Nursing - Caring Culture - Report Writing - Assessment Answer

Nursing Assignment

Assignment Task

Introduction

Caring culture is defined as a culture that facilitates equitable resource access to all individuals in need of care. The culture closely associates with a person-centred approach to care provision and serves to elevate human experiences (Hamington 2010, p. 678). It encompasses personally connecting with patients and members of their family so as to deeply understand and put an end to all levels of suffering (Ladden et al 2013, p. 1836). Further, the aspects of both caring and uncaring form a part of ‘culture of care’ and these serve to include the manner in which care providers tend to create and express meaning in care delivery (Smolowitz et al 2015, p. 133). Literature also serves to compare culture of care with organisational culture that can be measured with the help of three categories namely individual qualities, relational qualities and decision making qualities (Lee et al 2013, p. 153). The category of ‘individual qualities’ is defined by attributes of courage, integrity and curiosity (Decker & Decker, p. 152). On the other hand, the category of ‘relational qualities’ encompasses attributes of nurturing, fostering and valuing and the category of ‘decision making’ consists of attributes of balance, respect and attention (O’Ferrall 2013, p. 327). Psychological capital of professionals in a caring culture is harnessed in a positive manner so as to create shared values, build supportive relationships, listen to feedback and yield best possible patient outcomes (Hewlett & Winn 2014, p. 204).

This assessment is aimed at providing an overview of a speciality practice area with an emphasis on changes that have occurred over the past decade. Impact of these changes on nursing practice shall also be discussed. This will be followed by elaborating on the context of practice setting with the help of a person-centred approach. Evidence will be drawn from experiences of individuals receiving care and current practices in caring culture will be analysed. Finally, valuable recommendations for making improvements to caring culture will be discussed. Ambulatory care nursing has been selected as the area of speciality for the purpose of this assessment.

Practice Changes

A major change in ambulatory care nursing that occurred within the past decade is driven by technology (Martinez et al 2015, p. 59). Technological evolution has facilitated ease of access to information and delivery of healthcare services thereby eliminating the need for professionals to be tied up to monolithic systems (DeBrew 2010, p. 46). In other words, technology has given nursing professionals the ability to access records, consult with doctors and provide advice while operating outside the traditional hospital setting(Hamington 2010, p. 693). Electronic records have also served to improve decision making as everything is systematic and organised. This change has enabled nursing professionals to increasingly care for their patients outside hospital settings. The impact of this change can be clearly witnessed in the decreasing number of hospitalisations since 2009 (Ladden et al 2013, p. 1833). In accordance with published statistics, number of inpatient visits witnessed a fall of approximately 3.25% in 2014 while outpatient healthcare visits witnessed an increase of 14.15% in the same period. Further, the total number of outpatient stays increased by a total of 96% from 2006 to 2013 (Smolowitz et al 2015, 135).

Another change that has occurred during the past decade comprises of a rise in the number of ambulatory surgery centres. Ambulatory surgical centres are modern day state of the art healthcare provision centres that focus on providing of similar facilities as that of day care surgical centres (Lee et al 2013, p. 156). These centres make it possible for professionals to render surgical services that do not require patients to stay at a hospital overnight (O’Ferrall 2013, p. 325). Such procedures are far less complicated as compared to procedures performed in a hospital setting and are immensely helpful in reducing hospitalisation related costs for both patients as well as healthcare service providers (Hewlett & Winn 2014, p. 207). The rise of such centres has transformed the outlook of nursing care. Professionals have more job opportunities compared to the past and are beginning to accept ambulatory care as their first jobs (Vanderboom et al 2015, p. 19). Further, as the domain of healthcare becomes more holistic and community centred in nature, nursing professionals are getting new opportunities to utilise their skills. They are able to interact with a community as a whole and leave the premises of the hospital that they might be employed with (Sojournen et al 2010,p.334).

During the past decade, ambulatory care has also developed into a speciality that forms an integral part of the healthcare delivery system (DeBrew 2010, p. 47). In the past, ambulatory care nursing was often viewed as a sideline profession for new nursing graduates who are unable to secure hospital jobs. This thinking has significantly changedover the past decade (Ladden et al 2013, p. 1830-1834). Ambulatory care nurses are now viewed as professionals who are capable of working both in isolation and in collaboration with other team members and can shoulder the responsibility of providing quality care in less time (Chokshi et al 2014, p. 778). This change in thinking has had positive implications for nursing professionals and has also transformed their role. Ambulatory care nurses now serve more as coordinators and managers of care rather than being direct providers (Wall 2012, p.166). This in turn has enhanced their command over concepts of nursing profession as a strong clinical background is required so as to take on the responsibility of a care coordinator (Dyess et al 2010, p. 187).

Finally, ambulatory care services have evolved and come to be centred on four pillars of care namely quality of care provision, accessibility, clinical care and referral management. Earlier in the day, ambulatory care centres were treated as separate units where a majority of uninsured patients could receive help (Smolowitz et al 2015, 134). Transforming face of healthcare system however has converted these centres into feeders of the referral system. The change has also enabled nursing professionals to promote self-management of conditions and deliver healthcare related education (Lee et al 2013, p. 155). Professionals deployed at ambulatory care centres are more culturally competent and are able to connect better with the local population. They are also more aware of the locally available resources and hence are in a better position to guide patients who visit them (O’Ferrall 2013, p. 326).

Person-Centred Perspective

Ambulatory care nursing and its changing face over time has had a major role to play in aligning healthcare provision with its ultimate goal of being patient-centred (Bynum et al 2010, p. 1059). Increased complexity of aliments often requires higher levels and different types of nursing care as compared to that provided in traditional healthcare settings (Hamington 2010, p. 684). Ambulatory nursing practice facilitates healthcare provision based on participation of a wide variety of professionals. The domain of practice further facilitates both leadership for system of healthcare and treatment for patients (Martinez et al 2015, p. 59). Current models of service delivery in ambulatory care enable patients to receive innovative care in the form of care coordination and referrals to external and internal health resources (Ladden et al 2013, p. 1833). Further, assistance for transitioning between varied levels of acuity and different kinds of services is also available. In line with a patient centred approach, ambulatory care has enabled a shift in the focus of care provision (Chokshi et al 2014, p. 782). In complete contrast to perspectives of curing illness, the domain of healthcare (with ambulatory care at its forefront) focuses on promoting wellness and educating individuals regarding the same (Madsen 2012, p. 77). Support for navigating through the entire system of primary, secondary and tertiary healthcare is also provisioned along with necessary advice for reducing unnecessary healthcare costs (Hewlett & Winn 2014, p. 217).

Registered nurses have worked tirelessly to ensure care provision under the ambulatory care domain aligns well with patient-centred approach to care provision (Vanderboom et al 2015, 21). Quality committees are formed for each ambulatory healthcare centres with the objective of constantly identifying problems, setting benchmarks, disseminating preferred practices and enhancing patient safety (Lee et al 2013, p. 157). Quality committees ensuring participation of qualified nursing professionals at board of director level and constant reports are made on aspects of quality care provision and patient safety (O’Ferrall 2013, p. 328).

Further, the aspect of patient involvement and empowerment assumes a central role in care delivery by ambulatory healthcare centres (Sojournen et al 2010, 336). Patients are kept fully involved in all decision making regarding their healthcare and asked to provide their opinions on effectiveness of care measures adopted for them. Innovative care plans which facilitate self management of conditions and medications are devised and implemented (Wall 2012, p.170). Patients are openly encouraged to provide valuable inputs and remain in constant touch with their care professionals with the help of technological measures (Juthani-Mehta & Quagloarello 2010, p. 933). Since registered nurses working in ambulatory care settings deal with a variety of patients on everyday basis, they tend to gain cultural competence and knowledge of resources that are available at community level (Martinez et al 2015, p. 59). They are thus in a better position to direct and guide patients while also educating them regarding important issues (Madsen 2012, p. 78).

Finally, ambulatory healthcare centres facilitate interaction between professionals, patients and their family members thereby helping professions in eliminating different levels of suffering (Ladden et al 2013, p. 1834). Aspects of quality care are strongly emphasised and meaningful therapeutic relationships are created. Unlike traditional care settings, therapeutic relationships created in ambulatory care services do not end once a patient is discharged (Smolowitz et al 2015, 134). Rather, family members and patients can remain in constant touch with the help of technology thereby reducing the need for repeated consultations or admission to traditional care settings (Madsen 2012, p. 81).

Patient and Carer ExperiencesEvidence in terms of constantly improving quality and safety of ambulatory care can be seen from both patient as well as carer experiences (DeBrew 2010, p. 55). Care providers working in ambulatory care settings indicate that patients are far less anxious while visiting an ambulatory care unit and communicating with physicians and the entire care team (Smolowitz et al 2015, 131). Care providers based on their experiences also indicate that they are more successful in establishing a personal connect and eliciting required information from patients, their family members and relatives (Hamington 2010, p. 678). Further, involving patients in their care and care planning is easier compared to traditional care settings (Decker & Decker, p. 162). Both observation and accounts of professionals employed in ambulatory care settings reveal that the level of trust in patients visiting ambulatory healthcare centres is far higher as compared to that in traditional healthcare settings (Juthani-Mehta & Quagloarello 2010, p. 935). This enhanced level of trust enables improved cooperation during medical procedures, while trying to adhere with care regimes and following-up on their care. Observation also revealed a variety of reasons for increased levels of trust (Hewlett & Winn 2014, p. 220). These include systematic organisation of documents and healthcare records, ability to remain in constant touch with professionals, lower healthcare costs and availability of culturally competent healthcare professionals (Vanderboom et al 2015, 22).

Care providers also insist that they work towards wining patient trust and confidence while tending to their ailments. This in turn helps in creating a loyal patient base and improving overall image of this model of service delivery (Ladden et al 2013, p.1834). Nursing professionals further indicate that word of mouth is a major source of attracting patients to ambulatory care services as satisfied patients positively recommends these services to others in the community (Wall 2012, p.172). Care-focused purchasing is also a growing trend in the nation and is enabling employers to focus not just on claims but also on outcomes and satisfaction of patients. In other words, providers are focusing on constantly improving quality of healthcare provision and this is resulting in overall growth of the ambulatory healthcare sector (Sojournen et al 2010, 338).

From the perspective of healthcare providers, it could also be deciphered that constantly improving levels of patient satisfaction could partially be attributed to accreditation agencies (Dyess et al 2010, p. 193). Agencies which serve to accredit health plans are now beginning to evaluate levels of patient satisfaction during their process of accreditation. Plans are annually reviewed for their effectiveness and quality of care provision and this in turn serves to improve levels of community trust in care provision (Madsen 2012, p. 89).

In addition to care providers, perspectives of patients receiving care also elaborate on benefits of ambulatory care services in comparison to traditional care settings (Decker & Decker, p. 168). When patients were questioned regarding their growing levels of trust on ambulatory care services, they indicated that ambulatory healthcare services were open to feedbacks (Datta et al 2014, p. 1259). The service delivery model was more open to suggestions from patients and care providers were willing to accept and implement the same. Visiting an ambulatory care centre was also a lot cheaper as compared to visiting traditional healthcare centres (Bynum et al 2010, p. 1059).

Finally, patients visiting ambulatory healthcare centres also indicated that reputation of these healthcare centres and reviews received by their peers played a role in encouraging them to visit and benefit from this model of healthcare service delivery (Madsen 2012, p. 86).

Current Caring Culture

First, person-centred climate questionnaires (staff version) were used so as to evaluate the caring culture offered by ambulatory healthcare services. This questionnaire is aimed at assessing staff perspectives about existing culture of care (Hamington 2010, p. 679). The scale consists of 17 different questions and is a 7 point Likert Scale. It comments on the aspect of safety and patient-centred approach of the healthcare setting. Studies have evaluated results of deploying person-centred climate questionnaires in ambulatory healthcare settings across Australia (Smolowitz et al 2015, 136). Results reveal that staff members agreed to these healthcare settings being extremely patient-centred in nature. Professionals rated ambulatory care settings high in terms of safety of healthcare and indicated that they worked hard to match quality of care provision offered by traditional healthcare settings (Lee et al 2013, p. 158).

Person-centred climate questionnaire (patient version) was also used to evaluate the current state of caring culture offered by ambulatory healthcare settings. In similarity with its staff version, the patient version of this scale is also a Likert scale and consists of 17 questions (Ladden et al 2013, p. 1834). Use of this scale with patients of ambulatory care services reveals that healthcare provision is fairly patient-centred. This model of healthcare delivery allows service providers to coordinate care with various different professionals thereby ensuring quality (Datta et al 2014, p. 1259). Patients also felt that they could trust their service providers better as compared to service providers in traditional settings as they were more culturally competent and were easily accessible (Wall 2012, p.171).

Professional practice environment scale was also used to evaluate effectiveness of caring culture facilitated by ambulatory healthcare services. The questionnaire has been designed so as to be able to collect staff perspectives on eight different characteristics of professional practice in a healthcare setting (O’Ferrall 2013, p. 333). These include work motivation, practice control, leadership, staff-physician relationships, cultural sensitivity, safety, hospitality and everydayness. Ambulatory care rated high on all of the eight aspects (Bynum et al 2010, p. 1062). Professionals clearly indicated that since registered nurses were chief care providers in these practice settings, the degree of autonomy was high (Vanderboom et al 2015, 23). It was also indicated that the aspect of teamwork and care coordination with team members was high as this defined the core of care provision by ambulatory services. Finally, professionals found it easy to communicate with patients as their services were trusted and patients were far more cooperative as compared to traditional healthcare settings (Sojournen et al 2010, 341).

Recommendations for Improvement

Despite growing popularity of ambulatory healthcare services and improving patient satisfaction levels from the same, scope for improvement in these services can be identified (Chokshi et al 2014, p. 792). Ambulatory care services employ a mix of licensed and unlicensed professionals and there is significant confusion over the role of both these categories (Wall 2012, p.163). This in turn negatively impacts the aspect of trust in care provision. Thus, it would be beneficial to gain further trust and loyalty by clearly defining roles of professionals involved in care provision (Dyess et al 2010, p. 193).

Current state of care provision by ambulatory care services might further be improved by increasing the number of registered nurses that are hired and placed into ambulatory care provision settings (Datta et al 2014, p. 1262). Regulatory care standards require that aspects (such as assessment of patient condition, diagnosis of ailment, planning of care and intervention) of care provision are handled by qualified professionals (Chokshi et al 2014, p. 782). Further, requirements of invasive procedures undertaken at ambulatory care settings need to be catered to by registered professionals. Therefore, it would be necessary to recruit more qualified registered nursing professionals (Hewlett & Winn 2014, p. 227).

Finally, it is evident that telehealth services form an integral part of ambulatory care provision. Tele-health services allow professionals to maintain records electronically and continuously stay connected with their patients so as to offer quality advice (Ladden et al 2013, p. 1831)However, working knowledge of computers and the internet is necessary to be able to take advantage of these services. Therefore, it would be necessary to improve the level of community awareness and working knowledge of computer literary (Smolowitz et al 2015, 131).

Based on these recommendations, a future project might consist of investigating ways of improving the level of community awareness and trust on ambulatory care services.

Conclusion

In summary, it can be concluded that the culture of caring closely associates with a person-centred approach to care provision and serves to elevate human experiences. It encompasses personally connecting with patients and members of their family so as to deeply understand and put an end to all levels of suffering. During the past decade, a significant number of practice changes have taken place and these have transformed the manner in which nursing care is perceived. Major changes include technological innovations which facilitated ease of access to information and delivery of healthcare services, transforming perspective towards ambulatory care services and rise of ambulatory surgery centres. In addition to changing face of healthcare, analysis also revealed that ambulatory care model of healthcare service delivery is extremely person-centred in nature. It allows professionals to personally connect with patients, offer improved levels of trust and eliminate pain and suffering at various different levels. Various proven and established scales were used so as to evaluate the effectiveness of caring culture. These included both patient and staff versions of person-centred climate questionnaires. Findings of both revealed that the ambulatory model of healthcare service delivery model was significantly patient centred in nature. Recommendations to improving current state of caring culture included clearly defining roles of licensed and unlicensed professionals involved in care provision, increasing the number of registered nursing professionals and improving overall rate of computer literacy.