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  • Subject Name : Nursing

Nursing Workload in The Acute-Care Setting

Introduction to Importance of Caring in Nursing

Nursing is a profession which ensures the healthy sustenance of the society. The healthy sustenance involves physical, social, mental and emotional well-being of an individual. Whenever a person needs care to while going facing health issues, a nurse plays important role in their recovery. Therefore, caring is essential element of nursing. Without implying proper caring methods, a nurse may not be able to fulfil their duties with optimum outcome. The nursing ethics includes caring behaviour of the nurses which ensures proper recovery of the patient from symptoms.

Caring in Nursing

Caring in nursing is a broad phenomenon which is difficult to define. The description of caring involves different perspective, from the definition and essence of nursing to the often used phrases by them (Drahošová & Jarošová, 2016). Many aspects were recognised which were used to describe caring in nursing, such as, caring relationship between nurse and patient, caring as a protector and supporter of the patient, caring as a nursing involvement, caring as a lifestyle and caring to comprehend the spirit of nursing. Nurses try to understand every patient individually and the impact of their illness of their daily life. Nurses assume themselves to be a moral tool of care. They express eagerness to listen attentively and help their patient. This attentiveness is the core of caring. However, this approach is efficacious only through strength and valour of their own personalities (Drahošová & Jarošová, 2016). 

Although the nurses monitor and analyse the patient continuously, their patient also do the same. They observe and evaluate nurses and their behaviour create a long lasting impact on the patient. The patient is directly affected with the behaviour of the nurses. On the basis of their observation they conclude whether the nurse demonstrate caring nature or not.

The concept of caring is still a philosophical aspect. Andersson et. at., 2015 analysed four ways of understanding care in nursing; , caring as safeguarding, caring as person-centeredness the patient’s best interests, caring as contextually intertwined and caring as nursing interventions (Andersson et. al., 2015). Caring by safeguarding is described as the nurses guiding patients and bearing important information and knowledge about the patient to other team members and act as mediator. Caring as person-centeredness means that the nurse take care of the patient by encounter and examining the illness. The category of caring as contextually intertwined is described as prioritising medical task and essential patient care when there is heavy workload, lack of equipment and medication, insufficient staff and inadequate time to interact with patients. The last category, caring as nursing interventions, care is describes as the nurse consider cautious patient observation which results into either relief or improvement in patient’s condition and wellbeing (Andersson et. al., 2015).

Factors Affecting Caring Behaviour

It is observed that the caring nature of the nurses is affected by the psychological distress. The burnout, characterized as emotional exhaustion, lack of personal accomplishment and disability to combat stress due to poor emotion management, is very common in stressful professions like nursing (Chana et. al., 2015). The negative thought about oneself, lack of confidence in patient care and depersonalisation to negative and distrustful approach towards patients results into emotional distressing. Study done on 102 nurses by Chana et. al., 2015 showed that anxiety is co-related with work stress and inefficient preparation to take proper emotional care of the patient and their families. It also affected coping strategy in negative way. A similar output was acquired for depression. The caring behaviour of nursing staff was influenced by demographics. Remarkably, the caring behaviour is positively correlated with coping strategies, self-attitude and self-regulation. Therefore, these findings support the role of coping and appraisals, rather than factors like social support or flexibility in ensuring quality nursing care. This confirms that caring behaviour is enhanced by coping strategies and positive attitude, while stress, anxiety, depression and emotional burnout create negative impact on caring behaviour. 

The nurses go through heavy workload every day, and major part of this load is taking care of patients. According to Swiger et. al., 2016, nursing workload is defined as the amount of time and physical effort incorporated to fulfil direct patient care (Changing dressing, providing medication, emotional support), indirect patient care (gathering supplies, preparing documents, discharge plan) and non-patient activities (Training, education and delay caused by equipment). Nurse workload is influenced by oneself, patient, colleague and organization. They may generate a positive or negative impact on the time and effort required for optimal quality of patient care.

Moral Values Behind Caring Behaviour

Moral values in nurses plays key role in incubating caring behaviour in nurses (Numminen et. al., 2016). Moral values are essential part of nursing literature, since the time of Florence Nightingale. Florence Nightingale showed immense moral decomposition while taking care of injured soldiers. The moral courage encourage nurses to think and act with morality while doing professional practice. However, situations arise when the moral courage in nursing prove to be an indefinite concept. There are seven factors of moral courage that must be followed by nurses; honesty, moral integrity, personal risk, commitment, true presence, responsibility and advocacy (Numminen et. al., 2016). The nurses who exhibits moral courage, can provide better quality of care to patients. For example; a nurse looking after a patient suffering from contagious and easily communicable disease, like Covid-19, needs to show courage while providing care as there is constant risk of getting infected.

The nursing professional demands compassion towards patient in order to provide good care. The concept of compassion was well discussed by philosophers, religious and spirituals leader. It is an important part in nursing ethics. Compassion increases establishment of quality care in multicultural context (Papadopoulos & Ali, 2016). Some of the components of compassion are; empathy, caring, well established communication (verbal and non-verbal), competence and professionalism and involvement of patient and their families by informing about the care and providing choices for their care. The nursing education plays an important role in stimulating values of compassion, non-discriminatory and proficient nursing.

A well-established communication channel is extremely important in addressing the need of the patient and providing care. The psychological distance is very important in nurse-patient relationship (Heidari & Mardani Hamooleh, 2015). The research was conducted on student nurses in Iran by Heidari & Mardani Hamooleh, 2015 which showed the communication problems and method of improvement. One of the main reason behind improper communication is unfamiliarity with proper methods of communication with patients. It was found that crowdie environment create hindrance in communication (Heidari & Mardani Hamooleh, 2015). Teaching communication skill and conducting training programs improve communication skills in nurses which can ensure quality nursing care of the patients. The communication training and interview technique could be added in the nursing curriculum.

Future of Nursing Care

The caring in nursing can be further upgraded with the involvement of technology. The harmonious correlation between technology and nursing care will strengthen the caring process. The integration of technological competency in improving nursing proficiency will the use of advance technology (Locsin, 2017) can reduce workload and stress on nurses. The future of nursing care will be the engagement of human person and machine through an interface system. This system will be able to predict and prescribe the change in care with time (Locsin, 2015). This concept of co-existence of human and technology can be understood with the example of AR (autonomous robot) and human person. Although, it is a well-known fact that no machine can exhibits human emotions, response and intelligence. But, with the help of technology the caring of patient can be improvised.

Conclusion on Importance of Caring in Nursing

A lot of researched have been conducted supporting the caring behaviour in nursing. The nursing profession requires a balance of medical knowledge and caring behaviour. Nurses plays key role in maintaining health society and are building blocks of medical system. The ethics of nursing involves compassion and care. There are many factors that affect the caring behaviour of nurses in positive and negative manner like anxiety, stress, workload and coping strategies. A nurse need to have high moral values in order to take proper care of the patients. A good nurse is one who have great moral ethics. The patient recovery depends majorly on the nurse’s care. A lot of responsibilities are upon nurse. Therefore, it is highly recommended that nurses must be trained and educated such that all the dynamics behind developing caring behaviour is boosted.

Reference for Importance of Caring in Nursing

Andersson, E. K., Willman, A., Sjöström-Strand, A., & Borglin, G. (2015). Registered nurses’ descriptions of caring: a phenomenographic interview study. BMC Nursing, 14(1). doi:10.1186/s12912-015-0067-9

Chana, N., Kennedy, P., & Chessell, Z. J. (2015). Nursing staffs' emotional well‐being and caring behaviours. Journal of Clinical Nursing24(19-20), 2835-2848.

Drahošová, L., & Jarošová, D. (2016). Concept caring in nursing. Central European Journal of Nursing and Midwifery7(2), 453-460.

Heidari, H., & Mardani Hamooleh, M. (2015). Improving communication skills in clinical education of nursing students. Journal of Client-Centered Nursing Care1(2), 77-82.

Locsin, R. C. (2017). The Co-Existence of Technology and Caring in the Theory of Technological Competency as Caring in Nursing. The Journal of Medical Investigation, 64(1.2), 160–164.doi:10.2152/jmi.64.160 

Numminen, O., Repo, H., & Leino-Kilpi, H. (2016). Moral courage in nursing: A concept analysis. Nursing Ethics, 24(8), 878–891.doi:10.1177/0969733016634155 

Papadopoulos, I., & Ali, S. (2016). Measuring compassion in nurses and other healthcare professionals: An integrative review. Nurse Education in Practice, 16(1), 133–139. doi:10.1016/j.nepr.2015.08.001

Swiger, P. A., Vance, D. E., & Patrician, P. A. (2016). Nursing workload in the acute-care setting: A concept analysis of nursing workload. Nursing Outlook, 64(3), 244–254.doi:10.1016/j.outlook.2016.01.003 

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