Nursing Student Guide to Long-Term Care Management

Introduction

In order to make an optimal contribution to a medical institution and to their own career, a nurse must possess a refined set of skills in the areas of leading, coaching, and motivating a team of professionals and specialists. The student nurse program is designed to develop the skills crucial to implementing safe, high-quality patient care and to address the particular challenges of long-term health care. This paper discusses approaches for managing patient care in a long-term health care setting, including delegation of responsibilities, patient care planning, and multidisciplinary teamwork, from the perspective of a student nurse.

Patient Group and Outcomes Rationale

The provision of long-term health care falls under the aegis of adult nursing in the NMC Code, which addresses the health care needs of people from 18 years of age through to elderly people ("NMC Code," 2004). The focus of long-term health care is generally people with chronic health issues or elderly people who exhibit varying levels of dependency ("NMC Code," 2004). As in adult education, adult nursing begins with the understanding that adults do best when they can maintain autonomous and self-directed lives ("NMC Code," 2004). This dynamic does not fall away when adults require nursing care ("NMC Code," 2004).

In fact, a newly experienced level of dependency may make it more important to maintain self-direction in the therapeutic relationship, and may contribute to better patient outcomes in the long run ("NMC Code," 2004). Adult nursing is patient-centred and emphasises the unique attributes of people from diverse communities and backgrounds ("NMC Code," 2004). A student nurse preparing for management in long-term health care will work with an eye toward being as inclusive as possible, engaging patients and clients in the ongoing decision-making that forms the basis of their care ("NMC Code," 2004).

The challenges facing student nurses preparing to work in long-term health care are two-fold: support of patients as care pathways are collaboratively developed and implemented, and collaboration with others in a multidisciplinary approach that addresses all aspects of patient care ("NMC Code," 2004). The student nurse will need to "maximise opportunities for patient recovery, rehabilitation, adaptation to ongoing disease and disability, health education and health promotion" ("NMC Code," 2012). In order to achieve these goals, a student nurse will need to practise self-direction and lifelong learning throughout her career ("NMC Code," 2004).

Role Complexity and Improving Patient Outcomes

Regardless of the area of nursing that may be a focus of study, a student nurse is bound by the NMC Code of Professional Conduct, which outlines the standards for conduct, for the performance of duties, and for the ethics that guide all aspects of nursing ("NMC Code," 2004). The following discussion establishes the nexus between the student nurse as she prepares for management and the NMC Code of Professional Conduct ("NMC Code," 2004). To that end, the Code is paraphrased here for clarity and brevity where it is referenced.

An area that requires early attention is awareness of how to manage oneself, the expression of one's nursing practice, and the practice of others according to designated responsibilities ("NMC Code," 2004). The primacy of patient and client interests and well-being must always be top of mind, and appropriate confidentiality must be practised at all times ("NMC Code," 2004; Shaneyfelt et al., 1999). There will always be differences in beliefs and cultural practices in any health care setting, both among staff and among patients ("NMC Code," 2004). The student nurse must exercise care in her practice to be fair and to consciously refrain from discriminatory behaviour ("NMC Code," 2004). The theories of Madeleine Leininger are helpful in this regard, and the student nurse would do well to become familiar with Leininger's Sunrise Enabler as a support to thinking through the cultural, ethnic, and socioeconomic factors that contribute to patient need and responsive health care (Leininger, 1997; Leininger, 1998; "NMC Code," 2004; Suh, 2004).

One of the most crucial areas of nursing practice for the student nurse to master is the therapeutic relationship ("NMC Code," 2004). The refinement of appropriate communication and interpersonal skills occurs over time, but it is undoubtedly enhanced by a conscious effort on the part of the student nurse to ensure that communication supports the well-being of patients ("NMC Code," 2004). Along the same lines, the ability to create and utilise opportunities to promote the health and well-being of patients and clients includes an understanding of how to use the self as a tool for achieving those outcomes (Eccles & Wigfield, 2002; Fusco, 2012; "NMC Code," 2004).

A student nurse must comprehend how to conduct a comprehensive, systematic, and accurate nursing assessment of the patient, client, or community that includes consideration of their physical, social, psychological, and spiritual needs ("NMC Code," 2004). The student nurse will need to give consideration to the different facets of patients' and clients' lives — the cultural, social, spiritual, legal, political, and economic influences — that can be powerful forces in the provision of long-term health care ("NMC Code," 2004). It is from this base that the student nurse is able to develop and document the nursing care plan ("NMC Code," 2004).

The student nurse should remain ever mindful that the development of the care plan should be, as much as possible, a collaborative undertaking assisted by the patients and clients themselves, those who care for the patients and clients, and family members and friends ("NMC Code," 2004). Naturally, the student nurse will at all times consider the importance of informed consent ("NMC Code," 2004).

The fundamental importance of safe nursing practice requires the student nurse to secure knowledge and skills and to demonstrate appropriate utilisation of evidence-based practice (Burgers et al., 2003; Davis & Taylor-Vaisey, 1997; "NMC Code," 2004). It is essential that the student nurse systematically link the provision of nursing care to the documentation and evaluation of nursing outcomes and any interventions provided to the patient or client ("NMC Code," 2004; Wollersheim et al., 2005). Such documentation and evaluation will be substantially impacted by the student nurse's ability to demonstrate sound clinical judgment in all care delivery and professional contexts ("NMC Code," 2004). A component of this evaluation process is the implementation of a quality assurance and risk management plan that ensures public protection and a safe environment of nursing care ("NMC Code," 2004).

The student nurse will be aware of the collaborative nature of nursing care, which demands concerted and continual efforts to ensure that these relationships are conducted respectfully and that the contributions of all members of the health care team and the social care team are recognised and well utilised ("NMC Code," 2004; "Long-term Care," n.d.; "Social Care Model," 2005). As a person who is often on the receiving end of delegation, the student nurse will appreciate the importance of this duty and the critical need to ensure appropriate monitoring and supervision ("NMC Code," 2004). Within the practice of delegation lies the opportunity for the student nurse to demonstrate key nursing skills ("NMC Code," 2004).

In any fast-moving field tied to technological and pharmacological advances, the importance of continuing professional development is readily apparent ("NMC Code," 2004). Enabling these opportunities for herself and those she supervises will be an important way for the student nurse to enhance the knowledge, skills, attitudes, and values necessary to effective and safe nursing practice ("NMC Code," 2004). As the student nurse progresses in her profession, she will identify many opportunities to facilitate and promote professional development and ensure safe nursing care practice through her leadership, instruction and teaching, support of peers, and supervision ("NMC Code," 2004).

A student nurse has the responsibility of fulfilling her daily duties and, in addition, must lead the change efforts that will ensure a solid future for healthcare. Effective long-term health care is best supported by quality improvement systems and the careful, rational stewardship of scarce resources ("Long-term care," 2011). The establishment of a productive and balanced work environment is a manager's obligation — one that extends beyond the employees under her supervision to the patients and their families. Outside of the physician, a nurse has the most direct influence on the perspectives of the patient and the patient's family members during their healthcare experience. Furthermore, the nurse's impact on the professional culture at the medical facility where she practises will be long-term and widely felt, as it continues to influence the ability to recruit and retain excellent, experienced nurses. The portfolio of nurse management responsibilities includes working with other health care professionals, multidisciplinary teams, delegation, supervision, record keeping, report writing, time management, medication management, communication, and prioritising all of these.

Conclusion

This paper has focused on the ways and means for achieving the following principle from the NMC Code: work with others to protect and promote the health and well-being of those in your care, their families and carers, and the wider community. The hub of effective nursing care in the long-term health care environment consists of the following efforts: ensuring that information is shared with colleagues, working effectively as part of a team, delegating effectively, and managing risk.

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