Contexts of Practice

Table of Contents

Introduction.

Professional practice context- literature evidence and appraisal

Impact of evidence-based practice and its implications on professional practice context

Current evidence-based strategies.

Gap and challenges present in professional practice context

Research strategy.

Conclusion.

References.

Introduction to Scope of Nursing Practice

Scope of nursing practice is basically the services that a nurse as a qualified nurse undertakes so that the nurse can be deemed as a competent nurse and the practices are such that it is within the context of licensure (Nursing and Midwifery Board of Australia, 2015). To know and understand the scope of nursing practice it is required that one understands who a professional nurse is; it is a person who has completed a relevant education program. As registered nurse they are expected to practice and uphold the professional practice standards are prescribed by the national authorities and in the present case it is the professional standards given by the nursing and midwifery board of Australia (Nursing and Midwifery Board of Australia, 2015). There are various factors which affect the scope of nursing practice and that include educational preparation of the nurses, practice and competence. The guidelines, policies and evidence that exist, setting of the practice, level of collaboration in the practice and this scope is due to patient safety, needs and care outcomes. The aim of the present report is to locate and appraise the literature related to the scope of professional practice, impact and implications of the evidence-based practice. The report also discusses the evidence-based strategy and evaluation of the same and identification of gap related to the professional practice scope. This report also highlights the formulation of research strategy which can address the existing gap.

Professional Practice Context- Literature Evidence and Appraisal

NMBA has given guidelines which have been included as policy and procedures for work that is registered nursing standards, registration and endorsement, code of ethics of the nursing practice (Nursing and Midwifery Board of Australia, 2015). The nature of the healthcare is a dynamic one and the nurses are expected to work in such a way that they can cater to the needs of the patient by expanding their scope of practice for which there is provision of higher certification and education (Nursing and Midwifery Board of Australia, 2015). For the present report the professional practice context ‘scoping’ taken is as the scope of nurses practicing in primary healthcare setting. Professional practice of nurses can be defined as the exercise of profession which is an amalgamation of practice standards, nursing skills and expected professional performance. Professional practice is the base of the nursing exercise at the conceptual level which allows the nurses to make sure that they deliver a good quality of care to the patients in the context of profession. There is existing health disparity between the people living in different areas of Australia and one such measure to reduce it was establishment of primary health centres.

One of the most important workforce that is present in these centres are nurses and are often the first point of contact and help the patients in navigation through the system of healthcare (Halcomb et al., 2017). The healthcare system in Australia is a three-tier system which might pose challenge for the patients. Nurses in these settings have more autonomy compared to the nurses in institutional setting and they take up more roles in addition to their conventional role of just caring for the patient. Nurses take the role of healthcare provider, educator, nurse, counselor and others. The registered nursing standards and other guidelines and policies that have been prescribed for the nurses which are generic does not work the same way when it is applied for the work in primary health centre setting (Scanlon et al., 2016). The scope of practice changes and it does not work in the similar manner and the demarcation is bleak so that the practice boundaries and limitations are not fully understood by the nurses as well as policy makers (Birks et al., 2016). This often leads to disparity of health and healthcare in the people being catered for.

Impact of Evidence-Based Practice and Its Implications on Professional Practice Context

Evidence-based practice is the one which is the practice that is the integration of best available evidence which is external in nature, clinical expertise of the healthcare professionals in this case nurses and preferences of patients. Since the evidence-based practice has been included in the practice of nursing, nurses have been required to include the research as a more important part of the practice such that the result of the research can be included in the practice. In the report of Future of Nursing, it has reflected that the practice of nursing is the convergence of knowledge, quality and the new functions such that the safety of the patient can be proper with the quality of care (Stevens, 2013). In a primary healthcare setting, the practice of nurse is affected by various things like the difference in the cultural background of the patients, resources available and other things.

The evidence-based practice is not only affected by the practice but it also impacts the practice done by nurses. The education that is received by the nurses influences the incorporation of the evidence in practice and there are implications of the same on the professional practice context in primary healthcare setting (Lehane et al., 2019). One of the main implications of the evidence-based practice is that it affects the care process when the resources available do not cater to the needs to practice the procedure as per the evidence (Bleijenberg et al., 2018). Implication of the evidence-based practice is also influenced by the level of education that is given to the nurses, the practice that is being conducted in the nursing unit and the policy restriction of the organization as well as the community (Richards et al., 2018).

Current Evidence-Based Strategies

The current strategies that have are being conducted by the taskforce of the nursing in practice is by the one which they have been taught during the education of the licensure. There are various models which are in place for the practice of evidence base for the nursing so that they can analyze the evidence that is available so that they can use this information in the practice. The models that are present are Iowa Model, John Hopkins model and there are other models as well. There are frameworks according to which the nurses are expected to go about analyzing the evidence that is present and in their practice incorporate the evidence into their practice given the preferences of the patient. These are based on basic principle to evaluate the evidence that is present such that the strength, credibility, authenticity is explored as well as the reliability and validity of the results. There is hierarchy of evidence that is included which helps the healthcare professional to help in identification of the best possible level of evidence depending on the methodology of the research and the publication. This process works good if the research is credible but it depends of the healthcare professional. The external evidence should be compared and contrasted to the clinical expertise which is followed by the nurse. The nurse is expected to make a decision if the research evidence is conforming to the existing evidence so that either it can be accepted or refuted and included in the practice. 

Gap and Challenges Present in Professional Practice Context

When a nurse is working in a primary healthcare centre there are many factors that influence the incorporation of evidence-based practice in working practice. These gaps need to be identified and explored so that the measures can be taken to address them in such a way that the practice can be done for good health outcome and quality of care for the patients. In the recent times, the emphasis has been placed on the incorporation of the research into the practice such that the care and wellbeing of the patient can be improved (Richards et al., 2018). In general context the challenge that is faced by the healthcare professionals to include the evidence-based practice is such the lack of time to go through the vast amount of evidence that is present. It is required so that proper evidence can be used for the benefit of the patient and healthcare. Insufficient resources available for the search of evidence is another challenge that is present (Black et al., 2015). In specific context, in a primary healthcare setting the nurse working might face the issue of technology being the challenge.

The registered nursing standard has been made in such a way that it evidence-based practice is an important part of the patient care but it varies with the preference of the patient and clinical expertise which is given less importance by the policy makers (Barbiani et al., 2016). In the given context of primary healthcare it is seen that there can be lack of resources which might cause the unfavorable situation or pose challenge for the practice of evidence base. The other factor that might have profound affect is the fact that patient preferences might not be conforming to the evidence that is given and practice might have to be altered in respect to it. The registered nursing practice is such that there is less flexibility to use the available resources and patient preferences but this is where the evidence-based practice merges with person-centered care (Barbiani et al., 2016). The main gap that is exists is the perception of the healthcare professionals like nurses working in the primary healthcare setting so that the challenges can be addressed in policy and procedural changes in the working.

Research Strategy

The research strategy for addressing the gap and get the answer to what are the challenges faced by the nurses in the primary healthcare setting is to conduct a primary qualitative research. The primary qualitative research can be conducted with the study population as nurses working or have worked in primary healthcare setting. Focused group interviews or individual interviews can be conducted on the study participants with the help of interview guide and open-ended questions. The rationale behind the use of open-ended questionnaire is to get the flow of information in such a way that that study participants can say what they feel without restriction (Merriam & Grenier, 2019). The method that is suggested is the use of inductive approach without the use of preformed themes to guide the formation of the results. The interviews will be conducted in such a way that data saturation is obtained and themes can be derived, field notes will be taken, audio recording will be done and transcription notes will be sent to the study participants for verification. The interviews after transcription will be searched for similar context and repetitions so that they can be grouped under clusters and themes can be derived. The results that are obtained can help in getting the primary information about the challenges faced by the nurses in use of evidence-based practice in primary healthcare setting so that they can be overcome and improve quality of care.

Conclusion on Contexts of Practice

Nursing practice scope is such that they provide the services that can be provided by the nurses based on the qualification so that they can be called competent and the practice is such that it is within the context of their licensure. For the purpose of the present report the professional practice context ‘scoping’ is taken is primary centre setting. The nurses working in the setting have better autonomy compared to the nurses working in other institutional setting. Evidence-based practice is the practice of healthcare for the betterment of the patient in such a way that it integrates the best available external evidence, clinical expertise and preferences of patients. Currently available strategies are such that there is availability of models and frameworks which can be used as guide by the nurses like Iowa model and John Hopkins model for the incorporation of evidence. It is mostly dependent on the subjectivity of nurses. There are many challenges that are faced by nurses in the given context and the research strategy that best suits is a primary qualitative study. The challenges can be identified and explored such that they can be addressed and overcome to cater to the needs of the patients in the best possible way.

References for Contexts of Practice

Barbiani, R., Nora, C. R. D., & Schaefer, R. (2016). Nursing practices in the primary health care context: A scoping review. Revista Latino-Americana De Enfermagem24. https://doi.org/10.1590/1518-8345.0880.2721.

Birks, M., Davis, J., Smithson, J., & Cant, R. (2016). Registered nurse scope of practice in Australia: An integrative review of the literature. Contemporary Nurse52(5), 522-543. https://doi.org/10.1080/10376178.2016.1238773.

Black, A. T., Balneaves, L. G., Garossino, C., Puyat, J. H., & Qian, H. (2015). Promoting evidence-based practice through a research training program for point-of-care clinicians. The Journal Of Nursing Administration45(1), 14. https://doi.org/10.1097/NNA.0000000000000151.

Bleijenberg, N., Janneke, M., Trappenburg, J. C., Ettema, R. G., Sino, C. G., Heim, N., ... & Schuurmans, M. J. (2018). Increasing value and reducing waste by optimizing the development of complex interventions: Enriching the development phase of the Medical Research Council (MRC) Framework. International Journal of Nursing Studies79, 86-93. https://doi.org/10.1016/j.ijnurstu.2017.12.001.

Halcomb, E., Stephens, M., Bryce, J., Foley, E., & Ashley, C. (2017). The development of professional practice standards for Australian general practice nurses. Journal of Advanced Nursing73(8), 1958-1969. https://doi.org/10.1111/jan.13274.

Lehane, E., Leahy-Warren, P., O’Riordan, C., Savage, E., Drennan, J., O’Tuathaigh, C., ... & Lynch, H. (2019). Evidence-based practice education for healthcare professions: An expert view. BMJ Evidence-Based Medicine24(3), 103-108. http://dx.doi.org/10.1136/bmjebm-2018-111019.

Merriam, S. B., & Grenier, R. S. (Eds.). (2019). Qualitative research in practice: Examples for discussion and analysis. John Wiley & Sons.

Nursing and Midwifery Board of Australia (2015). Scope of practice of nurse practitioners. www.nursingmidwiferyboard.gov.au.

Poitras, M. E., Chouinard, M. C., Fortin, M., & Gallagher, F. (2016). How to report professional practice in nursing? A scoping review. BMC Nursing15(1), 31. http://dx.doi.org/10.1080/10376178.2016.1238773.

Richards, D. A., Hanssen, T. A., & Borglin, G. (2018). The second triennial systematic literature review of European nursing research: Impact on patient outcomes and implications for evidence‐based practice. Worldviews on Evidence‐Based Nursing15(5), 333-343. https://doi.org/10.1111/wvn.12320.

Scanlon, A., Cashin, A., Bryce, J., Kelly, J. G., & Buckely, T. (2016). The complexities of defining nurse practitioner scope of practice in the Australian context. Collegian23(1), 129-142. https://doi.org/10.1016/j.colegn.2014.09.009.

Stevens, K. (2013). The impact of evidence-based practice in nursing and the next big ideas. The Online Journal of Issues in Nursing18(2). https://doi.org/10.3912/OJIN.Vol18No02Man04.

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