Nursing

The Difference in competencies between Nurses prepared at the Associate Degree level versus the Baccalaureate Degree level - Nursing introduction. Name: Joy John-Dataset Grand Canyon University, Phoenix Arizona: MRS.-IV-0500 March 22, 2015 Introduction: Recent studies has shown that Nursing Education, and quality care is structured on securing a well-educated workforce based on the challenges and dynamics of today’s healthcare system.

According the (CAN) Facts sheets: It approaches today’s Nursing workforce with researches, relating education to outcomes, and also outline the capacity and preparedness f four year college, as means of improving the level of education in the United States. On this note, the definition of Associate Degree and Baccalaureate Degree are stated below: Associate Degree Nursing: This is a Nursing Degree which duration is typically 2-areas for completion It is usually awarded by community colleges or some nursing schools.

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Students with an Associate Degree can sit for UNCLE-RAN for license as Registered Nurse. The Associate Degree Nursing was founded by Dry. Mildred Montage in 1951, in order to alleviate the shortages of Nurses after the world war, by decreasing the length of education to areas, and also providing a good education for Nurses. According to Creaser & Fibber (2011). This program was deemed successful because of the Associate Degree Graduates were able to pass UNCLE, and showed sufficient level of clinical nursing competence, and they were employed as graduate nurses.

Baccalaureate Degree Nursing: This is an academic degree in the science and principles of nursing, granted by an accredited tertiary institution. The BBS is usually 4 to areas duration, which entails areas of general education and areas of core urging courses, which prepares nurses for wide variety of experience and enhances professional roles and graduate studies. Graduates of this program are qualified to take the UNCLE and become RAN.

Creaser & Fibber( 2011), Baccalaureate Nursing was formed in 1946, when congress passed a GIG Bill of rights, that introduced Veterans to acquire vocational training and college education. This increased the enrolment because Nurses in the Military took advantage of it to earn their degree in Nursing Education, and it also gave birth to the Collegiate Nursing programs. Competencies of the Associate Degree Nursing: This is typically two to three years of Nursing education, which is mainly exposed to clinical settings, disease conditions and bedside nursing, with little or no research done.

This affects the healthcare system in today’s practice because the trend is fast changing. Nurses are expected to ensure holistic patient care, and involvement in thorough research is important towards meeting the new standards of the healthcare system. More so, the DAN Nurses will not be able to compete fluently with other refashions in the healthcare system, based on the level of education without a collegiate degree curriculum. Recent studies has shown that most hospitals expecting a magnet status, are downsizing on the recruitment of DAN Nurses.

However, Diploma and DAN was formally what the society needed from nurses to be able to deliver bedside nursing with minimal cost. Although mortality rate was higher than what it is presently. Competencies of the Baccalaureate Degree Nursing: A Baccalaureate Degree Nurse is exposed to a longer period of education, with in-depth knowledge of Nursing curriculum. BBS entails more advanced nursing courses on leadership, Nurse management, administration, Humanities and extensive patient care.

Furthermore it approaches topics on education in community health, socio-cultural, economical, psychological and spiritual aspects of nursing. BBS Nurses can function effectively as administrative Nurses as well as bedside Nursing. They can present themselves more professionally, among other inter-disciplinary healthcare team, which comprises of Doctors, Pharmacists, Nutritionist, Physiotherapist etc. They can represent or advocate for their patients in various levels. They are trained to conduct research that improves the quality of care rendered to their patients.

It is also evidenced that BBS graduates bring more unique skills to their work and play vital role in safe patient care, earn more respect and recognition from both the public and other healthcare professionals. This is because of the wealth of experience and in-depth knowledge of nursing education acquired during the baccalaureate degree study. Patient care Situation based on decision making of educational preparation of Nursing: (Baccalaureate Degree Nursing versus Associate Degree Nursing):

An example is the End of life care (palliative-care), In most cases, these patients are unable to communicate their needs, which can make them withdrawn and refuse medication or food. In this case, An DAN nurse will go ahead to document patient refusal of food/medicine without proper assessment or understand what the problem might be. This is because they are mainly trained for giving medication, feeding the patients, checking vital signs etc. (bedside nursing). It is based on their educational background, and the strictness to clinical aspect of nursing without reparation for graduate studies.

Thus, limiting their skills to hands on patient care. In this case, A BBS nurse based on educational exposure, will recognize the cultural, psychological and spiritual significance in a dying patient, thereby advocating for the patient by involving the families to help in understanding the beliefs and spirituality of the patient. A BBS nurse will know when to talk, be silent, listen and show empathy. This will help the patient recuperate emotionally, physically and psychological . It will also foster better relationship and trust between patients, family ND caregiver.

Nursing

Understanding and implementing culturally competent and culturally congruent care are the key factors for effective and excellent nursing care (Srivastava, 2007). However, health care provider’s roles and responsibilities in meeting health care needs of the clients in consideration to cultural perspective and diversity are getting more challenging and complicated due to increased number of people from a group of multi-ethnic and multi-cultural society, which, in turn requires health care providers to acknowledge and understand variations of cultural healthcare beliefs, values and practices. Transcultural nursing is essential in the process of nursing care because of the different factors, which includes increasing diversity and multicultural identities, emergent use of health care equipment that occasionally dispute the cultural ethics and beliefs of the clients and a rise in feminism and gender issues (Andrews &ump; Boyle, 2008). Maier-Lorentz (2008) states that the fundamental aspect of healthcare is transcultural nursing since culturally competent nursing care help guarantee patient satisfactions and health beneficial outcome.

According to the Royal College of Nursing (2009), providing care with respect to health and illness based on the expectations of the people’s values, beliefs and practices corresponding with culture is the focal point of transcultural care. Influenced by the principles and theories of transcultural nursing, the author defines transcultural nursing as a discipline of culturally care for individuals, families, groups and communities representing different cultural lifestyle, values, habits, life process, beliefs and practices. Furthermore, the author believes that the aims of transcultural nursing are to bestow effective and excellent care to people from diverse backgrounds and avoid cultural conflicts and negligence related to health care practices. Transcultural nursing helps ensure effective communication, accurate assessment and culturally appropriate interventions to patients with distinct cultural backgrounds. (Andrews &ump; Boyle, 2008; Giger &ump; Davidhizar, 2004) Galanti (2008) report that increased patient contentment to health, developed and improved medical outcome and greater cost productivity are the main benefits of effective transcultural and culturally competent care. To provide effective transcultural care, nurses should have the required knowledge, skills, attitude, values and awareness in caring for people with different cultures.

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Nurses should understand the different cultures of the society they are caring for and develop awareness of ones own culture and ethnic identity to avoid biases, misunderstanding and prejudices to other culture (Royal College of Nursing, 2009). For the purpose of this essay the author will critically discuss and evaluate Campinha-Bacote’s Model of Cultural Competence (2003) and focus on the application of the above-mentioned model in the process of nursing care. The author chose the aforementioned model of transcultural nursing because the model specifically tackles the importance of culturally competent care in nursing practice. It is also concise, specific and easy to understand. Moreover, the model is simply applicable in all areas of healthcare practice. Aside from being useful as a structure in providing culturally relevant healthcare services, Campinha-Bacote’s model of cultural competence has been endorsed and recognized as a guiding framework for organization and administration development (Brathwaite, 2009; Campinha-Bacote &ump; Munoz, 2001). In the author’s point of view the model is categorically specific, measurable and systematically applicable in the assessment of healthcare provider’s competency in cultural care. In addition, the nurses can use the model as a step by step guide to understand and practice culturally competent care without biases and misunderstanding to other culture. However, like in the other theories and models of transcultural nursing, limitations also hits Campinha-Bacote’s model of cultural competence (2003).

In the author’s point of view, the model is not comprehensive; it merely focuses on cultural attributes of healthcare providers in providing culturally competent care. Capell, Veenstra &ump; Dean, (2007) report that the model is limited solely to the assessment and evaluation of the cultural competence of healthcare professional but the patient’s cultural attributes and possible health outcomes are not addressed. Campinha-Bacote’s Model of Cultural Competence (2003) is figuratively illustrated as a volcano in which the cultural desire serves as a stimulus in the course of cultural competence. Once the cultural desire erupts, strong inclination in seeking cultural awareness, attaining cultural knowledge, searching for cultural encounters and showing cultural skills take place. The model regards cultural competence as a continuing process for healthcare providers in achieving culturally competent care. It consists of five major constructs which includes cultural awareness, cultural knowledge, cultural skill, cultural encounters and cultural desire, as discussed below based on Campinha-Bacote’s model of care (2002). Cultural awareness is the process of introspection and detailed exploration of one’s own cultural background.

It involves avoidance of cultural imposition (imposing personal beliefs, values and behaviour on another culture). Cultural awareness helps identify one’s predisposition, prejudices, biases and assumptions to individual with diverse cultural backgrounds. The stages of cultural awareness are unconscious incompetence, conscious incompetence, conscious competence and unconscious competence (Weber &ump; Kelley, 2009). Cultural knowledge is the process of searching and acquiring fundamental facts and information about different cultural and ethnic groups focusing specifically on the issues of health-related beliefs and cultural values, disease prevalence and treatment effectiveness. Whereas, cultural skill is one’s own capability in gathering relevant cultural information concerning to patient’s problem and accurately conducting culturally based physical assessment. Cultural encounters, on the other hand, are defined as a process that inspires healthcare provider to continuously engage openly in cross-cultural relations to individual with diverse cultural backgrounds. In addition, cultural encounter helps avoid possible stereotyping and culture-related negligence. Lastly, cultural desire is the driving force of the healthcare provider to participate in the process of becoming culturally aware, knowledgeable, skillful and familiar with cultural encounters (Campinha-Bacote, 2003a).

The author as a healthcare assistant working in the nursing home will present a case study of a patient who is confined in the frail unit of the care home. The author nursed the patient for more than three months until now and was able to have continuous one to one interaction occasionally. The author will critically discuss the relevant culture-related aspect of care of this patient and identify transcultural challenges encountered from admission to the delivery of care. Moreover, using Campinha-Bacote’s Model of Cultural Competence (2003), the author will critically address and discuss the patient’s culture-related issues and care through the process of assessment, planning, implementation and evaluation. Mrs. Somers is an 88 years old British Asian who was born and grew up in Birmingham, England but presently residing and transferred to Kent, England eleven years ago. She was discharged from a tertiary hospital and admitted to the nursing home where the author works on the 16th of October, 2010. She was diagnosed with osteoporosis, respiratory infections, rheumatoid arthritis, hypertension and myocardial infarction aside from a history of right hip replacement and spinal fusion approximately seven years ago. She was admitted to the nursing home because she needs partial to full assistance on her activities of daily living due to her present condition.

Apparently, her only child is in France at the moment and no one could look after her as her whole family is in Birmingham. Mrs. Somers mentioned that she came from a happy or “lovely” family as she termed it. Her mother is English while her father is half British and half Indian. She has two siblings and she is the eldest and the only girl among them. Aside from being used to the British culture as she was raised here, Mrs. Somers points out that her parents specifically her father thought her with some Indian cultures that she continuously practiced until now like dressing modestly, as all her clothes are below the knee and must cover the shoulders. Family roles and organization is a big issue for Mrs. Somers. She is married to a nurse. According to her, she has a prosperous life with her one and only child. She gets whatever she wants and considers herself as the luckiest person in the world until her husband died in 1989 and problematic personal issues appears, which is the same reason why she leaves Birmingham with her child and transferred to Kent. As for workforce, Mrs. Somers is a nurse same with her husband. No high-risk behaviors was identified as she does not smoke or drink alcohol. On pregnancy and childbearing practices, Mrs. Somers explained that she did not opposed contraception but she was extremely against abortion. For communication, Mrs. Somers speaks two languages, Hindi and English.

She prefers to socialize more with women and avoids physical contact with men in public. As she is adapted to English culture, eye contact in communication and punctuality is very significant. In addition, Mrs. Somers honestly said that sometimes as part of being Indian, she just can’t say no when asked by someone. She sometimes has a habit of offering a response that she thinks someone wants to hear. In terms of religion, Mrs. Somers mother is a Catholic while her father is a Sikh. Even though her parents are practicing two different religions, the siblings were given the free will to choose which religion they would wish to follow. Mrs. Somers chose Catholicism but said that she also has high regards to Sikh beliefs and practices. In accordance with spirituality, Mrs. Somers pray three times a day, every morning after she wakes up, every afternoon (6pm) with the holy rosary and before she go to sleep in the evening as she explained when asked about her prayer routine.

On death and dying issues, Mrs. Somers believe in life after death, that the soul still exist after death and judgement, either to heaven, purgatory or hell. Mrs. Somers added that she is against euthanasia. She further added that the sacrament of the dying and sick is essential as it will comfort the ill person and make them feel secure. Their family practiced common death rites which include washing and draping the body with white cloth, but prefer cremation after death. With regards to her Nutrition and Dietary habits, Mrs. Somers prefer to eat British foods like sandwich, fish and chips, pies, lamb and chicken served with potatoes and one other vegetable. In addition, as being part of Catholicism, she practiced meat restriction every Friday and fasting on specified holy days especially during lent. In terms of health care belief and practices, Mrs. Somers consider medical treatment at the same time with natural/ traditional remedies as her father thought her. For instance, for fever she drinks chamomile tea, for cough and congestion she put formaldehyde crystals in a plastic bag and places it on her chest and for indigestion she drink buttermilk. Mrs. Somers further added that she takes cod liver oil daily to maintain health. She also mentioned that after cleaning a sick room she drinks brown ale to prevent catching the disease.

Using Campinha-Bacote’s Model of Cultural Competence the author will now illustrate how the aforementioned model will help the health care workers to provide culturally competent and quality nursing care. To provide excellent and culturally competent care to this patient, health care provider must reflect first and informally assess their level of cultural competence using the mnemonic, ASKED – Awareness, Skill, Knowledge, Encounter, Desire (Campinha-Bacote, 2003b). The care workers of Mrs. Somers may ask themselves with the following questions: For Awareness: Am I sensitive and supportive to the values, beliefs and life ways of Mrs. Somers? Am I aware to my personal prejudices and biases towards the culture of Mrs. Somers? How can my own cultural beliefs and background affect the care that I need to give to Mrs. Somers? If Mrs. Somers cry for help and become demanding, should I ignore or disregard her? Would I behave like this toward any of my other patients? For Skill: Do I have the skill to conduct a cultural assessment in a sensitive manner? Do I have a skill to perform culture-based physical assessment and interpret the data accurately? Is there any language barrier in communication? For Knowledge: Let me ask Mrs. Somers if she’s more used to British culture or Indian culture? Let me ask her about her cultural beliefs and practices that may affect the quality of nursing care. For Encounters: The care worker would like to care for other British Asian clients to learn more and gain additional knowledge and skills.

For Desire: The health care provider showed signs of cultural desire by wanting to participate in the process of becoming culturally aware, knowledgeable, skillful as well as considering ways to have additional encounters with other British Asian patients. The author will now critically discuss the cultural challenges identified as well as the aim, plan and evaluation of care based on the information obtained from Mrs. Somers. One of the identified cultural challenges is in the area of communication and cultural behaviour. As mentioned above, Mrs. Somers claimed that she sometimes has a habit of offering a response that she thinks someone wants to hear. This cultural behaviour serves as a barrier in providing excellent cultural care. For instance, the care worker asked Mrs. Somers if she wants to join in the fun art activity with other residents, Mrs. Somers said yes, but in the actual activity the care worker noticed that Mrs. Somers is not doing the activity, don’t want to interact with others and not as bubbly as she usually was. When the care worker asked her if she’s alright, Mrs. Somers said that she’s not feeling well and wants to be alone in her room. So, the care worker decided to bring Mrs. Somers back to her room and asked if she wants anything, Mrs. Somers replied that she just want to have a rest with the music on while having a cup of tea.

When the care worker followed her request, Mrs. Somers become relaxed and looks happy. Care worker can overcome this barrier by looking for nonverbal cues such as facial expression that shows reluctance or excitement or enthusiastic response. Evaluation revealed positive outcome as the care worker makes Mrs. Somers comfortable and fulfilled. Another cultural problem identified is in the area of heath care belief and practices. The doctor wants to change Mrs. Somers old medications for heart condition and hypertension to the more effective one but the problem is, Mrs. Somers is still taking cod liver oil that may counteract and lessen the effectiveness of the new medication. When the doctor and the nurse explained and politely asked Mrs. Somers if she can stop taking cod liver oil, Mrs. Somers refused and get mad. Then, the doctor decided not to change the medication and lessen up the dosage that Mrs. Somers taking up for her cod liver oil. Care provider explained to Mrs. Somers that she can still include her natural remedies if it is not dangerous to her health but she must still need to follow her medical treatment to improve her health. Evaluation revealed positive outcome as care provider respect and value patient’s right and cultural beliefs while giving best possible care. Healthcare professionals can overcome this cultural problem by providing better alternative actions while respecting patient’s right and cultural practices (Zerweck &ump; Claborn, 2006).

In conclusion, the main goal of transcultural nursing is to promote culturally competence care. However, excellent and quality cultural nursing care is impossible to achieve unless care provider acquire knowledge and skills in cultural health care as well as learn and apply cultural competency models into practice (Dayer-Berenson, 2009). The author learns that to attain cultural competence and provide adequate cultural care, healthcare provider should develop the desire to achieve congruent care, be aware to any personal biases and prejudices, acknowledge and support other person’s cultural belief and practices, avoid stereotyping and cultural imposition and most importantly identify and overcome the barriers to effective assessment and intervention. Understanding one’s own culture, being supportive, appreciative and sensitive to other culture and differences are the key factors to achieve cultural competence. The author recommends that aside from being focused to care provider’s cultural competency and cultural assessment, transcultural nursing theories and concepts also needs to develop ways on how to avoid cultural negligence, overcome personal biases and resolve cultural barriers that may affect quality nursing care.

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