Practices and Principles of Adult Nursing Essay

This is essay is going to examine the principles of nursing and health. In order to do this it must look at the concept of health then describe the dimensions that make up health. Secondly, an adult individual will be chosen in order to discuss the determinants that affect their health. It will then go on to explain the underpinning professional, ethical and legal principles that would be taken into consideration if the individual were to require nursing care. Finally, it will identify how carrying out this assignment has informed the writers personal concept of nursing.Practices and Principles of Adult Nursing Essay

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Before being able to describe the dimensions of health, it is important to look at the concept of health. Throughout the…show more content…
The final dimension of health is environmental. This is concerned with the environment that the individual lives in, their economic standing and occupational hazards. An adult individual has been chosen to provide an overview and look at the determinants that affect their health. For the purpose of this essay, the individual will be referred to as George. This is to maintain the individual’s confidentiality and anonymity; therefore, a false name has been used. Consent has been gained to base this essay on the individual. George is a 58-year-old white male, who was born and raised in the west of Scotland. He has a mild learning disability and little educational qualifications. He assists in the distribution of the local press, which involves sitting in a van for long periods with heavy lifting in-between. George’s employment provides him with only a low income and therefore he does not own his home. George does not see family or friends often, as he prefers to stay in playing his computer or watching television. George has coronary heart disease, which led to a myocardial infarction. George recently underwent a quadruple bypass. Before this, George had developed type two diabetes mellitus, for which he was encouraged to change his diet, exercise and prescribed medication. Since the heart attack, George is now dependant on insulin. In order to discuss the determinants that affect Georges health Practices and Principles of Adult Nursing Essay

This paper is the product of individuals who worked to identify basic principles and expectations for the coordinated contributions of various participants in the care process. It is intended to provide common reference points to guide coordinated collaboration among health professionals, patients, and families—ultimately helping to accelerate interprofessional team-based
care. The authors are participants drawn from the Best Practices Innovation Collaborative of the
Institute of Medicine (IOM) Roundtable on Value & Science-Driven Health Care. The Collaborative is inclusive—without walls—and its participants are drawn from professional organizations representing clinicians on the front lines of health care delivery; members of government
agencies that are either actively involved in patient care or with programs and policies centrally
concerned with the identification and application of best clinical services; and others involved in
the evolution of the health care workforce and the health professions.
Teams in health care take many forms, for example, there are disaster response teams;
teams that perform emergency operations; hospital teams caring for acutely ill patients; teams Practices and Principles of Adult Nursing Essay
that care for people at home; office-based care teams; geographically disparate teams that care
for ambulatory patients; teams limited to one clinician and patient; and teams that include the
patient and loved ones, as well as a number of supporting health professionals. Teams in health
care can therefore be large or small, centralized or dispersed, virtual or face-to-face—while their
tasks can be focused and brief or broad and lengthy. This extreme heterogeneity in tasks, patient
types, and settings is a challenge to defining optimal team-based health care, including specific
guidance on the best structure and functions for teams. Still, regardless of their specific tasks,
patients, and settings, effective teams throughout health care are guided by basic principles that
can be measured, compared, learned, and replicated. This paper identifies and describes a set of
core principles, the purpose of which is to help enable health professionals, researchers, policy
makers, administrators, and patients to achieve appropriate, high-value team-based health care.
THE EVOLUTION OF TEAMS IN HEALTH CARE
Health care has not always been recognized as a team sport, as we have recently come to
think of it. In the “good old days,” people were cared for by one all-knowing doctor who lived in
the community, visited the home, and was available to attend to needs at any time of day or
night. If nursing care was needed, it was often provided by family members, or in the case of a

Participants drawn from the Best Practices Innovation Collaborative of the IOM Roundtable on Value & ScienceDriven Health Care.
Copyright 2012 by the National Academy of Sciences. All rights reserved.
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family of means, by a private-duty nurse who “lived in.” Although this conveyed elements of
teamwork, health care has changed enormously since then and the pace has quickened even more
dramatically in the past 20 years. The rapidity of change will continue to accelerate as both clinicians and patients integrate new technologies into their management of wellness, illness, and
complicated aging. The clinician operating in isolation is now seen as undesirable in health Practices and Principles of Adult Nursing Essay
care—a lone ranger, a cowboy, an individual who works long and hard to provide the care needed, but whose dependence on solitary resources and perspective may put the patient at risk.1,2
A driving force behind health care practitioners’ transition from being soloists to members of an orchestra is the complexity of modern health care, which is evolving at a breakneck
pace. The U.S. National Guideline Clearinghouse now lists over 2,700 clinical practice guidelines, and, each year, the results of more than 25,000 new clinical trials are published.3 No single
person can absorb and use all this information. In order to benefit from the detailed information
and specific knowledge needed for his or her health care, the typical Medicare beneficiary visits
two primary care clinicians and five specialists per year, as well as providers of diagnostic,
pharmacy, and other services.4
This figure is several times larger for people with multiple chronic conditions.5
The implication of these dynamics is enormous. By one estimate, primary care
physicians caring for Medicare patients are linked in the care of their patients to, on average, 229
other physicians yearly,6
to say nothing of the vital relationships between physicians, nurses,
physician assistants, advanced practice nurses, pharmacists, social workers, dieticians, technicians, administrators, and many more members of the team. With the geometric rise in complexity in health care, which shows no signs of reversal, the number of connections among health care
providers and patients will likely continue to increase and become more complicated. Data already suggest that referrals from primary care providers to specialists rose dramatically from
1999 to 2009.7
Given this complexity of information and interpersonal connections, it is not only difficult for one clinician to provide care in isolation but also potentially harmful. As multiple clinicians provide care to the same patient or family, clinicians become a team—a group working Practices and Principles of Adult Nursing Essay
with at least one common aim: the best possible care—whether or not they acknowledge this
fact. Each clinician relies upon information and action from other members of the team. Yet,
without explicit acknowledgment and purposeful cultivation of the team, systematic inefficiencies and errors cannot be addressed and prevented. Now, more than ever, there is an obligation to
strive for perfection in the science and practice of interprofessional team-based health care.
URGENT NEED FOR HIGH-FUNCTIONING TEAMS
The incorporation of multiple perspectives in health care offers the benefit of diverse
knowledge and experience; however, in practice, shared responsibility without high-quality
teamwork can be fraught with peril. For example, “handoffs,” in which one clinician gives over
to another the primary responsibility for care of a hospitalized patient, are associated with both
avoidable adverse events and “near misses,” due in part to inadequacy of communication among
clinicians.8-12 In addition to the immediate risks for patients, lack of purposeful team care can
also lead to unnecessary waste and cost.13 Given the frequently uncoordinated state of care by
groups of people who have not developed team skills, it is not surprising that some clinicians report that team care can be cumbersome and may increase medical errors.14 By acknowledging
the aspects of collaboration inherent in health care and striving to improve systems and skills,
identification of best practices in interdisciplinary team-based care holds the potential to address  Practices and Principles of Adult Nursing Essay
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some of these dangers, and might help to control costs.15,16 Identifying best practices through
rigorous study and comparison remains a challenge, and data on optimal processes for teambased care are elusive at least partly due to lack of agreement about the core elements of teambased care. Once the underlying principles are defined, researchers will be able to more easily
compare team-based care models, payers will be able to identify and promote effective practices,
and the essential elements for promoting and spreading team-based care will be evident.
THE STATE OF PLAY
The high-performing team is now widely recognized as an essential tool for constructing
a more patient-centered, coordinated, and effective health care delivery system. As a result, a
number of models have been developed and implemented to coordinate the activities of health
care providers. Building on foundations established by earlier reports from the IOM17 and the
Pew Health Professions Commission,
18 team-based care has gained additional momentum in recent years in the form of legislative support through the Patient Protection and Affordable Care
Act of 2010 and the emergence of substantial interprofessional policy and practice development
organizations, such as the Patient-Centered Primary Care Collaborative and the Interprofessional
Education Collaborative (IPEC).
In addition to national initiatives, there are many deeply considered, well-executed initiatives in team-based care in pockets across the United States. High-functioning teams have been
formed in a variety of practice environments, including both primary and acute care settings.
1,19-
24 Teams have also been formed to serve specific patients or patient populations, for example,
chronic care teams, hospital rapid response teams, and hospice teams.Practices and Principles of Adult Nursing Essay
25-27
Analyses of the quality and cost of team-based care do not yet provide a comprehensive,
incontrovertible picture of success. Still, two reviews indicate that team-based care can result in
improvements in both health care quality and health outcomes, and one review indicates that
costs may be better controlled, particularly in transitional care models.16,28 Research on teambased care has been hindered by lack of common definitions. While common elements, success
factors, and outcome measures are beginning to be described in a variety of team-based care scenarios, a widely-accepted framework does not yet exist to understand, compare, teach, and implement team-based care across settings and disciplines.
Fundamental to the success of any model for team-based care is the skill and reliability
with which team members work together. Team function has been described in one conceptualization as a spectrum running from parallel practice, in which clinicians mostly work separately,
to integrative care, in which the interdisciplinary team approach is pervasive and nonhierarchical
and utilizes consensus building, with many variations along the way.
29 It is likely that the appropriate team structure varies by situation, as determined by the needs of the patient, the availability of staff and other resources, and more. A unifying set of principles must not only
acknowledge this variation but embrace as formative the underlying situation-defined needs and
capacities.
Despite the pervasiveness of people working together in health care, the explicit uptake
of interprofessional team-based care has been limited. At the most basic level, establishing and
maintaining high-functioning teams takes work. In economic terms, if the transaction costs of
team functioning outweigh the benefit to team members, there is little incentive to embark on the
journey toward formal team-based care.30 Some of the specific costs that may be restraining
forces include lack of experience and expertise, cultural silos, deficient infrastructure, and inade-
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quate or absent reimbursement.31 These barriers were outlined in a 2011 conference convened by
the Health Resources and Services Administration, the Josiah Macy Jr. Foundation, the Robert Practices and Principles of Adult Nursing Essay
Wood Johnson Foundation, and the ABIM Foundation in collaboration with IPEC. The publication of the proceedings, Team-Based Competencies: Building a Shared Foundation for Education and Clinical Practice, identified key barriers to change, including the absence of role models and reimbursement, resistance to change, and logistical barriers.
Despite these barriers, teams are built and maintained. Researchers have identified facilitators of team-based care, or factors that constitute and promote good teams and teamwork. For
instance, Grumbach and Bodenheimer found that key facilitators include having measurable outcomes, clinical and administrative systems, division of labor, training of all team members, effective communication, and leadership.
1,30 IPEC has focused on effective interprofessional work
and has defined four domains of core competencies: values/ethics, roles/responsibilities, communication, and teamwork/team-based care.32
Our aim is to build from this prior work to identify a set of core principles underlying teambased care across settings, as well as the essential values that are common to the members of
high-functioning teams throughout health care. By doing so, we hope to help reduce barriers to
team-based care, while supporting the facilitators of effective teamwork in health care.
APPROACH
The authors are individuals knowledgeable about team-based care who participated in an
interprofessional work group that was drawn from the IOM’s Best Practices Innovation Collaborative. To achieve the goal of identifying basic principles and values for interprofessional teambased care, we first synthesized the factors previously identified in various health care contexts,
then took these distilled principles to the field to understand how well they represent team-based Practices and Principles of Adult Nursing Essay
care in action. We held monthly conference calls between October 2011 and June 2012 with frequent e-mail collaboration in the intervals. We then reviewed the health professions’ and “gray”
literature and discussed common elements. Using this information, we drafted a definition of
team-based care and a sample set of principles and values critical to team-based care. To test the
applicability and validity of the principles and values, and to understand their on-the-ground actualization, we performed “reality check” interviews with members of team-based health care
practices. Teams with various compositions, practice settings, and patient profiles were identified
around the country through the literature review and the input of experts. A draft of the teambased care definition, principles, and values was sent to teams in advance of a telephone interview. We then interviewed members of the teams by telephone during January 2012 using a
semi-structured approach. Based upon the results of the interviews, we refined the team-based
care principles and values, identified key themes, and added illustrative examples.

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A PROPOSED DEFINITION OF TEAM-BASED HEALTH CARE
To inform a proposed definition of team-based care, we reviewed the literature and reflected on the definitions and factors identified in prior work. Elements found across the definitions we reviewed include the patient and family as team members, more than one clinician, mutual identification of the preferred goal, close coordination across settings, and clear communication and feedback channels. Ultimately, we chose to adapt the definition developed through a
detailed literature review and consensus process by Naylor and colleagues.28 Although this defi- Practices and Principles of Adult Nursing Essay
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nition was developed for use in the context of primary care for chronically ill adults, its core elements were easily adapted to apply to the work of teams across settings:
Team-based health care is the provision of health services to individuals, families,
and/or their communities by at least two health providers who work collaboratively with patients and their caregivers—to the extent preferred by each patient—
to accomplish shared goals within and across settings to achieve coordinated,
high-quality care.28
VALUES
In the process of considering and refining the principles of team-based care, we noted
that while teams are groups, they are also made up of individuals. In addition to particular behaviors that facilitate the function of the team, we heard from the teams we interviewed that certain
personal values are necessary for individuals to function well within the team. This harmonizes
with the core competency domain of “values/ethics” put forward in IPEC’s Team-Based Competencies.
The following are five personal values that characterize the most effective members of
high-functioning teams in health care.
Honesty: Team members put a high value on effective communication within the team,
including transparency about aims, decisions, uncertainty, and mistakes. Honesty is critical to continued improvement and for maintaining the mutual trust necessary for a highfunctioning team.
Discipline: Team members carry out their roles and responsibilities with discipline, even
when it seems inconvenient. At the same time, team members are disciplined in seeking
out and sharing new information to improve individual and team functioning, even when
doing so may be uncomfortable. Such discipline allows teams to develop and stick to
their standards and protocols even as they seek ways to improve.
Creativity: Team members are excited by the possibility of tackling new or emerging
problems creatively. They see even errors and unanticipated bad outcomes as potential
opportunities to learn and improve.Practices and Principles of Adult Nursing Essay
Humility: Team members recognize differences in training but do not believe that one
type of training or perspective is uniformly superior to the training of others. They also
recognize that they are human and will make mistakes. Hence, a key value of working in
a team is that fellow team members can rely on each other to help recognize and avert
failures, regardless of where they are in the hierarchy. In this regard, as Atul Gawande
has said, effective teamwork is a practical response to the recognition that each of us is
imperfect and “no matter who you are, how experienced or smart, you will fail.”2
Curiosity: Team members are dedicated to reflecting upon the lessons learned in the
course of their daily activities and using those insights for continuous improvement of
their own work and the functioning of the team.
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PRINCIPLES OF TEAM-BASED HEALTH CARE
Each health care team is unique—it has its own purpose, size, setting, set of core members, and methods of communication. Despite these differences, we sought to identify core principles that embody “teamness.” After reviewing the literature and published accounts of team
processes and design, five principles emerged: shared goals, clear roles, mutual trust, effective
communication, and measurable processes and outcomes. These principles are not intended to be
considered in isolation—they are interwoven, and each is dependent on the others. Eleven teams
across the nation considered the principles, verified and clarified the meaning of each, and described how each comes into play in their own team environments. Descriptions of the teams are
listed throughout. The following section describes each of the principles in detail, provides examples from the teams we interviewed, and considers organizational factors to support development of teams that cultivate these five principles, as well as the values that support high-quality
team-based health care. Arguably, the most important organizational factor supporting teambased health care is institutional leadership that fully and unequivocally embraces and supports
these principles in word and action.
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Shared Goals
The team—including the patient and, where appropriate, family members or other support persons—works to establish shared goals that reflect patient and family priorities, and that can be
clearly articulated, understood, and supported by all team members.
The foundation of successful and effective team-based health care is the entire team’s active adoption of a clearly articulated set of shared goals for both the patient’s care and the team’s
work in providing that care. Although obvious to some extent, the explicit development and articulation of a set of shared goals, with the active involvement of the patient, other caregivers,
and family members, does not happen easily or by chance. We found that teams shared several
strategies and practices with regard to establishing shared roles Practices and Principles of Adult Nursing Essay

Professionalism in nursing means much more than simply wearing a uniform and speaking politely. It encompasses a set of values that are critical to elevating the quality of patient care while improving the methods, standards, and judgments that guide nursing practices every day. Working in professional environments can help nurses develop skills that are valuable at any stage of their career, from novice clinical roles to senior leadership positions. Accumulating work experience and pursuing higher education can create further opportunities to strengthen core professional values.

Professionalism in Nursing: The Basics
In nursing, professionalism reflects the act of providing quality patient care while honoring the values of respect, advocacy, and responsibility. Professionalism also extends to a nurse’s ability to communicate clearly and self-reflect on behaviors and actions, always striving for both professional and personal development.Practices and Principles of Adult Nursing Essay

A study published in the Iranian Journal of Nursing and Midwifery Research (IJNMR) groups the diverse components of nursing professionalism into three equally important categories: cognitive, attitudinal, and psychomotor.

Cognitive – The cognitive type of professionalism focuses on the ability to continually learn about professional conduct and apply this growing base of knowledge in work settings. Ultimately, nurses who practice this skill should develop the key tools they need to prioritize and make decisions effectively.
Attitudinal – The attitudinal dimension of nursing professionalism involves the attitudes and ideas that guide nurses as they perform their job duties and advance through their careers. Ideally, the attitudes of nurses should align with practical standards and the broader goals of their organizations. A nurse’s willingness to be flexible and make compromises for the greater good has a major bearing on the ability to navigate professional challenges that lie ahead.
Psychomotor – The psychomotor aspect of professionalism in nursing promotes the idea that as professionals gain experience, they can do more than build their clinical skills. They can sharpen their management skills and better understand the inherent obligations and commitments involved in the practice of nursing. Over the span of their careers, nurses can implement proven methods to bolster their self-discipline and self-learning skills.
Nurses may apply these principles of professional conduct to become better leaders, guide actions using value judgments, and establish self-directed commitments to provide the highest level of patient care.Practices and Principles of Adult Nursing Essay

Real-World Applications of Nursing Professionalism
There are many ways in which nurses can exhibit professionalism to benefit their patients, organizations, coworkers, and careers. According to the code of professional standards as outlined by the Nursing and Midwifery Council (NMC), nurse professionals in health care settings can do their best to customize care to patients’ needs, proactively collaborate with medical staff, and act with honesty and integrity, especially when under pressure. Other guidelines speak to additional core components of nursing professionalism, including the following.

Care Comes First – Communication is key. Listen to others, and provide information and advice clearly so every patient can understand. Make well-informed decisions that are best for the patient. Do not accept gifts for preferential treatment.
Individual Treatment – Treat patients and colleagues as individuals with their own unique values, beliefs, and needs.
Respect Dignity – Protect patient privacy. Never give client information to an unauthorized person, and preserve anonymity when citing patient cases in coursework, research, or other public documents.Practices and Principles of Adult Nursing Essay
Work Together – Cooperate with team members and respect their contributions. Always treat everyone with respect.
High Standards of Care – Be punctual. Acknowledge when a situation is beyond your professional scope. Don’t be afraid to ask for help.
Honesty and Integrity – Do not plagiarize coursework or professional assessments. Compile an accurate CV to reflect your education and work experience. Always aspire to the highest levels of personal and professional conduct.
Uphold Reputation – Be aware that all actions—even outside of work—may have consequences.
Benefits of Professionalism
Exhibiting professionalism in the practice of nursing has many benefits. One of the most important is that it helps ensure and safeguard the health and well-being of patients. For example, treating patients respectfully and providing them with easy-to-understand facts can encourage them to make better personal health decisions. Maintaining collaborative relationships and clear lines of communication can enable medical teams to share patient information and plan treatment options more efficiently and securely. Providing team members opportunities to ask for help is a sound strategy that can help minimize the risk of harmful mistakes.Practices and Principles of Adult Nursing Essay

Professionalism also positively impacts the atmosphere and efficiency of health care institutions. Encouraging and maintaining a culture of respect, cooperation, honesty, and integrity allows nurses to inspire close-knit team collaboration, unified by the common goal of providing the best possible care for patients. By promoting communication and compassion, professionalism may reduce the risks associated with workplace conflict that can result from biases or personal differences.

Skills Attributed to Professionalism
Professionalism fosters the development of many admirable soft skills. Nurses may learn these skills through their life and work experience, and develop them over the course of their careers. Examples include:

Conflict resolution – This involves a professional’s ability to de-escalate a problem. It requires the nurse to consider the needs of everyone involved in the conflict, while communicating possible solutions with respect.Practices and Principles of Adult Nursing Essay
Ethical thinking – This skill enables nurses to make value-based judgments that align with professional standards and moral codes, prioritizing the needs of patients and colleagues ahead of their own.
Adaptability – This demonstrates the capacity to combine new information with education, experience, and professional guidelines to re-evaluate a situation and make changes that lead to more effective solutions.
Leadership – A sought-after attribute, leadership is founded on excellent communication skills, attention to detail, respect, and resourcefulness. Professionals commonly build leadership skills as they move on to more senior roles in which they can guide others to provide higher levels of care.
Collaboration – This is key to professionalism. Working with others and being able to communicate and cooperate is crucial to developing an efficient work environment that places patient needs at the forefront.
Developing Professionalism
The development of professionalism in nursing is an ongoing process; there are always new and changing areas in which to improve. In the workplace, nurse professionals should self-reflect on their actions and integrate new, experience-based knowledge into their daily practices. When it comes to education, advanced nursing degree programs are an excellent way to provide additional avenues to sharpen professional skills.Practices and Principles of Adult Nursing Essay

Earning a DNP is a valuable pursuit for nurses who wish to elevate their leadership skills and develop new clinical expertise as their careers mature. According to the Journal of Nursing Education, the Doctor of Nursing Practice (DNP) curriculum educates aspiring nurse leaders “to provide care management, critical and complex clinical judgment, nursing therapeutics, and the appropriate use of technology to effect change Practices and Principles of Adult Nursing Essay