Research Paper: Nursing Is a Rewarding, but Challenging

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¶ … nursing is a rewarding, but challenging, career choice. The modern nurse's role is not limited only to assist the doctor in procedures, however. Instead, the contemporary nursing professional takes on a partnership role with both the doctor and patient as advocate caregiver, teacher, researcher, counselor, and case manager. The caregiver role includes those activities that assist the client physically, mentally, and emotionally, while still preserving the client's dignity. In order for a nurse to be an effective caregiver, the patient must be treated in a holistic manner. Patient advocacy is another role that the modern nurse assumes when providing quality care. Advocacy is the active support of an important cause, supporting others, or speaking on behalf of those who cannot speak for themselves (Kozier, Erb, & Blais, 1997). This is especially true when one places the nursing paradigm with particular types of palliative and post-operative care: for instance when dealing with prophylactic mastectomies.

The prophylactic mastectomy (PM) is a procedure that offers at least 90% reduction in the risk of breast cancer to women who have genetic or hereditary risk. However, despite this overwhelming statistic edge, acceptance of the procedure is quite low in North America, likely due to socio-cultural attitudes that stem from the amount of information often available to patients. In a qualitative study, researchers from various cancer care institutions in Boston, Massachusetts explored interest in and the acceptability of psychological consultation for issues related to PM among women who were considering this procedure, or had already had it done (Patenaude, Orozco, Lu, Kaelin, Gadd et al. 2008).

The method used for this project was qualitative, focusing on interviews conducted with 26 health women who had already gone through PM with both breasts, 45 women who had undergone PM with at least one breast after diagnosis of invasive cancer, and 37 women who were considering the surgery. Analysis of the results showed that almost 2/3 of the individuals interviewed believed post-surgical psychological intervention would be helpful. All of the women who were considering PM believed psychological counseling would aid their decision-making and surgical preparation; and all respondents validated the need for strong emotional and professional support from other women who had undergone PM and women health professionals with experience in PM (Patenaude, et.al., 838-41).

Area of Research

Addressed in Patenaude, et.al.

Background Information

The authors briefly define the PM procedure and, through the use of qualitative statistics, show the success in lowering risk the procedure has with those women who have significant genetic bias towards breast cancer. They also point out that in most areas of the world, there are little or no regrets from high-risk women who have undergone PM, believing that it was far better to have the procedure than risk the almost certain diagnosis of breast cancer.

Review of the Literature

Unlike many studies of this type, the literature review was not formalized within this article. Instead, previous scholarly studies were included in the methods and discussion sections, particularly those that dealt with psychological intervention, either prior to or after the PM procedure.

Discussion of Methodology

Methodology in this case was qualitative. The authors were after feelings, emotions, and opinions about psychological care, the types of care expected, and the way women who were on both sides of the PM procedure felt about that procedure, their anxiousness, fear, and other concerns. However, the authors did utilize several structured questions that could be analyzed post-survey in more of a quantitative manner -- allowing certain views to be placed on a scale and compared with one another.

Specific Data Analysis

The data was analyzed based on three groups; based on their stage of surgery. The results were analyzed based on demographics and compared to the other groups to allow for consistency. Additional data was collected regarding surgical history, breast cancer history within the family, and general attitudes toward preventative care, psychological and family support, and expectations from the medical system.

Conclusions

Many of the conclusions were based on the data revolving around the types of psychological intervention and care each of the three groups seemed to prefer. There were, of course, barriers to psychological care: professional availability, costs, insurance issues, and how much family and peer support the individuals could count on. The individual narratives illustrate the nature and intensity of the types and need for psychological intervention. The authors conclude that a more robust offering of such is critical in proactively managing PM care.

Because the research was dealing with such a tremendously fearful and personal issue, ethics of confidentiality and beneficence were likely foremost in the researcher's minds. This was particularly true in cases in which the women were considering the procedure but had very little psychological support base, and lived in areas that might not afford them access to trained professionals.

Because the research, in this case, was qualitative in nature the authors were able to uncover only a slice of information that, while likely to be applicable to other groups, requires further study. For example, demographics were used in the analysis, but not necessarily ethnicity. In addition, because this was a small group (around 100 participants) over a small block of time, there were no longitudinal characteristics evident that might help researchers understand the psychological needs of PM patients and families. In this way, further studies would be helpful in assisting preparation for alternative post-support groups.

B. Under the paradigm of quality health care, modern nurses should interpret this as "quality patient care" -- which comprises three important factors -- sound theoretical knowledge of the latest medical procedures, information and innovations; superior communication skills that are multi-culturally based; and the ability to empathize appropriately with the patient and family to buttress the role of caregiver. The necessity for modern nurses is to be far more than ever -- more of a multitasking professional with superior communication and organization skills -- and even more focused on the holistic model of the patient and the manner in which they, the nurse, affects the outcome of the patient's care experience (Brown 2007).

It is a given that the modern nurse will have a far greater exposure to new medical methods, pharmaceutical interactions, and techniques than many nurses of the past. In fact, "the use of clinical judgment in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death" is one of the definitions of modern nursing (Defining Nursing 2003). In fact, with such a vast amount of clinical information needed, combined with the stress of a busy hospital, and the various insurance and legalities to be considered, many contemporary nurse managers find that it is helpful for the modern nurse to utilize a "medical checklist" to improve patient care (Hales 2007). In the contemporary world, it is important to note that a more holistic approach is preferable, seeing the patient as more than their disease, and advocating for that patient's proper care and assistance when they are unable (Kozier, Erb, & Blais, 1997).

C. Annotated Bibliography Matrix: Carative/Advocacy Nursing Models

Author

Source

Type

Pop/

Sample

Outcome

Data

Concl.

Comm.

Siegel and Korniewica; Keeping Patients Safe: An Interventional Hygiene Study at an Oncology Center

Clinical Journal of Oncology Nursing

2007

Quasi-Experimental

Limited to one hospital

Overwhelming positive affects with greater hygiene for health workers

Suggest further studies, more longitudinal

Hygienic carative models remain important

Further study necessary with larger population groups

Upvall and Bost; Developing Cultural Competence in Nursing Students Through Their Experiences With a Refugee Population

Journal of Nursing Education

2007

Ethnographic

Somali refugee families

Results showed a number of expected challenges (linguistic, cultural, fear, etc.).

Some of the issues within the American paradigm, however, are not transferable to another culture -- for instance, a male nurse visiting a female patient without an appropriate chaperone

Good background for new nurses

Expand to other cultures

Watson, J. Social Justice and Human Caring

Creative Nursing

2008

Review

Lit. Review

Bring carative theory into the nursing model.

Previous literature suggests change in the paradigm of nursing.

Humanity must not be lost to technology in nursing.

More psychologically based, not robust or fact filled.

Hanks, R.

Barriers to Nursing Advocacy

Nursing Forum

2007

Concept Analysis

Qualitative

How advocacy fits into modern nursing theory

Examines implication for nursing practice

Nursing has claimed client advocacy as an important core component

Advocacy must be clarified as a result; too vague as a concept at present

Cioffi and Ferguson; Team Nursing in Acute Care Settings

Contemporary Nurse

2009

Qualitative

Nursing in high volume acute care settings

Interviews, cross-tabulation of qualitative data

Team nursing more likely to be implemented because of healthcare costs and issues

Nursing models with teams require further development.

Acute care setting changing as well.

Newman, D;

Community Nursing Center for the Health Promotion of Senior Citizens

Nursing Education Perspectives

2005

Combination; qualitative with quantitative

Patient records in senior care center

Interviews plus analysis of records… [END OF PREVIEW]

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