Medical/surgical nursing focuses on a person’s response to actual or potential alterations in health status, and takes into account their individual situation such as history, social support systems, age, and cultural and linguistic diversity (LeMone et al., 2017). Regardless of the health care service or setting, medical/surgical nurses must use the best available evidence to inform their practice in order to provide safe, competent care. Nursing care activities focus on returning the person to a state of well-being (LeMone et al., 2017).
A plan of care, based on underlying knowledge and a thorough patient assessment, is formulated using critical thinking and clinical reasoning processes with an aim to provide care that is:
Complies with legislation, professional standards, and codes that govern nursing practice in Australia.
This topic will examine:
Key terms and definitions
Health and Illness and the Nurse’s Role
Review of the Nursing Process as a framework for practice
Accountability and responsible practice
It is important to note, that while these topics are being discussed in relation to acute medical / surgical nursing, they also apply to nursing generally, and across all settings.
1. Key Terms and Definitions
These terms by now will not be new to you, but it may be helpful to review what they mean.
Evidence-based practice in nursing is defined as “a problem solving approach to clinical decision-making that incorporates a search for the best and latest evidence, clinical expertise and assessment, and patient preference values within a context of caring” (International Council of Nurses [ICN], 2012, p.6).
Culturally inclusive care:
Cultural competence incorporates cultural awareness and is set of behaviours, attitudes, and policies that come together to enable a system, agency, or professionals to work effectively in cross-cultural situations (Australian Institute of Health and Welfare [AIHW], 2015a. p.2)
Cultural Safety reflects the effective nursing care of a person or family from another culture, and is determined by that person or family. Culture includes but is not restricted to, age or generation; gender; sexual orientation; occupation and socioeconomic status; ethnic origin or migrant experience; religious or spiritual belief; and disability (Crisp, Taylor, Douglas, & Rebeiro, 2013).
Person centred care:
Patient-centred care is health care that is respectful of, and responsive to, the preferences, needs and values of each individual person. The widely accepted dimensions of patient-centred care are respect, emotional support, physical comfort, information and communication, continuity and transition, care coordination, involvement of family and carers, and access to care (Dewi, Evans, Bradley & Ullrich, 2014; LeMone et al., 2017).
Holistic care is care in which all aspects / dimensions of a person (physical, psychological, cultural, and spiritual) are considered and included as essential components of individualised care (LeMone et al., 2017).
Critical thinking is a collection of cognitive skills. It is defined as “the intellectually disciplined process of actively and skillfully conceptualizing, applying, analysing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action” (Critical Thinking Community, 2016). Key skills in critical thinking include divergent thinking, reasoning, clarifying and reflection (LeMone et al., 2017, p. 4).
Clinical reasoning is the ability to differentiate between facts and guesses (LeMone et al., 2017). Clinical reasoning is the process by which nurses collect cues, process the information, come to an understanding of a patient problem or situation, plan and implement interventions, evaluate outcomes, and reflect on and learn from the process (Levett-Jones et al., 2010).
Reflection (Reflective Practice)
Reflection is the circular process that a person uses to think about experiences, to review, develop new insights, and thus guide and inform thoughts, actions and practice. Reflective processes facilitate self-awareness, deeper understanding, meaningful communication and connections, stress management and ultimately transformation and growth of the individual, personally and professionally (Johnson, 2013; O’Toole, 2016).