This paper examines the multifaceted roles of the contemporary nurse, including caregiver, patient advocate, teacher, counselor, and case manager. It analyzes a qualitative study on psychological support needs among women considering or having undergone prophylactic mastectomy (PM), summarizing its methodology, ethical considerations, and limitations. The paper also addresses quality patient care principles — theoretical knowledge, multicultural communication, and empathetic holistic practice — and presents an annotated bibliography matrix of ten nursing studies covering carative and advocacy models, cultural competence, team nursing, senior care, and clinical decision-making in modern healthcare settings.
Modern nursing is a rewarding but challenging career choice. The contemporary nurse's role is not limited to assisting the doctor in procedures. Instead, the modern nursing professional takes on a partnership role with both the doctor and the patient, serving as advocate, caregiver, teacher, researcher, counselor, and case manager. The caregiver role includes activities that assist the client physically, mentally, and emotionally while 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 nursing practice intersects 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 a 90 percent reduction in the risk of breast cancer to women who have genetic or hereditary risk. However, despite this overwhelming statistical advantage, acceptance of the procedure is quite low in North America, likely due to socio-cultural attitudes stemming from the amount of information 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 the procedure or had already undergone it (Patenaude, Orozco, Lu, Kaelin, Gadd et al., 2008).
The method used for this project was qualitative, focusing on interviews conducted with 26 healthy women who had already undergone PM on both breasts, 45 women who had undergone PM on at least one breast after a diagnosis of invasive cancer, and 37 women who were considering the surgery. Analysis of the results showed that almost two-thirds 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 confirmed the need for strong emotional and professional support from other women who had undergone PM and from women health professionals with experience in PM (Patenaude et al., 838–41).
Because the research was dealing with such a tremendously fearful and personal issue, ethics of confidentiality and beneficence were likely foremost in the researchers' minds. This was particularly true in cases where women were considering the procedure but had very little psychological support and lived in areas that might not afford them access to trained professionals.
Because the research was qualitative in nature, the authors were able to uncover only a portion of information that, while likely applicable to other groups, requires further study. For example, demographics were used in the analysis, but ethnicity was not necessarily considered. In addition, because this was a small group (approximately 100 participants) studied over a limited period of time, no longitudinal characteristics were evident that might help researchers understand the long-term psychological needs of PM patients and their families. Further studies would therefore be helpful in informing the development of alternative post-surgical support groups.
Under the paradigm of quality health care, modern nurses should interpret their mandate 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 multiculturally grounded; and the ability to empathize appropriately with the patient and family to strengthen the caregiver role. The modern nurse must be more multidimensional than ever — a multitasking professional with superior communication and organizational skills — and even more focused on the holistic model of the patient and the manner in which the nurse affects the outcome of the patient's care experience (Brown, 2007).
It is a given that the modern nurse will have far greater exposure to new medical methods, pharmaceutical interactions, and techniques than nurses of the past. Indeed, "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 definition of modern nursing ("Defining Nursing," 2003). Given the vast amount of clinical information required, combined with the stress of a busy hospital environment and the various insurance and legal considerations involved, many contemporary nurse managers find it helpful for nurses to utilize a medical checklist to improve patient care (Hales, 2007). In the contemporary healthcare environment, a holistic approach is preferable — one that sees the patient as more than their disease, and that advocates for the patient's proper care and assistance when they are unable to do so themselves (Kozier, Erb, & Blais, 1997).
Brown, C. "Where are the Patients in the Quality of Healthcare?" International Journal for Quality in Healthcare 19, no. 3 (2007): 125.
"Defining Nursing." Royal College of Nursing. January 2003. (accessed November 2010).
Hales, B. "Development of Medical Checklists for Improved Quality of Patient Care." International Journal for Quality in Healthcare 20, no. 1 (2007): 22+.
Kozier, Erb, and Blais. Professional Nursing Practice. 3rd ed. Trenton, NJ: Addison-Wesley, 1997.
Patenaude, Orozco, Lu, Kaelin, Gadd et al. "Support Needs and Acceptability of Psychological and Peer Consultation." Psycho-Oncology 17, no. 2 (July 2008): 831–43.
Articles for Annotated Bibliography
Ciotti, J. and L. Ferguson. (2009). "Team Nursing in Acute Care Settings." Contemporary Nurse. 33 (1): 2+.
Doane, Browne, et al. (2009). "Enacting Nursing Obligations: Public Health Nurses' Theorizing in Practice." Research and Theory for Nursing Practice. 23 (2): 88+.
Gillespie and Peterson. (2009). "Helping Novice Nurses Make Effective Clinical Decisions." Nursing Education Perspectives. 30 (3): 164+.
Hanks, R. (2007). "Barriers to Nursing Advocacy: A Concept Analysis." Nursing Forum. 42 (4): 171+.
Newman, D. (2005). "A Community Nursing Center for the Health Promotion of Senior Citizens Based on the Neuman Systems Model." Nursing Education Perspectives. 26 (4): 221+.
Penrod, et al. (2007). "Reframing Person-Centered Nursing Care for Persons With Dementia." Research and Theory for Nursing Practice. 21 (1): 57+.
Rajapaksa and Rothstein. (2009). "Factors That Influence the Decisions of Men and Women Nurses to Leave Nursing." Nursing Forum. 44 (4): 195+.
Siegel, J. and D. Korniewicz. (2007). "Keeping Patients Safe: An Interventional Hand Hygiene Study at an Oncology Center." Clinical Journal of Oncology Nursing. 11 (5): 643.
Upvall, M. and M. Bost. (2007). "Developing Cultural Competence in Nursing Students Through Their Experiences With a Refugee Population." Journal of Nursing Education. 46 (8): 380.
Watson, J. (2008). "Social Justice and Human Caring." Creative Nursing. 14 (2): 54+.
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