ABSTRACT
The therapeutic nature of the nurse-patient relationship is grounded in an ethic of caring. Florence Nightingale envisioned nursing as an art and a science...a blending of humanistic, caring presence with evidence-based knowledge and exquisite skill. In this article, the author explores the caring practice of nursing as a framework for understanding moral accountability and integrity in practice. Being morally accountable and responsible for one's judgment and actions is central to the nurse's role as a moral agent. Nurses who practice with moral integrity possess a strong sense of themselves and act in ways consistent with what they understand is the right thing to do. A review of the literature related to caring theory, the concepts of moral accountability and integrity, and the documents that speak of these values and concepts in professional practice (eg, Code of Ethics for Nurses with Interpretive Statements, Nursing's Social Policy Statement) are presented in this article.
Subject(s)
Empathy , Moral Obligations , Nurse's Role , Nurse-Patient Relations/ethics , Patient Advocacy , Adult , Codes of Ethics , Consciousness , Existentialism/psychology , Female , Health Knowledge, Attitudes, Practice , Humanism , Humans , Knowledge , Male , Middle Aged , Nurse's Role/psychology , Nursing Theory , Patient Advocacy/ethics , Patient Advocacy/psychology , Professional Competence , Trust/psychologyABSTRACT
Consistent with the sphere of clinical nurse specialist (CNS) practice related to advancing nursing practice and patient outcomes, a CNS task force of 20 of the 60 CNSs in our large teaching hospital was convened to plan, implement and evaluate a comprehensive wound care education program. The purpose of the program was to ensure the 24-7 hospital-wide availability of nurses with evidenced-based wound care knowledge and skills. The facilitative environment, in which the program was developed and operates, is analyzed using the Promoting Action on Research Implementation in Health Services framework. Outcomes of the CNS task force include (1) designation of unit-based CNS as the first line resources for wound care at the unit level, (2) education of almost 10% of the 3,800 nurses at Massachusetts General Hospital as staff nurse resources, and (3) a shift in the nature of CNS wound care consultations from prescription to validation of the staff nurse-initiated wound care plan.
Subject(s)
Nurse Clinicians/education , Program Development , Program Evaluation/methods , Wound Healing , Curriculum , Evidence-Based Nursing/education , HumansABSTRACT
Clinical nurse specialists (CNSs) are vital members of the healthcare delivery leadership team. The knowledge and expertise of the CNS is germane to the quality of care a patient receives. More than 50 CNSs practice at Massachusetts General Hospital (the state's first Magnet hospital), where they share their clinical skills, mentor staff through difficult situations, identify learning needs, and implement innovative approaches to patient care. This article presents a brief history of the CNS role and describes how the CNS role is operationalized at Massachusetts General Hospital and its impact on unit-based and organizational outcomes. In addition, several programs and interventions identified by the CNSs in response to results of the Staff Perception of the Professional Practice Environment Survey are discussed. How the CNS influences the professional development of staff and potential implications for the future role of the CNS are described. An exemplar is included depicting a typical work day of a CNS on an acute adult medical unit.
