CONTEMPORARY NURSING PRACTICE NRS 430

CONTEMPORARY NURSING PRACTICE NRS 430

CONTEMPORARY NURSING PRACTICE NRS 430

Nursing practice has changed over the decades from when nurses had minimal education to having complex nursing training programs and when nurses provided basic care to performing complex medical and nursing procedures. Nursing was initially a woman’s work where women cared for the sick at home in the era where there were no hospitals (Egenes, 2017). Modern nursing is attributed to Florence Nightingale, who developed nursing practices that created new standards for nursing practice.  In this regard, this paper will discuss the evolution of nursing practice, the differences between ADN and BSN nurses, and the significance of evidence-based practice in nursing.

Evolution of Nursing Practice

Nurses were formerly not provided formal nursing education but were instead given on-job training on how to provide basic care such as clean and dress wounds. They did not have autonomy and received instructions from physicians. As the nursing practice evolved and more hospitals were established, women began receiving nursing training in small to medium-size hospital systems (Egenes, 2017). However, the training was observation-based, taking two to three years, and the scientific rationale for interventions was not emphasized.  

Advances in medicine and technology created a need for complex and specialized nursing education. As a result, nursing training shifted from hospital observation to the classroom.  Certification programs have been created, changing the scope of nursing practice (Egenes, 2017). Nurses also have Master’s and Doctorate levels, which increase a nurse’s scope of practice to include duties similar to physicians such as taking history and physical exams, making diagnoses, interpreting diagnostic results, and initiating treatment plans.  Furthermore, standards of nursing practice have been created to ensure quality nursing care, and nurses are educated on ethical practice and providing culturally sensitive care.

Practice Competencies between an Associate and Baccalaureate Education in Nursing

Nurses with an Associate Degree in Nursing (ADN) and with a Baccalaureate Degree (BSN) are both registered nurses (RNs). Both BSN and ADN programs prepare nursing students to deliver patient care that meets the set standards. Besides, both programs equip the future RN with nursing skills and ensure they attain the clinical practice competencies necessary for nursing practice (Northrup-Snyder et al., 2017). However, the BSN program emphasizes more on areas of informatics and research. It also has courses not offered in the ADN program, such as nursing theories, social sciences, public health, leadership, and management. The differences in the ADN and BSN training result in differences in the scope of practice. ADN RNs are generally more focused on technical, clinical duties and everyday direct patient care, including monitoring patients, administering treatment, performing basic nursing procedures, and updating charts (Ghaffari, 2017). On the other hand, the scope of BSN nurses includes nursing educator, research, public health, administrative, leadership, management roles, and direct patient care.

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Approaches to Decision-Making in a Patient Care Situation of a BSN vs.ADN

            Approaches to decision‐making would differ in a BSN and ADN nurse caring for a diabetic patient with uncontrolled sugars and a worsening foot ulcer.  An ADN nurse will care for the patient by providing basic care such as dressing the wound, administering insulin or hypoglycemics, and monitoring blood sugar levels. Conversely, the BSN nurse will perform these tasks but get concerned about the uncontrolled sugars and delayed wound healing. As a result, the BSN will assess the patient’s diet and exercise patterns and educate the patient on the needed changes to promote optimal glycemic levels. Besides, the nurse will apply evidence-based interventions to promote healing of the ulcer and educate the patient on foot care.

Applying Evidence‐Based Practice to Nursing Care

            In the past decades, evidence-based practice (EBP) has become a key element of excellent patient care. EBP is applied in various aspects of nursing as it offers valuable insight into clinical care approaches backed by evidence to address issues in direct patient care, infection control, and patient workflow (Mackey & Bassendowski, 2017). It enables nurses to apply the latest research methods in the patient care setting, including direct patient care. It focuses on established outcomes, thus promoting enhanced patient care. The BSN program equips students with knowledge and skills on EBP, which helps to analyze patient care approaches that can improve health outcomes (Mackey & Bassendowski, 2017). Students are trained on scientific research, gathering, and analyzing evidence, which they apply to establish the best patient care interventions.

Interdisciplinary Communication and Collaboration in Nursing Practice

Nurses today are part of the interdisciplinary teams and play a major role in developing patients’ care plans. Nurses communicate with the interdisciplinary teams using CUS and SBAR protocols. CUS is an acronym for Concerned, Uncomfortable, and Safety. It is a communication tool used by nurses to express concerns to the interdisciplinary team about changes in a patient’s health status respectfully and professionally. The SBAR protocol representing situation, background, assessment, and recommendations is used by nurses when having a clinical problem that needs to be conveyed to the team (Müller et al., 2018). Communication using the SBAR protocol is usually purposive, straight, and prepared and promotes information exchange between the nurse and the team. The CUS and SBAR protocols foster quality and safe patient care since patient information is communicated through an efficient and well-organized format.

Conclusion

Unlike in the past, where nurses conducted similar tasks, nurses’ scope today is determined by their level of education and the specialized courses they have undertaken. Both BSN and ADN nurses have the same licensing level; however, some of their roles are different. ADNs focus on technical, clinical duties, while BSNs focuses on research, management, leadership, and informatics.  Nurses need to communicate accurately, succinctly, and purposeful with the interdisciplinary teams to promote collaborative care.

CONTEMPORARY NURSING PRACTICE NRS 430 References

Egenes, K. J. (2017). History of nursing. Issues and trends in nursing: Essential knowledge for today and tomorrow, 1-26.

Ghaffari, M. (2017). Preparing Nurses for Community Health Care: A Comparative Study of the ADN and BSN Programs. International Journal, 5(2), 32-45. https://doi.org/10.18488/journal.9.2018.52.32.45

Mackey, A., & Bassendowski, S. (2017). The history of evidence-based practice in nursing education and practice. Journal of Professional Nursing, 33(1), 51-55. https://doi.org/10.1016/j.profnurs.2016.05.009

Northrup-Snyder, K., Menkens, R. M., & Dean, M. (2017). Student competency perceptions from associate degree to bachelor degree completion. Journal of Nursing Education, 56(10), 581-590. https://doi.org/10.3928/01484834-20170918-02

Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W. E., & Stock, S. (2018). Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review. BMJ open, 8(8), e022202. https://doi.org/10.1136/bmjopen-2018-022202

Assessment Description

The field of nursing has changed over time. In a 750‐1,000 word paper, discuss nursing practice today by addressing the following:

1. Explain how nursing practice has changed over time and how this evolution has changed the scope of practice and the approach to treating the individual.
2. Compare and contrast the differentiated practice competencies between an associate and baccalaureate education in nursing. Explain how scope of practice changes between an associate and baccalaureate nurse.
3. Identify a patient care situation and describe how nursing care, or approaches to decision‐making, differ between the BSN‐prepared nurse and the ADN nurse.
4. Discuss the significance of applying evidence‐based practice to nursing care and explain how the academic preparation of the RN‐BSN nurse supports its application.
5. Discuss how nurses today communicate and collaborate with interdisciplinary teams and how this supports safer and more effective patient outcomes.

You are required to cite a minimum of three sources to complete this assignment. Sources must be appropriate for the assignment and relevant to nursing practice.  

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

To excel in their professional roles, nurses should acquire diverse skills and comprehensively understand practice problems and solutions. Basic clinical skills can be acquired through certificates, diplomas, or degrees. A nurse’s competence is typically higher when they acquire the highest education possible, making nurses perceive continued education positively (Thielmann et al., 2019). As nurses continue to implement their roles, the nursing practice evolves in multiple dimensions. This evolution impacts patient care outcomes, communication strategies, and care models, among other critical aspects. Nurses should understand this evolution and adapt effectively. The purpose of this paper is to describe nursing practice today while primarily focusing on its evolution and differences between associate (ADN) and baccalaureate (BSN) education in nursing.

Nursing Practice Changes, Scope of Practice, and Approach to Client Care

Nursing has evolved in many aspects, profoundly impacting nursing scope and patient care approaches. One of the many changes characterizing modern practice is the evolution of care delivery models. Undeniably, remote care is increasingly dominant in the current practice as providers strive to improve access to care and reduce costs (Snoswell et al., 2020). Besides, there is an increased focus on value-based care in an attempt to improve care quality and patient satisfaction. Another significant change defining the current practice is the broadened scope of nursing. Nurses’ role is not limited to clinical care; nurses can effectively perform other roles that optimize health outcomes, including policymaking, advocacy, and health education.

The progressive changes in nursing practice have broadened nursing practice not to be limited to patient care. As the push for higher patient outcomes continues, nurses are currently playing a pivotal role in creating safer environments and promoting patient rights. This role typifies patient advocacy, where nurses serve as the voice of patients (Nsiah et al., 2019). Regarding the approach to treating the individual, there is an increased focus on patient-centeredness and patient engagement. In such approaches, healthcare providers are not the sole decision-makers. Patients should understand the treatment processes and consent to them as nurses tailor care according to patient needs.

Comparison of Practice Competencies and Scope of Practice

Nurses’ competencies impact their ability to implement comprehensive patient care and other roles. An ADN is a two-year degree that prepares students to be registered nurses (RNs). However, since it takes a short time, an ADN focuses primarily on the technical skills that prepare nurses as clinicians. As Deering (2023) stated, BSN-prepared nurses are more skilled in clinical roles and other practice areas such as research, nursing leadership, and public health. The four-year program provides BSN nurses with a larger base of knowledge than AND-prepared nurses. The BSN further provides expanded skills in critical thinking and administration. Regarding the scope of practice, BSN nurses have broader roles than ADN nurses due to more competence and a more comprehensive understanding of patient care. Research further confirms a positive link between BSN nurses’ expanded skills and higher patient outcomes, which underlines the need for more such nursing professionals (Anbari, 2019; American Association of Colleges of Nursing, n.d.). As ADN nurses concentrate on the clinical role, BSN nurses conduct research, engage in leadership, and implement change in routine practice. Importantly, BSN nurses also enjoy more independence in decision-making than ADN nurses.

Nursing Care or Approaches to Decision Making

The differences in skills level between ADN and BSN-prepared nurses affect how they approach client care situations. A suitable scenario is where a patient presents to the healthcare setting with a persistent headache. An ADN will likely have a somatic approach to relieve symptoms while trying to calm and comfort the patient. The genesis of the headache could be established through a routine diagnosis to determine an effective treatment. On the other hand, as Kim and Sim (2020) suggested, BSN-prepared nurses are more skilled in critical thinking, communication, and decision-making. Therefore, they will likely take a more holistic approach in the assessment process to determine the potential cause of the illness. Their higher communication and assessment skills would enable them to communicate with the patient, establish a healthy nurse-patient relationship, and develop a treatment plan that integrates the patient to foster adherence.

Significance of Applying Evidence-Based Practice to Nursing Care

The current nursing practice stresses evidence-based practice (EBP) and encourages nurses to apply it to address simple and complex health matters. EBP is primarily about blending current research evidence with clinical expertise and patient values for higher patient outcomes (Abu-Baker et al., 2021). It ensures that multiple components are considered during decision-making to address patient needs comprehensively. The academic preparation of the RN-BSN nurse supports EBP application by expanding nurses’ research and leadership skills. Research skills enable nurses to explore, analyze, and critique current, peer-reviewed research. Leadership skills prepare nurses to lead change whose positive outcomes are achieved by implementing EBP.

Nursing Communication and Collaboration

Nurses work in different settings and need a shared approach to decision-making to achieve enhanced, consistent outcomes. They communicate and collaborate with interdisciplinary teams by sharing information and approaching common issues as a team. Technologies have also allowed timely data sharing and analysis for better communication and collaboration. According to Walton et al. (2019), collaboration across disciplines supports safer and more effective practices by reducing errors and improving care coordination. Health care practitioners within the interdisciplinary team benefit from shared roles and diverse perspectives that enhance their understanding of patient care and interventions as situations obligate.

Conclusion

Nursing is an evolving practice characterized by many changes in patient care approaches occurring over time. Nurses should be competent multi-dimensionally to address patient needs comprehensively and adapt as the practice evolves. As discussed in this paper, the competency differences between ADN and BSN-prepared nurses affect how they respond to situations. Although both sets of nurses are skilled in clinical roles, BSN nurses have expanded knowledge of research, leadership, and critical thinking skills. Research skills prepare BSN nurses for a higher role in implementing evidence-based practice.

CONTEMPORARY NURSING PRACTICE NRS 430 References

Abu-Baker, N. N., AbuAlrub, S., Obeidat, R. F., & Assmairan, K. (2021). Evidence-based practice beliefs and implementations: a cross-sectional study among undergraduate nursing students. BMC Nursing, 20(1), 1-8. https://doi.org/10.1186/s12912-020-00522-x

Anbari, A. B. (2019). What makes a BSN a BSN? Western Journal of Nursing Research, 41(2), 167–170. https://doi.org/10.1177/0193945918803683

American Association of Colleges of Nursing. (n.d.). Fact sheet: the impact of education on

nursing practice. https://www.aacnnursing.org/Portals/42/News/Factsheets/Education-Impact-Fact-Sheet.pdf

Deering, M. (2023). RN Diploma vs. ADN vs. BSN degree: what’s the difference? NurseJournal. https://nursejournal.org/degrees/bsn/rn-and-bsn-degree-differences/#:~:text=A%20BSN%20degree%20and%20an,school%20and%20your%20career%20goals.

Kim, A. Y., & Sim, I. O. (2020). Communication skills, problem-solving ability, understanding of patients’ conditions, and nurse’s perception of professionalism among clinical nurses: a structural equation model analysis. International Journal of Environmental Research and Public Health, 17(13), 4896. https://doi.org/10.3390/ijerph17134896

Nsiah, C., Siakwa, M., & Ninnoni, J. P. K. (2019). Registered Nurses’ description of patient advocacy in the clinical setting. Nursing Open, 6(3), 1124–1132. https://doi.org/10.1002/nop2.307

Snoswell, C. L., Taylor, M. L., Comans, T. A., Smith, A. C., Gray, L. C., & Caffery, L. J. (2020). Determining if telehealth can reduce health system costs: Scoping review. Journal of Medical Internet Research, 22(10), e17298. https://doi.org/10.2196/17298

Thielmann, B., Parker, K., Post, J., & Abraham, S. (2019). Factors influencing nurses’ perceptions of the Baccalaureate Degree in Nursing as minimum requirement for Professional Practice. Nursing Education Perspectives, 40 (1), 25-29. doi: 10.1097/01.NEP.0000000000000391.

Walton, V., Hogden, A., Long, J. C., Johnson, J. K., & Greenfield, D. (2019). How do interprofessional healthcare teams perceive the benefits and challenges of interdisciplinary ward rounds. Journal of Multidisciplinary Healthcare, 12, 1023–1032. https://doi.org/10.2147/JMDH.S226330

According to The Foundation for Critical Thinking (2019), “Critical thinking is, in short, self-directed, self-disciplined, self-monitored, and self-corrective thinking.” I think of critical thinking as all inclusive. One must incorporate knowledge/research, skills, attitude and experience. Putting the puzzle pieces together to come to a conclusion. One should be able to perform an assessment, interpret those findings and apply them to the situation at hand. Critical thinking enables someone to combine all off the “tools in their tool shed” and think outside of the box to come up with a solution. I feel that in my department, labor and delivery, this applies in many aspects. Critically thinking is important by adding up all the signs and symptoms and knowing when to speak to a physician. Knowing how to properly care for not only mom, but an unborn human who you cannot physically see or touch, requires evidence based knowledge, critical thinking and experience. Critical thinking is important in order keep or patients safe and alive. “Evidence-based practice (EBP), is a process used to review, analyze, and translate the latest scientific evidence”. (2022). I think that critical thinking and EBP give us the fundamental skills for the nursing process and practice which directly impacts patient care. The nursing process includes assessment, diagnosis, outcomes/planning, implementation and evaluation (American Nurses Association 2022). I think nurses go through this process multiple times a day, continuously evaluating and reevaluating. We use our knowledge of EBP and combine that with our critical thinking skills, effective communication and problem-solving skills to formulate the best plan of care for our patients for optimal health. I think by having good critical thinking skills and foundation for EBP allows the nurse to detect and act early; which then, improves patient outcomes.