The Effect Of Hammonds Cognitive Continuum Theory On The Health Care System

I define my philosophy of nursing within the three nursing domains of person, health, and environment. My goal is to communicate the importance of nursing as a knowledge-based career, depending not only on the nurse fulfilling her role but also on the patient’s compliance. A patient must learn to provide self-care at home in the same capacity as the nurse would provide care in the clinical setting. I discuss various subjects within nursing. I explain why I want to be a nurse, what I believe a nurse’s role is, the different domains of nursing, and where I believe nursing will be in the future. My philosophy demonstrates the interdependence of the nursing domains. You cannot fully evaluate a person without evaluating their health,

This paper will discuss three theories of decision-making that can be adopted in nursing practice, additionally how decision-making theories are able to be implemented and used. Decision-making in nursing is adopted through the critical thinking process that provides each nurse a model to make the best choices, solve problems and to meet goals in clinical practice (Berman & Kozier 2018, pp. 199-200; Levett-Jones & Hoffman 2013, pp. 4-5). Effective decision-making in nursing is a vital component and part of the role of a registered nurse; each year a substantial number of patients die due to medical errors and poor decision-making (Levett-Jones & Hoffman 2013, pp. 4-5; Nibbelink & Brewer 2017, p. 3). Through the use of

Standing (2011), defines clinical decision-making as a complex process that involves observation, gathering information, critical thinking, evaluating evidence, applying necessary knowledge, reflection and problem-solving skills. Every day nurses make important clinical decisions and these decisions have important implications for patient outcomes and deserve serious consideration. Therefore, it is important for nurses to have a better insight of the decision-making process, be able to deliver holistic care and meet essential and complex physical and mental health needs of the patient.

Workload was described to be heavy, stressful, increase in intensity and overtime hours. As a result 25.8% consider resigning, 20.2% consider retiring and 25.6% consider leaving profession. Another problem that was observed at individual level was poor commitment to care. One of the factors that often limited nurses to provide therapeutic care was the change in nurse to patient ratio. As nurses assignments increase with the increase in the number of patients (i.e. 1 nurse to 6-8 patients) the quality of care provided decreases. Nurses’ ability to maintain safe environment became challenging. As part of caring, nurses also showed decreased amount of time spent with their patient. This eventually led to nurses being less satisfied with their current job. Self – efficacy was often low. Nurses felt that they did not have enough knowledge and skills required for professional practice (Newhouse, Hoffman, & Hairston, 2007). This often led into stressful transition and the ability to care for a patient even harder. New graduate nurses often had difficulty maintaining leadership role. They often felt that they did not have the ability to self advocate and raise their voice to be heard by others. They often feared that they would be over heard and that no one would listen to them (Mooney, 2007).

There are many major challenges facing the nursing shortage environment today. One of those challenges includes the facility recruitment of registered nurses and then the facility retention of the registered nurses that they have recruited. Factors to consider would be as to why a registered nurse chose to accept a particular job and will they choose to stay at the facility after being given an employment opportunity. A facility’s reputation, union status, autonomy and salary are among some of the factors that influence recruitment. Factors that influence retention includes the inclusion in decision making, practice

Across the United States, hospitals are experiencing a nursing shortage. Yet, according to the American Association of Colleges of Nursing, 63,857 students graduated from nursing school in 2015 alone and enrollment is increasing. It seems like a lot of new nurses to fill those vacancies, does it not? Studies show, however, that within a year, about thirty percent of those new graduates have voluntarily left their job (Hillman). Further studies have attributed the high turnover rate to new nurses’ lack of competency to handle conflict, make critical decisions, and function autonomously (Bratt). Many of the new graduates are disappointed with the hospital’s orientation, or lack thereof. Lack of knowledgeable preceptors and lack of nursing staffing in general has led to new nurses being thrown into autonomous function more quickly. Without proper training, these nurses must make sound clinical judgements and provide competent care to patients, which anyone can imagine is stressful. Today, Nurse Residency Programs (NRPs) are being instituted in numerous hospitals as a way to improve new graduate nursing skill, but research shows many other benefits to these programs. NRPs also reduce hospital spending costs, increase patient safety, and most importantly increase new nurse retention rates.

Within the practice of nursing, situations often arise where nurses are forced to make decisions regardless of their level of experience in the profession. Providing care and following the physician’s orders historically were the nurse’s sole responsibilities. However, social change, changes in health care finances, increasing international perspectives, and demographic population changes, have resulted in a significant evolution of the roles and responsibilities emplaced on today’s nurses (The National Association of Clinical Nurse Specialists (NACNS), 2007). Kelly and Crawford (2013) believe budget cuts, higher client acuity and clients with complex needs, mergers of hospital corporations as well as a general shortage of qualified nurses has made it necessary for nurses to play a role in decision making. Decision making is defined as “cognitive process leading to the selection of a course of action among alternatives” (Kelly & Crawford, 2013, p. 352).

The nursing professional faces a myriad of decisions on a daily basis. The effectiveness of the decision-making process is crucial to ensuring positive outcomes in the clinical setting. If the nursing process is misunderstood or misapplied to the decision-making process by a failure to use critical thinking skills, the results can be catastrophic to the anticipated outcomes. Furthermore, an immaturity in critical thinking may influence decisions because of insufficient knowledge and experience. This paper will explore the role of critical thinking and the nursing process in making clinical decisions. Additionally, clinical maturity will be addressed as a key component of critical thinking

Clinical reasoning can be defined as, ‘the process by which nurses (and other clinicians) collect cues, process the information, come to an understanding of a patient’s problem or situation, plan and implement interventions, evaluate outcomes and reflect on and learn from the process’ (Levett-Jones & Hoffman 2013, p.4). It requires health professionals to be able to think critically and ensures better engagement and results for the patient (Tanner 2006, p.209). The Quality in Australian Healthcare Study (Wilson 1995, p.460) discovered that ‘cognitive failure’ resulted in approximately 57% of unfavourable clinical events involving the failure to produce and act correctly on clinical information. It also recognises that often nurse’s preconceptions and assumptions can greatly affect patient care and by going through such a process, one can take into account the holistic nature of the patient and provide the best, most appropriate care.

By recognizing that burnout is a serious problem that impacts an organization’s viability, an assembly of staff nurses, nursing supervisors, human resource staff, social services, nurse administrators, and a physician champion will be arranged to construct mission, objectives and strategies to help ameliorate the issues at hand. Researching literature on nursing burnout is essential so that the members of the task force has a solid grasp on potential underlying hardships contributing to nursing burnout within the facility as well as the financial effects on the organization. Furthermore, in order to determine a solution, the nurse’s work environment should be assessed (Nedd, 2006) and measured using the 26-item Brisbane Practice Environment Measure (B-PEM) (Flint, Farrugia, Courtney, & Webster, 2010). The B-PEM instrument was developed to measure nursing satisfaction within the work environment and the perceived facilities inadequacies (Flint et al. 2010; Hayes et al., 2014; Nedd, 2006). Next, the Conditions of Work Effectiveness - Questionnaire-II (CWEQ-II) will also be utilized to measure the nurses’ perceived access to the four job related empowerment structures: opportunity, information, support, and resources will be administered (Laschinger et al., 2003). Then nursing burnout will be assessed and analyzed by using the Maslach Burnout Inventory (MBI) which is a widely used instrument to assess burnout and is considered the gold standard due to its established

Nursing care delivery is defined as the way task allocation, responsibility, and authority are organized to achieve patient care. Tiedeman and Lookinland (2004) suggested that systems of nursing care delivery are a reflection of social values, management ideology, and economic considerations. (Tiedeman&Lookinland, 2004) According to Fewer (2006), the quality of nursing care delivery systems affects continuity of care, the relationship between nurse and patient, morale, nurse job satisfaction and educational preparation.(Fewer, 2006) Nurses are essential human resources to provide medical services with professional knowledge and skills in the healthcare setting. However, the registered nurse turnover rate has increased in recent years resulting

Cognitive Theory claims that behavior can be changed through changing faulty thinking, irrational thoughts, automatic thoughts, or learned cognitive misconceptions. When a client has negative images of themselves or their accomplishments, it sets the pace for their behavior, perceptions and expectations; when that thinking is exposed as faulty to the client, the client can then begin to change their behavior based upon restructured, truer images of reality. It has been shown to be effective therapy for individual, group, marital and family treatment, in treating depression, addiction, anxiety, PTSD, personality disorders, and some organic conditions such as schizophrenia, and in many social work settings, such as child welfare, private practice, mental health, crisis intervention, and health care.

Patricia Benner described the first stage as the novice nurse who is taught general rules to perform tasks without any, or very few, clinical experience. This rule-governed behavior is limited and inflexible (“From Novice to Expert”, 2013). Most nursing students are in the novice stage while they are completing their educational requirements (Cherry & Jacob, 2014). Although they have some exposure to clinical experience, it is limited and under the guidance of a nursing instructor rather than in a “real world” setting. According to Cherry & Jacob (2014), once the nursing student graduates, he or she will begin the progression into the advanced beginner stage (second stage). The advanced beginner nurse is able to make some judgment calls based on having experience in actual situations and performance is adequate. During this stage, the nurse begins to formulate principles to guide actions (“From Novice

Critical thinking skills, decision-making and problem-solving are attributes that nurses must have in today's healthcare environment. Strategies such as the use of nursing theories are sometimes implemented in education of nurses (Oldenburg & Hung, 2010). When examining the decision making and problem solving utilization within nursing theories, the reason behind

Havva Arsln yurumezoglu, BSN,PHD,Department of Nursing Management, and Dokuz Eylul University, lzmir, Turkey observed that nurses have a high intent to leave their organization and as a result lead to nursing shortage which make the problem more serve, and call for immediate action.Thus,both of the researchers worked extensively tryig to find asolution and finally come out with a proposed pilot study in utilizing evidence-based nursing management and evaluate its practical effects in improving the levels of both job satisfaction, organizational commitment, and intent to leave among nurses in Turkey.There are a great deal of strenghths which show how well the authors carried out those elements. Yet, there are defacts or weakness which get our attention and we will illustrate it later.