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Course: Medical Surgical Nursing

Topic: Professional Nursing Practice

The Nurses International Community

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COPYRIGHT

NI Privacy Policy and Terms of Use.

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Module Goals

Learners will be able to

Identify some of the professional nursing roles.
Review the nursing professional competencies.
Describe the elements of patient-centered care.

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Medical-Surgical Nurse Definition (AMSN, 2019)

“...Medical-surgical nurses provide care to adults with a variety of medical issues or who are preparing for/recovering from surgery. They have a broad knowledge base and are experts in their practice. Medical-surgical nurses have advanced organizational, prioritization, assessment, and communication skills and are leaders in coordinating care among the interprofessional healthcare team.

Medical-surgical nursing is practiced in several settings across the healthcare industry, including hospitals, outpatient settings, homes, via telemedicine and other non-traditional settings. The specialty of medical-surgical nursing happens in almost every care environment because medical-surgical nursing is what you practice, not where.”

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Medical-Surgical Nurse

Possesses sound knowledge, understanding, and skills related to

Anatomy
Physiology
Pathophysiology
Evidence-based clinical treatment and care of various medical and surgical conditions

Assists with

Regaining or maintaining optimal health
Disease prevention

All specialty areas of nursing have their roots in medical–surgical nursing.

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MS Nurse: Care Settings

Acute and subacute care facilities
Detention centers
Summer camps
Organizations
Long-term care centers
Assisted-living facilities
Home care
Outpatient clinics
Primary care offices
Community healthcare center
Schools
Flight nurse

Western Governor University, 2020

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Critical Thinking Question

In which of the following settings might an MS nurse practice? (Select all that apply).

Acute and subacute care facilities
Long-term care centers
Assisted-living facilities
Outpatient clinics
Billing and coding departments

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Role of an MS Nurse

Healthcare provider
Team coordinator
Collaborator
Health educator
Client advocate
Change agent
Leader
Manager
Researcher

Arkansas State University, 2017

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MS Nurse: Healthcare Provider

Identifies the client’s health problems and needs
Provides preventive, curative, and palliative care to clients across the lifespan

Provides education for disease prevention and health promotion
Administers medications and treatments
Provides skilled care
Provides emotional support and comfort

Health promotion

Focuses on improving social determinants of health

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MS Nurse: Team Coordinator

Essential members of the team:

Client
Nurse
Physician/doctor
Physiotherapist
Psychologist
Dietician
Lab technician
Social worker

Coordinating roles:

Promote team communication
Facilitate effective team outcomes

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MS Nurse: Collaborator

Interprofessional partnerships: an essential competency for the MS nurse.

Collaborates with care team members, clients, families, and communities to optimize care, enhance the healthcare experience, and strengthen outcomes.

Collaborates with disciplines guided by the client’s health needs.
Functions with an understanding of healthcare disciplines and how they relate to client care.

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MS Nurse: Health Educator

Client education/counseling is a significant part of the MS nurse’s responsibility.
Provides client education/counseling to

Prevents medical conditions such as

Obesity
Diabetes
Communicable diseases

Decreases the possibility of complications
Empowers client to be independent/self-sufficient

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MS Nurse: Health Educator (Continued)

Initiates client education/counseling at initial contact and continues until the client no longer requires care.

Education takes place at the hospital, outpatient clinic, and in the community setting.

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MS Nurse: Client Advocate

Client advocacy is a vital part of an MS nurse’s responsibility
Supports clients and acts in their best interest
Advocacy roles include

Informing clients of their rights
Protecting clients’ rights
Helping clients make informed decisions
Ensuring client safety
Identifying gaps in client care
Helping clients identify resources that support their well-being

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Critical Thinking Question

Medical-surgical nurses, in their role as _________ _________, coordinate client care through accurate and efficient communications among client care team members.

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MS Nurse: Manager

MS nurse manages

Client care activities at the bedside.
Nursing staff in a specific unit in a healthcare delivery system or as nurse/hospital administrators.
Nursing profession through participation in professional nursing councils/associations/organizations.

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MS Nurse: Researcher

Practice must be evidence-based and aligned with continuous research.
An important source of information for the design, implementation, and evaluation of healthcare research.

Frontline healthcare providers
Present with the client throughout their care

Plays the role of a researcher by identifying research areas, implementing research protocols, and sharing the results within the healthcare community.

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MS Nurse: Change Agent

At the Bedside

Updates and normalizes evolving evidence-based practices.
Demonstrates ethics and practices that influence the practice of peers and student nurses.

Managers/Administrators

Creates/directs guidelines/policies that enable nurses to provide optimum client care.
Creates working environments that foster the best care practices.
Engages in dialogue with the public, community leaders, and other stakeholders to promote safe healthcare delivery systems and practices.

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MS Nurse: Leader

Role of a leader is inherent in the professional nurse
Every nurse is a leader in their area of nursing practice:

Identification of client health needs
Prioritization of client care activities
Coordination of client care with the care team
Advocation of client rights and care services

Nurses are required to have leadership skills

The nurse needs to be a leader to become a change agent!

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Critical Thinking Question

Which of the following are areas of nurse management?

Managing client care activities
Managing the nursing staff in a specific unit
Managing the healthcare delivery system as a nurse hospital administrator
Managing the nursing profession through participation in nursing councils/associations/organizations

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Competencies for Universal Health Coverage

for Health Workers (WHO, 2022)

Domain I: People-centeredness

Places people at the center of all practice
Promotes individual and community agency
Provides culturally sensitive, respectful, and compassionate care
Incorporates a holistic approach to health

Domain II: Decision-making

Takes an adaptive, collaborative, and rigorous approach to decision-making
Incorporates a systems approach to decision-making
Takes a solutions-oriented approach to problem-solving
Adapts to unexpected or changing situations

WHO, 2022

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Competencies For Universal Health (Continued)

Domain III: Communication

Proactively manages interactions with others
Adapts communication to the goals, needs, urgency, and sensitivity of the interaction
Listens actively and attentively
Conveys information purposefully
Manages information sharing and documentation

Domain IV: Collaboration

Engages in collaborative practice
Builds and maintains trusting partnerships
Learns from, with and about others
Constructively manages tensions and conflicts

WHO, 2022

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Competencies For Universal Health (Continued)

Domain V: Evidence-informed practice

Applies the principles of evidence-informed practice
Assesses data and information from a range of sources
Contributes to a culture of safety and continuous quality improvement

Domain VI: Personal conduct

Works within the limits of competence and scope of practice
Demonstrates high standards of ethical conduct
Engages in lifelong learning and reflective practice
Manages own health and well-being

WHO, 2022

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Critical Thinking Question

The MS nurse, as a member of the professional nursing team, is expected to behave accordingly. Which of the following competencies aligns with the personal conduct an MS nurse should always exhibit?

Works within the limits of competence and scope of practice
Demonstrates high standards of ethical conduct
Incorporates a systems approach to decision-making
Takes a solutions-oriented approach to problem-solving
Engages in lifelong learning and reflective practice
Manages own health and well-being

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Professional Characteristics of the MS Nurse

Professional behavior and attitude
Empathetic and compassionate
Work within professional boundaries
Critical thinker
Effective communicator
Culturally competent
Agile learner
Assertive and possesses moral courage
Self-care

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MS Nurse: Professional Behavior/Attitude

MS nurse behaviors:

Welcoming and respectful attitude and behavior
Practices within the boundaries set by national nursing authorities:

Nursing Standards of Practice
Code of Ethics/Code of Conduct

Accountable for their practice
Addresses ethical issues related to end-of-life care, professional relationship with colleagues/coworkers

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MS Nurse: Empathy and Compassion

Empathetic

Able to share and understand the feelings of their clients

Communication

Learning to listen to the whole person and not just their words
Helps clients feel seen, heard, and understood

Compassionate care:

Comprised of empathy, kindness, willingness to help others, cultural competence and being non-judgmental

Bettercare, n.d.

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MS Nurse: Critical Thinker

Open-minded
Mindful of alternatives
Well-informed
Evaluates the credibility of sources
Practices the identification of assumptions, conclusions, rationales
Evaluates the logic and reason of an argument
Can develop/defend a reasonable position
Asks questions to gain knowledge
Develops and tests hypotheses
Reaches conclusions when appropriate

Ennis, 2011,

as cited in Leibold, 2020

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MS Nurse: Effective Communicator

Verbal and nonverbal communication competency

Clear and concise
Uses the language the client understands
Able to read body language; notices nonverbal cues

Actively listens

Listens not only to what is being said but also to what is left unsaid by the client.

Ensures accuracy and continuity of information among the multidisciplinary team.

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MS Nurse: Culturally Competent

Provides nursing care to clients whose cultural backgrounds are different from that of the nurse.
Is aware of self and client’s culture and beliefs, recognizes the differences, and provides care that remains respectful of those differences.
Considers that not all people from the same cultural background share the same behaviors and views.
Avoids stereotyping or generalization of cultural values/beliefs.

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MS Nurse: Agile Learner

Learning agility is defined as “the willingness and ability to learn from experience, and subsequently apply that learning to perform successfully under new or first-time conditions.” (Lombardo & Eichinger, 2000)

MS nurses should be able to sense and respond quickly to changes in the healthcare system and practices.

Should respond to change proactively, adaptively, and resiliently.

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MS Nurse: Agile Learner (Continued)

Learning agility to address evolving changes in health care:

Roles and responsibilities of the nurse have transformed rapidly
Client management and treatments continue to evolve
Client’s expectations of nursing care have increased
Health information technologies continue to change
Care interventions and treatments continue to evolve

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MS Nurse: Moral Courage and Assertiveness

Moral courage - "an individual's ability to overcome fear and to fight for the values in which he or she believes, which he or she considers fundamental."

MS nurses are agents of moral courage. They are professionally assertive

To ensure the client’s rights
To ensure the client’s care needs are met
To promote improved workplace culture

Santos et al., 2018

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MS Nurse: Self-Care

Quality client care is possible only when the nurse is physically fit and psychologically and emotionally stable.
MS nurses are at risk for health issues:

Physical health problems:

physically demanding tasks, staffing shortages, and work overload

Mental health stressors:

Witness clients’ physical, emotional, and spiritual suffering
Personal family and other sociocultural issues

Nurses with physical and/or mental health problems are at increased risk of making errors.

Substance Abuse and Mental Health Services Administration, 2020b

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MS Nurse: Self-Care (Continued)

Best self-care practices for MS nurses:

Self-reflection
Regular exercise
Adequate sleep
Maintain relationships
Talk about one’s feelings, get help
Make time for hobbies
Cultivate mindfulness
Engage in spiritual practices
Stress management techniques

Substance Abuse and Mental Health Services Administration, 2020b

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What Would the Nurse Do?

Quality client care is possible only when the nurse is physically fit and psychologically and emotionally stable.

Give examples of self-care practices for MS nurses.

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures, talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures, family members play a large role in healthcare decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting and following treatment recommendations.

AHRQ, 2020

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Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may affect health-seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family.
Interpersonal customs: Eye contact or physical touch may be acceptable in some cultures but inappropriate or offensive in others.

AHRQ, 2020

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Cultural Considerations: Examples

It is expected that the MS nurse knows and understands the clients’ culture and incorporates it into the plan of care to avoid additional pain and treatment delays. The MS nurse is expected to apply and understand the following:

Ethical principles in nursing care
Religious issues
Communication issues
Family organization issues
Ethical issues

Substance Abuse and Mental Health Services Administration, 2020a

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References:

Academy of Medical-Surgical Nurses (AMSN). (2019). What is med-surg nursing? https://www.amsn.org/about-amsn/what-med-surg-nursing

Agency for Healthcare Research and Quality (AHRQ). (2020). Health literacy universal precautions toolkit (2nd ed.). U.S. Department of Health and Human Services, National Institutes of Health. https://www.ahrq.gov/health-literacy/improve/precautions/tool10.html

Arkansas State University. (2017). The role of a professional nurse today. https://degree.astate.edu/articles/nursing/role-of-professional-nurse-today.aspx

Bettercare. (n.d.) Empathetic care: Introduction to kindness, empathy and compassion. https://bettercare.co.za/learn/empathetic-care-a-guide-for-community-health-workers/text/01-introduction-to-kindness-empathy-compassion.html

Contact info: info@nursesinternational.org

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References:

Leibold, N. (2020). The praxis of critical thinking in nursing (2nd ed.) Nanza Publications. https://thepraxisofcriticalthinkinginnursing.yolasite.com/resources/2.2e%20The%20Praxis%20of%20Critical%20Thinking%20in%20Nursing%20By%20Nancyruth%20Leibold.pdf

Lombardo, M. M., & Eichinger, R. W. (2000). High potentials as high learners. Human Resource Management, 39(4), 321–329.

Santos, R., Garros, D., & Carnevale, F. (2018). Difficult decisions in pediatric practice and moral distress in the intensive care unit. Revista Brasileira de Terapia Intensiva, 30(2), 226–232. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6031410/

Substance Abuse and Mental Health Services Administration. (2020a). Improving cultural competence. https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4849.pdf

Contact info: info@nursesinternational.org

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References:

Substance Abuse and Mental Health Services Administration. (2020b). Tips for healthcare professionals: Coping with stress and compassion fatigue. https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-01-01-016_508.pdf

Western Governor University. (2020). Surgical nurse job description and career guide. https://www.wgu.edu/blog/surgical-nurse-job-description-career-guide2008.html#close

World Health Organization (WHO). (2022). Global competency and outcomes framework for universal health coverage. https://www.who.int/publications/i/item/9789240034662

Contact info: info@nursesinternational.org

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