Soapbox
Your say about nursing issues
Susan Tregoning
School of Nursing and Midwifery, University of South Australia, SA
PP: 033 - 034
Article Text
Erosion of the Role of the Nurse
Judith Wilcox
Lecturer: Department of Nursing Sciences
James Cook University of North Queensland.
I am very concerned at what I refer to as the erosion of the role of the nurse. Many aspects of patient care which not so long ago were the domain of nursing are gradually (and in some cases more rapidly) being taken over by other health care professionals. Interestingly, certain practices which tended not to be valued highly by nurses, have gained a degree of respectability and status in the hands of other disciplines. Let me cite a few examples drawn from my own area of clinical practice in the acute care setting. Even those of us who were 'trained' in the 70s were taught that two hourly chest physiotherapy was routine for most post-operative patients. Nonetheless, I do not believe that nurses have tended to be particularly vigilant with this practice. A need was there that we did not fulfil - so enter the physiotherapist! Suddenly coughing and breathing exercises have become a 'science' and sputum is respectable. I believe that 'passive limb movements' for the unconscious patient are following a similar worrying trend. Unfortunately for nursing (but perhaps fortunately for the clients concerned) the allied health professions are picking up our discarded or neglected duties. In the care of neurosurgical/neurological patients other examples abound. I know that speech therapists are immeasurably more articulate in their assessment of the swallowing reflex. However, as an experienced critical care nurse, I can tell whether green jelly is coming out a tracheotomy. Perhaps even more importantly, I am more likely to be able to competently deal with any ensuing respiratory distress, if indeed this should occur. However, we failed to meet an important need of our neurologically impaired clients - so another profession has taken the opportunity to step in. In some instances it is too late to retrieve lost roles!
Admittedly my assertions are based on anecdotal evidence rather than scientifically validated data. Space prohibits me from hypothesising how or why such role erosion is occurring - although I believe that there are a variety of sociological, psychological and perhaps even political issues involved. I know that nurses at the 'coal-face' are busy! It is not difficult to understand that any offers of help - particularly if they involve taking over some of the less glamorous or more time consuming nursing roles - can seem too attractive to refuse. However, the question I ask is 'at what cost to nursing?'
The notion of a multi-disciplinary team approach to health care is becoming trendy and may well be the 'way to go'. However, my concern is that if we as nurses do not stake our claim on our own clinical practice, we may sooner or later discover that we are no longer part of the team!
Caring for Those who Care
Susan Devries
Senior Tutor: University College of Central Queensland, Rockhampton
There has been an increased awareness on the part of governments and the public in general about the value of the work done in the community in caring for the aged and/or disabled in the home. This has become evident in Queensland with the establishment of the Queensland Council of Carers. The recognition of the value of this work is an important step in the establishment of what I would like to call the 'caring ethic' in our community. Unfortunately, this value that society has placed on caring for others has not yet been widely identified with the profession of nursing. Many nurses spend their entire working life caring for others. Some of them do this work during the same time of life that they care for their children, parents, neighbours and possibly other members of the community. These individuals provide a greater than average amount of time caring for members of our society for little financial or social recognition. Socially, there is a general subliminal impression that nurses must be obedient. It is evident amongst many nurses that they feel powerless to change their situation. One of the factors contributing to this is that there is little value placed on the work that many nurses do, in particular, the caring component of that work.
Increasingly, our society is becoming aware of occupational health and safety issues and their cost to the community. It is time that some serious effort was made to establish a mechanism of caring for the caregivers. This would be an economically and socially sound decision on the part of any government or other interest group. In the mean time, as nurses, we are always able to take a positive step and care for each other. This caring must be a personal decision taken by every member of the nursing profession. I urge you to take the decision now, to be more caring in your dealings with other nurses, and to be more open in your ability to ask for help when you need it. These small steps can make significant inroads into further improving our profession and the lives of those individuals who are the recipients of our care.
A Case for Advocacy
Susan Tregoning
Senior Lecturer: University of South Australia, Salisbury Campus
The following situation was related to me by a Registered Nurse working in a nursing home where I had been supervising student nurse practice.
A resident from the nursing home, had recently returned from a general hospital for treatment of a gynaecological problem. The resident, in her late fifties, suffers from multiple sclerosis and has no support persons outside of the nursing home. On her return to the nursing home, the client displayed physical and emotional signs of distress. From the ensuing discussions it became apparent that the resident had not been treated by the general hospital staff in the way she had expected.
On first being admitted to the general hospital the resident was fully involved and informed about the decisions that were being made about her care. This continued until it was noted (in front of the patient) that she came from a nursing home. The resident reported that from thereafter the medical officers in particular treated her as if she didn't have the ability to be involved with decisions which affected her or to understand any significant communications. I wonder how often the situation occurs, when staff make assumptions about clients based on information beyond that which has been gained through an accurate physical and psychosocial assessment. I consider that in these situations, the nurse has a particular advocacy role to play. The nursing care plan, developed from the nursing assessment, should indicate that the client is able to understand and be involved with decisions regarding her care. Further, nurses should clearly indicate to the client their awareness of the potential problems that may result from the client's particular circumstances, and that they are prepared to intervene if the client believes that she is experiencing discriminatory behaviour from other staff members.
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