Nursing Directives and Theories

Based on the posed question, it seems implied that the availability of improvement tools could obstruct effective interactions between the patient and the nurse, perhaps even leading to an unintended disconnect. Could it be that with more particulars concerning patient status, we could be getting in the way of implementing the caring features of our profession? The Nurse Bedside Shift Report Implementation Handbook published by the Agency for Healthcare Research and Quality (2014) contends that the implementation of the bedside shift report provides an environment that enhances “patient safety and quality, patient experience of care, and nursing staff satisfaction” (AHRQ, 2014, p. 3). In light of this pertinent question concerning the patient-centered approach, this handbook will shed light on the currently accepted practice of point-of-care testing, perhaps, leading us to some meaningful conclusions in patient care in the twenty-first century.

These tools, or assessment rubrics, comprise three different angles. The first is an introduction to the patient and family of exactly what the report is. Delivered upon arrival to the hospital, the brochure quickly briefs the patient what they should expect from their care provider and what is expected of them (p. 3). The second tool, a one-page checklist, makes an opportunity for the nurse to confirm all six steps of quality control are addressed (p. 3). The third tool, a PowerPoint slide and video clip, allows the nurse to see exactly how a proper bedside shift report is implemented (p. 3). Together, these tools supply a specific rubric for caregivers.

From my point of view, I am not convinced this pedagogic approach is going to dramatically detract from the report experience. Hospital culture demands organization and protocols, and, while it is difficult to mandate the appropriate dynamics of human interactions, such efforts must be taken to provide clearly defined standards. Ideally, the professional caregiver will intuitively grasp the characteristics outlined by the tools. If not, they must learn.

A simplistic answer would come in the form of researching a pre-conceived bias highlighting some particular psychological need to positively compare to other professions based on a sense of lacking perspective or professionalism. Nursing, at its most rudimentary function, fills the role of humans taking care of others. Should not nurses qualify and quantify this principled expenditure of energy to place it in the most endorsable frame of reference? However, I find that the professional world is a diverse landscape, full of individuals from different walks of life and with widely contrasting ambitions. When situations arise with a need for recuperation via sickness or surgery, all of these people arrive under the protection of healthcare service providers. Nursing theory, rather than comparing its standards to others, adapts to these multiple ideas by continuously searching to gain from the insights of the professions of the people they are charged with caring for.

For example, in the course of research, construction and testing have been thoroughly addressed in the work of physicists and psychologists alike. Paul E. Meehl (1967) took significant pains to develop a methodological comparison between the two fields: “In the physical sciences, the usual result of an improvement in experimental design . . . is to increase the difficulty of the ‘observational hurdle’ which the . . . theory . . . must successfully surmount; whereas, in psychology . . . the usual effect . . . is to provide an easier hurdle . . . to surmount” (p. 103). Each field takes an approach that focuses on testing situations with a methodology that provides rigorous justification for given views. Physicists want extremely specific rules that can fit into theorems and formulas. Psychologists look for soft determinations to theories and recognize that even one variable x may result in a different response between two different groups (p. 104). Depending on the nuances of construction and testing in the nursing profession, both the physical and psychological processes could have a useful application.

References

Meehl, P. E. (1967) Theory-testing in psychology and physics: A methodological paradox. Philosophy of Science 34.2: 103.

Agency for Healthcare Research and Quality. AHRQ, 1 Jan. 2014.9 Feb. 2014. <http://www.ahrq.gov/professionals/systems/>.