Clinical Nursing Environment

The clinical nursing environment plays an important role in the provision of health care. Nurses ensure that patients receive proper health care services, preventing them from any harm (Child & Institute of Medicine, 2004). Thus, it is crucial to determine the level of nursing expertise to ensure the nursing practitioners are effective and efficient. Various studies and research have been used to determine the skills and efficiency of nurses.

The clinical environment is an entity with a complex and challenging issues to define. Thus, its research heavily relies on the social context. The theoretical structure and framework of nursing are developed to ensure patients get positive results of treatment. An increasing number of researchers relate nursing experience levels to the results of care provided. Also, experience and expertise levels are paramount in determining the performance of all nursing functions, which are critical when establishing healthy lifestyles in the society. To facilitate this difficult research, it is important to establish a scientific approach. The analysis of several factors like social and cultural environment is crucial when preparing any nursing research.  Although there are benefits of studying social structures, very few studies have been performed in the clinical environment. Proper knowledge of the social climate can be of assistance for people to improve their quality of life.

This research provides the fundamental issues of clinical nursing environment and explains the framework of assessing nurses. Well-described aspects and theoretical perspectives help to better understand the clinical environment. However, the necessary resources would not be readily available because clinical nursing occurs in diverse settings and under different formats. There is a broad range of environments where healing can take place. This environment includes laboratories, hospitals, seminars, and workshops, creating the need to set the resources all over these areas (Davis & Lacour, 2014). The resources would also be hard to locate because nursing mainly involves the consolidation of practical skills and knowledge obtained. Their efficiency during working may be judged by the obtained results, making it an inaccurate method when determining their usefulness.

The paper provides specific criteria and processes for defining a clinical nursing with an overview of the stages that involve the validation in clinical research. It also discusses the problem of the identification and implementation of knowledge in the practice of clinical nursing. The study would also explore the extent to which nursing research was focused on clinical issues together with problems facing nurses in the implementation and methodologies. The diagnoses criteria are also explained in this paper. The description of the diagnosis process is made in a systematic way, showing each step the nurses take when carrying out this important medical function.

1. Methodologies Used in the Clinical Studying Environment

Enhancement of the clinical nursing experience is made through research on Evidence Based Nursing (EBN). It puts into practice many methods of providing health care through the assessment of valuable studies and statistical research results. The major role of EBN is to develop and add progress of the healthcare structure and improve the safety and health of the patients. EBN provides systematic procedures for collecting, interpolating, evaluating, and integrating applicable and valid research. EBN implementation can be made by determining the knowledge of the nurse as well as the patients’ needs to find an effective solution to the problem (Stainton, Hughson, Funnell, Koutoukidis, & Lawrence, 2011)

Steps of Carrying out an EBN

(a) Cultivating and developing a spirit of inquiry, which involves the process of asking questions about the nursing practice. The questioning ensures that the people in the healthcare division take the challenge through asking questions and eventually create change and improvements.

(b) Asking clinical questions that mainly address the number of patients, their involvement, the comparison group, the results, and the time frames. These questions help to improve the quality and ensure well-organized results. For example, how many patients had heart surgery (population)? What was the effect of performing the surgery (intervention)? Comparison of the various medications used (comparison). Controlling of the pain after the surgery (the outcome); Effects after 12 hours of the surgery (time).

(c) Searching and collecting relevant evidence are as a result of weighing all the options at all levels. Seven levels of evidence are to be considered; the level 1 is the strongest while level 7 is the weakest. The highest levels of facts and evidence are well-arranged reviews, analysis and summarizing, as well as obtaining the confirmation using qualitative measures. Then the gathered evidence allows generating a clear summary.

(d)  Critically evaluating the evidence mainly involves the process of verifying the reliability, validity, and applicability of the established evidence. The major inquiries made are; what is the validity of the findings and results? Validity is determined with nearness to the truth. What are the results? Reliability of the study is measured on the account whether another researcher could get the same results. Applicability of the results when taking care of the patients? The study may be practically used when taking care of patients. A conformity of the three questions shows that the gathered evidence is feasible.

(e) Integrating the evidence is concerned with encouraging the patient feel free and take part in the decision-making process. Contradictions may make the patient disagree with the decision made. Therefore, it is vital to assess the history of the patient based on previous treatment.

(f)  Evaluating the outcomes helps in the determination and assessment of the effectiveness of the therapy. The evaluation is done by looking at the results of the patient. It is vital to assess the outcome in a clinical setting that is real to help determine the effect of transforming health care quality.

(g) The final step is to disseminate the outcome by sharing and comparing results to benefit others. Presentations and publications help to spread the results acquired.

2. Practical Validation Techniques

Validation is the process through which a product, system or service meets the need of customers and other shareholders. It is done so that the goods and services of an organization could fulfill the user’s operational requirements. The requirements involved include special regulations and specifications based on qualified verification.

Categories of Validation Used

Prospective validation can be used before any new rules are provided to the patients. The validation may involve new treatment, which should function properly. Safety standards of all new drugs are confirmed. The most used parameters applied for validation include accuracy and precision, selectivity, repeatability, system suitability, curve fitting, and limit of detection. All of them have to meet the accepted standards. New clinical guidelines evaluate, identify and summarize the data about medication, risk, prevention, benefits, diagnosis, prognosis, and cost of the drug. The guidelines are the most important considerations that determine the outcome. Some guidelines even contain algorithms that are computational, which helps to provide the most effective treatment.

However, some methodologies do not work properly during the methodology and validation process. Some guidelines might lose their importance and relevance as the new research replaces the old one. It is also crucial to note that some simple clinical practices are left out. Also, nurses and other medical practitioners may overlook some procedures. Moreover, some guidelines may have a conflict of interest or bear problems that are methodological, thus being of an inappropriate standard.

Implementation of Confirmation and Validation of Empirical Knowledge

Implementation is the process of putting things into practice. An approval committee is involved together with all the nurses. The processes involved include discovery, summary, translation, integration, and evaluation. It also presupposes the conversion of research findings from primary results to health outcomes through various stages. These steps ensure the transformation of knowledge to useful clinical outcomes.

(a) Knowledge discovery is obtained through ancient empirical research, which mainly involves qualitative and quantitative analysis and studies.

(b)  Evidence summary includes the synthesis of the research on a particular problem from findings and analysis.

(c) Translation into the practice of the recommendations is made in the form of a summary and is combined with evidence from the clinical expertise and then interpreted in a way that would facilitate the understanding by the involved parties.

(d) Integration into the practice is done through the implementation of both formal and informal methods considering organizational factors and individuals that can affect the adoption process.

(e)  The evaluation process involves the outcomes of the health care and the client satisfaction. Other methods for collecting data are the nursing assessments provided from the starting point for establishing all nursing diagnoses. It is paramount that a known nursing evaluation framework is used to determine and categorize the patient’s problems, risks, outcomes and results for the improvement of his or her health condition. The utilization of evidence-based nursing structure such as Gordon’s Functional Health Pattern Assessment ought to give guidelines that help nurses in the determination of almost all nursing diagnoses ( Glynn, Drake, & Hutchison, 2012). A valuable, evidence-based assessment framework is an optimal approach used to obtain the correct nursing diagnoses.

Methods used include the following:

1. Interviewing of the patient accurately;
2. Close physical examination of the patient to see his or her body condition;
3. Obtaining an accurate health history of the patient (including all the data relating to diet and feeding habits);
4. Family history and report to verify some genetic and hereditary diseases;
5. Diagnostic data of the client to get the proper results;
6. Observation and result analysis;
7. Giving the required feedback, medication and treatment to the patient.

Diagnosing Phase

Nursing diagnoses signify the nurse’s clinical decision about genuine or probable health problems and life processes happening within an individual, family, group or community. The accuracy involved in the nursing diagnosis is validated when a nurse can clearly identify and relate the interrelated factors as well as risk factors found within the patient’s assessment. Multiple nursing diagnoses may be made and observed in one client, whose condition is quite complicated.

Planning Phase

In agreement with the patient, the nurse tackles each of the predicaments identified in the diagnosing phase. When there are many nursing diagnoses to be assessed in the seriously ill patients, the nurses choose which diagnoses to prioritize, emphasizing the most severe ones and those that are likely to cause the most significant outcome. For each predicament, a measurable target/outcome is laid down. For each goal/outcome, the nurses select interventions that will assist them to realize the goal/outcome (Artinian, West, & Conger, 2011). A conventional technique of formulating the expected results is to apply evidence-based Nursing Outcomes Classification to allow the use of standardized language, which advances the consistency of terminology by defining the measures and outcome. The criteria applied in the Nursing Interventions Classification permit the use of standardized language, which improves the consistency of terminology, definition, and ability to identify nursing activities, which are also part of nursing workload and staffing indices. The result of this step is a nursing care plan.

Implementing Phase

The nurse employs the nursing caring program by performing the determined variables that were selected to help meet the outcomes. Delegated tasks and the monitoring of the variables is included here, as well.

Activities involved in the implementing phase include the following:

• Pre-assessment of the client done before carrying out the implementation phase to determine if it is relevant;
• Determination of the client’s need for assistance;
• Implementation of nursing orders to the letter;
• Delegation and supervision to decide who should carry out various actions.

Evaluating Phase

The nurse evaluates the progress toward the goals/outcomes identified in the previous steps. If the movement towards the objective is slow, or regression has happened, the nurse must change the plan of care according to the situation. However, if the goal has been achieved, then the caring activity can be stopped. However, new issues may develop at this stage. In such a case, the whole process will start all over again.

Characteristics of Methodology Phases

The nursing care development is a cyclical, continuing, repetitive and ongoing process that can finish at any stage in case a problem is completely solved (Vincent, 2006). The nursing procedures exist for every crisis that a person, family or community may be involved. The nursing process not only articulates on ways of advancing only the physical needs but also all the social and emotional needs, as well. The clinical nursing process should have the following valuable characteristics:

1. Cyclic and dynamic;
2. Goal-directed and client-centered;
3. Be interpersonal and collaborative;
4. Be universally applicable to all areas;
5. Be systematic and be well-organized in a way that is easy to understand.

      3. Factors Affecting the Implementation

Gender issues have affected nursing regardless of stated equal opportunities, and nursing continues to be dominated by females. For example, the male-to-female proportion of nurses is approximately 1:19 in Canadian hospitals.

There are many very myths concerning nursing, including the occupation and the individuals that work as nurses. One of the most widespread stereotypes is that all nurses are females. The nursing departments are populated and dominated by women, but there are a few male nurses in the profession, as well.  Major women involvement makes the decision-making process difficult when developing new procedures to female patients especially when there are male nurses. Also, disagreements might occur when performing certain procedures (Earp, French, & Gilkey, 2008).

Social predicaments that have an influence on the quality of life of patients of interest may affect the effectiveness of the implementation process. Thus, broad participation of numerous sources of information that are both subjective and objective impacts people’s perception of various healthcare phenomena. Social issues may make them resist new drugs and medications as people are naturally defensive when it comes to the implementation of innovative approaches (Chinn & Kramer, 2013).

Epidemiological assessment involves the determination and focusing on specific health issues of the patients by prioritizing their health needs. Based on these priorities, the goals and objectives for the programs are being developed and then established.  Epidemiological assessment mainly includes the analyzing of secondary data collection. Identifying these risks is a strict process making the implementation process difficult.

At times, the methodologies used to develop clinical analysis may not work hence making the stakeholders frustrated. Lack of money may cause health institutions to stick to old and outdated procedures (Chinn & Kramer, 2013).

Disagreement may occur in the decision-making process hence making the process slow thus wasting time. This issue may occur between nurses and patients, nurses and nurses, nurses and other stakeholders. When ideas do not converge, much time is wasted by holding meetings to liberate on the way forward. This precious time can be used for the research and development of clinical nursing instead of focusing only on establishing a dialogue.

The risk of failure of the assessment has made in-hospital patients to avoid being a tool of research. Patients may feel used for performing clinical nursing experiments from the fear of getting unknown diseases or develop a feeling of being lab-rats in the implementation of new approaches.

The risk of the contributing factors such as postural hypotension.

Failure of the analysis, management or the poor attendance of injuries (Chinn & Kramer, 2013).

Among other problems that make the implementation difficult is the religious actor. Some religions may reject some treatment or examination methods. Some ethnic groups may refuse the treatment because it is taboo to them. Interaction with the community and their cultural norms makes the nurses understand a very wide range of cultures. The planning process is also made challenging and time-consuming. To cope with this pressure, the nurses have to increase their skills of interaction. To conclude, all nurses have to be aware of the cultural needs of their clients. The nurses today must meet the cultural peculiarities to of diverse groups.

From the other side, employee training and friendly and healthy working environment will be the significant factors that would facilitate the process.

4. Nursing Diagnosis that Is not Currently in the Taxonomy

A nursing diagnosis is part of a healing process that determines clinical judgments involving potential health problems. A diagnosis is developed based on the assessment of the nurse. Medical diagnoses mainly determine body disorders. Laboratory findings, symptoms, and signs form the basis for clinical diagnosis. Differential diagnosis of a disease is made by observing the symptoms. The inspection gives the physical diagnosis. The nursing diagnosis involves four steps starting from the collection of available data from the interviews. Alterations of health status and the physical assessment follow the collection of the data, but a continuous revision of the database is necessary. The second step involves the analysis of the patient’s problem response and determining whether he or she is healthy or unhealthy. The third phase is the organization of the data to summarize the uniformity of the problem. The last step is the accurate concluding of the diagnosis based on the gathered information. It is identified and listed in the diagnosis association manuals. A medical diagnosis is not included in the nursing diagnoses taxonomy because it involves complex body disorders like brain damages, heart disorders, and damage to internal organs. Most of the medical diagnoses are made using X-rays while the nursing diagnoses are through assessing the symptoms and general appearance. The North American Nursing Diagnosis Association (NANDA) has standardized levels of evidence uniform definitions and characteristics that show potential diagnoses (Doenges, Moorhouse, & Murr, 2016). It ensures that all nurses use standardized languages in the description and defining the characteristics of diagnoses. NANDA is used in numerous countries such as Nigeria, Ghana, Peru, Honduras, Brazil, and Germany. NANDA system has four broad categories.

(a) The actual diagnosis made as a clinical judgment involving health and life conditions. A real diagnosis is sleep deprivation.

(b) Risk diagnosis helps to describe the response of health and life processes. It is supported by factors involving the risk of increasing the dangers, for example, the risk of shock.

(c) Health promotion diagnosis is the clinical judgment about a person’s family or the motivation of the community bringing the desire to increase and improve a person’s well-being.

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