to provide individualised care and tailor measures to meet patients’ needs. Sometimes it can be difficult to effect professional demands, given the scarcity of resources (Table 1). Nurses need to provide evidence-based care compassionately, sensitively, cost-effectively and efficiently, thereby meeting the needs of different partners in care, combating compassion fatigue and achieving the revalidation requirements of the future. An ability to think critically fosters reflection, self-confidence, inquisitiveness and open-mindedness (Scheffer and Rubenfeld 2000). Critical thinking is a transferable skill that enables nurses to analyse situations from multiple viewpoints (Lloyd and Murphy 2008, du Boulay 2009) and can lead to changes in attitudes. Furthermore, critical thinking involves cognitive flexibility, which allows the nurse to scrutinise the evidence and its usefulness meticulously. By so doing, the nurse is complying with the need to practise evidence-based learning as encouraged by professional bodies (NMC 2008, DH and NHSCB 2012). Good research skills help nurses to access information on legislation and professional requirements. Nurses require information on sources of training and to acquire ‘professional know-how’ to understand what type of care will have an effect, what is practicable, and what is ethical and sensitive. Gaining access to this information helps
2 Describe the main challenges faced by nurses as a result of the different expectations of them by different partners in care. Compare your answers with the challenges listed in Table 1. 3 Identify the core professional practice skills required by nurses to meet different expectations. Describe how such skills can help in achieving the 6Cs in practice.
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CPD professional issues the nurse not only to provide care that meets patients’ needs and uses resources efficiently but also complies with statutory expectations and The Code (NMC 2008). Clauses 40 and 41 of the code require nurses to update their knowledge and skills throughout their working life by participating and engaging in learning activities that promote competence and improve performance (NMC 2008).
The importance of concise, timely and accurate documentation has been noted as a prerequisite for safe and effective nursing practice (Casey and Wallis 2011). Decision making is the basis of professional practice, particularly given the competing demands on nurses and the scarcity of resources, which necessitates the rationing of care. Decision making underpins ethics (doing what is right) and morals (pursuing behaviour
TABLE 1 Barriers and aids to care Challenges and barriers
Assisting factors
Increasing legislative and professional expectations. Increasing paperwork.
Continuing professional development. Research skills. Reading. Decision-making skills. Information and communications technology. Critical thinking. Sharing of information. Report writing.
Workplace policies and practices.
Assistance with interpreting workplace policies. Engaging nurses in all aspects of care initiatives. Seeking nurses’ views and acting on them accordingly. An open culture that is not intimidating. A culture that helps with effective communication.
Lack of managerial support. Unhelpful organisational culture.
Management support. A transparent and fair work environment. An environment that promotes learning and encourages nurses to speak out. Counselling and emotional support.
Lack of resources: Severe staff and/or skill shortages. Heavy workloads. Poor working conditions.
Availability of adequate resources. More nurses with appropriate skills. Opportunities to assist with integrating research evidence into practice. Willingness to share knowledge and skills that only come with experience. Promoting a positive work environment.
Lack of time.
Effective time management. Decision-making and negotiation skills.
Theory-practice gap.
Research skills. Ability to select knowledge and reflect on practice. Critical thinking ability. Learning from each other.
Poor pay and increasing cost of living.
Pay rises for nurses. Other incentives.
Lack of appreciation and recognition for nurses.
Feeling valued, appreciated and supported by: - The ward sister and other leaders. - Management. - The state.
Diversity of nursing, professional relationships with colleagues.
Teamwork. Effective communication skills. Good interpersonal skills. Motivation and respect for each other.
Low staff morale (Royal College of Nursing 2014), low job satisfaction, compassion fatigue.
Increase in wages. Teamwork. Nurses sharing a common vision. Support from colleagues and mentors.
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that society finds acceptable) (Fry and Johnstone 2008). Ethics, morals and values – as well as professional knowledge – are essential components of decision making in practice. Nurses’ duties are set and regulated by legislation and professional bodies; however, when equipped with the right knowledge, skills, resources and attitudes, rather than operating simply as passive observers of the rules, nurses should be able to make decisions that meet the needs of all partners in care by identifying and analysing problems, and performing searches for evidence-based information. Learning in practice fosters competence, which is one of
the 6Cs. ‘People have a right to expect safe, effective, compassionate, high-quality care’ (CQC 2013) – the right knowledge, skills and attitudes are vital to the provision of such care.
Communication skills in compassionate care and effective nursing practice
For the purpose of this article, communication is defined as social interaction through messages (Fiske 2011). Communication is multidimensional. It involves the transmission of information from one person to another. It has a clear purpose. For example, during a consultation between a nurse and a patient, the model developed
TABLE 2 Essential practice skills for nurses and their relevance to practice Essential practice skills
Relevance to practice
Critical thinking and decision making.
Critical thinking enables nurses to be open-minded, see the bigger picture and reflect, so they can make more effective judgements and clinical decisions. Decision making is a significant aspect of clinical practice. Critical thinking and decision making promote ethical practice, since nurses can argue why their organisations’ actions or inaction deprive patients of their rights and wellbeing. By acting as the patient’s advocate and using the right knowledge in the right situations, nurses work towards achieving components of the 6Cs, including competence, commitment, care and courage. Critical thinking and decision making promote a less stressful environment, since nurses are able to critically analyse situations to arrive at a clinical decision that helps achieve desired health outcomes. This promotes effectiveness and ultimately efficiency by maximising the use of limited resources.
Information and communications technology (ICT), writing, reading, note-taking, proofreading.
Knowledge of ICT is relevant to clinical practice because of its increasing use in care. Good knowledge of ICT assists competence and care, by allowing the nurse to access recent research to provide evidence-based care. Legible and concise writing of care plans achieves effective communication and continuity of care. Smart reading and note-taking saves time in busy clinical environments. Proofreading minimises mistakes, improves understanding and promotes competence in practice.
Interpersonal skills, teamwork.
As noted in the 6Cs, communication is central to providing care. Nurses need to communicate with patients, carers, relatives, colleagues and other partners in care, and to work in teams. Good communication and interpersonal skills enable nurses to demonstrate empathy and an ability to listen and provide care, underpinned by respect and dignity.
Presentation skills.
Nurses need good communication skills to conduct presentations. Presenting information in a manner that is convincing and easy to understand is vital.
Consultation and negotiation skills.
Nurses work in consultation with patients to help them feel they are partners in their own care. This results in greater co-operation since nurses and patients agree on care that is acceptable and right for them. Nurses constantly negotiate with patients, colleagues and other healthcare professionals.
Time management and cost management.
Time is a finite resource. There is a need to deal with matters quickly and prioritise them according to their importance. A nurse needs the time and knowledge to assess a patient, process different types of data, and define the problem, its components and its origins. Carefully analysing costs enables the nurse to devise a plan of action and set realistic goals, resulting in resources being used more strategically. Careful use of equipment and disposable items should also be considered.
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CPD professional issues
4 Are your communication skills serving you well? Think of an example in clinical practice where you had a consultation with a patient, carer or relative. Reflect on your performance using the statements shown in Box 1.
by Silverman et al (2004) suggests that effective communication involves moving from developing a rapport to developing a relationship that puts the patient at ease, with the nurse asking questions, using active listening, reflecting on what is heard, rephrasing responses to ensure that the patient and the nurse have the same understanding of events, and agree on a care plan. The importance of effective communication is stressed by NMC (2008), which emphasises that the information that people need or want to know about their health should be shared with them in a way that they can understand. Nursing demands effective verbal and non-verbal communication skills (Debnath 2010), including active and purposeful listening. Listening skills are vital in improving the quality of communication. They show the person with whom you are talking that you respect and value him or her. ‘Good communication is central to working with people. It’s important to be able to communicate both on a one-to-one basis and in a group context. Communication is not just about the words you use but also your manner of speaking, body language and, above all, the effectiveness with which you listen. To communicate effectively it is important to take account of culture and context, for example where English is an additional language’ (Department for Education and Skills 2005). Complete time out activity 4
BOX 1 Assessing your communication skills I am a good listener. I maintain good eye contact when I’m speaking to someone. I don’t know how to maintain eye contact because of my cultural upbringing. I am aware of my body language, posture, tone of voice, pitch and expression. I do not think it is wrong to chew gum when I’m speaking to patients, relatives or colleagues. I give patients my full attention when they speak to me. My voice is naturally loud. My tone of voice is patronising. I come across as aggressive but I am not. My body language is open and receptive. I keep an open mind when communicating with someone. I try not to interrupt when someone is speaking to me. I listen to the unspoken words. I ask for clarification by paraphrasing what the other person says to me. I am emotionally available when someone is speaking to me. I act on feedback to improve my communication skills.
Good communication skills affect the working environment, colleagues, the quality of care, and how patients feel and respond to treatment. Francis (2013) noted a public concern that patients are treated in a dehumanising and impersonal way. In the light of current public complaints about poor nursing care, effective communication is vital. Effective communication requires the nurse to know how best to gather information from a patient and how to explore sensitive issues. To help achieve this, the nurse can offer genuine acceptance, ensure confidentiality and listen with interest. Communication serves different functions. It expresses our state of mind and emotional state. This involves seeing and hearing and, to some extent, feeling (intuition). Nurses therefore need to observe patients’ body language (non-verbal clues), gestures and facial expressions. Nurses should also listen for words that suggest doubt, anxiety, discomfort, anger, denial, acceptance and gratitude, among other emotions. One focused method of communication is to make links between what patients say and their intention to act on it. Does what the nurse sees and hears suggest that the patient could be at risk of self-harm? Does it suggest that the patient has given up hope? If so, how will that affect the patient’s adherence to treatment and the treatment outcome? With this knowledge, the nurse can plan and implement targeted intervention strategies. Empathy entails considering the situation from the patient’s point of view. After listening to patients, nurses should show their understanding of what they have heard by paraphrasing and repeating it back to the patients. Treatment plans should be negotiated in a confident, reassuring manner that suggests that the proposed treatments are patient-centred. This can be done by sitting on a chair next to the patient, perhaps holding the patient’s hand, making eye contact and using an appropriate tone of voice that clearly conveys the message that you care. Nurses should always communicate with patients in a manner that is sensitive and respectful. Trust in nurses is especially important, given the public’s belief that some nurses are uncaring (Francis 2013). Developing trusting relationships with patients and colleagues can enable all parties to feel valued and respected. Listening to and respecting patients fosters and restores
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trust. This assists nurses to provide care that is culturally sensitive, complying with The Code (NMC 2008). As a patient’s advocate, nurses need to learn the skill of negotiation. Enhanced interpersonal and negotiation skills enable nurses to influence decisions that affect patients’ health (Christiansen et al 2014). For example, given the scarcity of resources, nurses have to negotiate with patients about what care can be provided. Having professional practice skills assists nurses in reviewing, co-ordinating and justifying care. Sometimes this will mean advocating patients’ needs and having the courage to speak up about cuts in funding, the government’s drive for targets and the challenges and negative effects these initiatives can have on the provision of compassionate and sensitive care to patients.
Importance of teamwork Teamwork involves individuals working co-operatively to achieve the objectives and goals of the organisation (West 2012). Teamwork is assisted by having clear goals and a shared understanding of how these goals will be achieved, thereby instilling shared responsibility (Thompson 2011). Nursing involves teamwork, interaction and the sharing of information with other team members to ensure the continuity of patient care (CQC 2013). Complete time out activity 5 To promote effective teamwork, nurses should appreciate individual differences, respect each other, and appreciate and value the different skills, knowledge and expertise of each team member. Nurses should trust one another and collaborate to achieve good patient care. Teamwork is challenging. The growing diversity of nurses’ ages and cultural and educational backgrounds could lead to conflict. Team members’ different personalities can give rise to conflict (West 2012). Nurses should be aware of this and use different ways of resolving conflict. In some cases, this may require recognising and managing self-esteem and insecurities, being humble in acknowledging limitations and mistakes, and compromising to promote collaboration. Nurses have a responsibility to treat others with respect and dignity (DH and NHSCB 2012). Diversity enriches workplace
culture. Different skills and knowledge offer greater opportunities for informal learning. However, different views and perspectives require effective management to ensure the organisation maximises opportunities for learning in its teams. According to Lloyd and Murphy (2008), learning to work with others is a vital skill. Peer support for and trust in one another are prerequisites for an effective team. These can be achieved through a shared goal of continuous learning and a culture that encourages nurses to participate actively and maximise their roles and responsibilities in the team. Acceptance and integration of human resources policies and practices (Gratton and Truss 2003) can be achieved through teamwork, through the search for new knowledge and skills, and sharing professional knowledge in achieving organisational goals. Good communication skills enable team members to negotiate tasks, resolve conflicts maturely, promote loyalty and influence, and motivate others. Having the right attitude and willingness to work with others is a starting point. One method of achieving this is to provide a welcoming environment that values and promotes the sharing of ideas and learning among nurses. An appreciation and acceptance of our cultural and individual differences shows respect for and an ability to collaborate and seek advice from each other (NMC 2008). Colleagues serve as a valuable source of ‘social capital’ (Lee et al 2011) for learning, using networks and co-ordinating
5 Reflect on the statements in Box 2. Outline what nurses can do to promote teamwork. Describe the benefits of teamwork to providing effective nursing care.
BOX 2 Assessing your teamworking abilities I am more respectful and courteous when I speak to doctors than to patients and colleagues. I am good at managing conflict with colleagues. I acknowledge individual differences in the team and treat others with respect. I am dismissive of colleagues who can’t speak proper English or who have strong accents. I keep my ideas to myself. I fear that if I share my ideas with others, they will know more and seem cleverer than I do. I am afraid of asking questions in case people think I am stupid. I don’t like to be criticised. I struggle to express myself because English is not my first language. I am not confident about giving presentations because I fear I will make a fool of myself. I worry that people will laugh at my accent. I am a good team player. I can’t stand colleagues who are lazy and don’t do their fair share of the work.
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CPD professional issues to improve efficiency. Acceptance of others and feeling a sense of belonging offers a comfortable, less threatening working environment and improves job satisfaction (Rafferty et al 2001), particularly at a time when morale is low. Nurses are encouraged to learn from positive role models and from each other’s strengths and shortcomings, irrespective of ethnicity, gender, age, grade, and professional discipline or status. Sharing information with colleagues helps with recall, improving understanding. Effective communication can enable nurses to articulate their roles and contributions within the team. Learning to communicate increases confidence. It enables nurses to answer patients’ and relatives’ queries and to allay their anxieties sensitively, inspiring confidence and trust. Good communication skills can help to give nurses confidence to speak in public (McMillan and Weyers 2012) and present
ideas to individuals in small and large groups. In contrast, the inability to communicate properly can be misconstrued and can undermine a nurse’s authority and right to be taken seriously. Nurses use different ways of communicating in a team. The Code (NMC 2008) requires nurses to keep clear and accurate records of assessments, discussions, the treatments offered, and the treatments’ effectiveness, and to keep these records securely. In the course of nurses’ professional lives, nurses will regularly communicate by writing care plans and reports. An ability to take notes and to write in a structured and concise manner will promote ease of reading, prevent ambiguity and promote a logical understanding of this information. This way, continuity of care can be ensured (Kripalani et al 2007). Technical and presentational aspects of writing can be improved by proofreading (Fairbairn and Winch 2011).
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Department of Health, NHS Commissioning Board (2012) Compassion in Practice: Nursing, Midwifery and Care Staff, Our Vision and Strategy. tinyurl. com/c5lc4n2 (Last accessed: August 19 2014.) du Boulay D (2009) Study Skills for Dummies. John Wiley and Sons, Chichester. Ellis P (2013) Evidence-Based Practice in Nursing. Second edition. Sage Publications, London. Fairbairn G, Winch C (2011) Reading, Writing and Reasoning: A Guide for Students. Third Edition. Open University Press, Maidenhead. Fiske J (2011) Introduction to Communication Studies. Third edition. Routledge, Abingdon. Francis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. tinyurl.com/omsm882 (Last accessed: August 14 2014.)
Fry ST, Johnstone M-J (2008) Ethics in Nursing Practice: A Guide to Ethical Decision Making. Second edition. Blackwell Publishing, Oxford. Gratton L, Truss K (2003) The three-dimensional people strategy: putting human resources policies into action. Academy of Management Executive. 17, 3, 74-86. Groves WN (2012) Diagnosing and Prescribing by Nurses in Different Health Care Settings: Perceptions And Experiences of Key Stakeholders in Cameroon. Unpublished PhD thesis. Kingston University, London. Keogh K (2013) Patients and employers given a say on whether nurses are fit to practise. Nursing Standard. 28, 3, 12. Kozier B, Erb G, Berman A, Snyder S, Lake R, Harvey S (2011) Fundamentals of Nursing: Concepts, Process and Practice. Second edition. Pearson Education, Harlow.
58 september :: volRCNi.com 29 no 1 ::by2014 NURSING STANDARD / RCN Downloaded3from ${individualUser.displayName} on Nov 21, 2015.©For personal use only. No other usesPUBLISHING without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Conclusion Nurses face many challenges as a result of often conflicting demands from different partners in care. Changes in how health care is delivered have resulted in greater powers for patients and, consequently, increased expectations of standards of care. Recommendations by regulatory and professional bodies have resulted in increasing workloads for nurses without a corresponding increase in staff and capital. This can lead to compassion fatigue and stress among nurses. These challenges require a greater commitment from nurses to develop essential professional practice skills, such as effective communication and teamwork. Developing professional practice skills assists nurses by providing a clear strategy to equip nurses with the right knowledge, skills and attitudes, and is one way of enabling nurses to cope with professional
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demands. Effective application of these skills will fulfil the expectations and needs of different partners in care, enable nurses to provide compassionate care, equip them with the knowledge to liberate themselves from accusations of poor care, and enable them to manage personal and work-related stress NS Complete time out activity 6
USEFUL RESOURCES NHS England: Compassion in practice: www.england.nhs.uk/nursingvision/ NHS England Chief Nursing Officer: www.england.nhs.uk/tag/chief-nursingofficer/ Nursing and Midwifery Council: Revalidation: www.nmc-uk.org/Nurses-and-midwives/ Revalidation/ Royal College of Nursing: Defining nursing: tinyurl.com/4yu6jl2 (All websites last accessed: August 19 2014.)
needs regarding evidence-based practice: implications for accelerating the paradigm shift. Worldviews on Evidence-Based Nursing. 1, 3, 185-193. Newman K, Maylor U, Chansarkar B (2002) “The nurse satisfaction, service quality and nurse retention chain”: implications for management of recruitment and retention. Journal of Management in Medicine. 16, 4-5, 271-291. Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. NMC, London. Nursing and Midwifery Council (2014) Code of Conduct. www.nmc-uk.org/Documents/ Consultations/2014/Draftrevised-code.pdf (Last accessed: August 19 2014.) Oku J, Reid J (2009) Study Skills for Health and
Social Care Students. Sage Publications, London. Rafferty AM, Ball J, Aiken LH (2001) Are teamwork and professional autonomy compatible, and do they result in improved hospital care? Quality in Health Care. 10, Suppl 2, ii32-ii37. Reynolds W, Scott PA, Austin W (2000) Nursing, empathy and perception of the moral. Journal of Advanced Nursing. 32, 1, 235-242. Ross SJ, Polsky D, Sochalski J (2005) Nursing shortages and international nurse migration. International Nursing Review. 52, 4, 253-262. Royal College of Nursing (2003) Defining Nursing. tinyurl. com/4yu6jl2 (Last accessed: August 19 2014.) Royal College of Nursing (2014) Nursing Workforce
6 Now that you have completed the article, you may like to write a reflective account. Guidelines to help you are on page 62.
Morale at All-time Low. tinyurl. com/pqasun4 (Last accessed: August 19 2014.) Scheffer BK, Rubenfeld MG (2000) A consensus statement on critical thinking in nursing. Journal of Nursing Education. 39, 8, 352-359. Silverman J, Kurtz S, Draper J (2004) Skills for Communicating With Patients. Second edition. Radcliffe Publishing, Oxford. Thompson N (2011) Effective Communication: A Guide for the People Professions. Second edition. Palgrave Macmillan, Basingstoke. Watterson L (2013) 6Cs + principles = care. Nursing Standard. 27, 46, 24-25. West MA (2012) Effective Teamwork: Practical Lessons From Organizational Research. Third edition. BPS Blackwell, Chichester.
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