What Is Professional Competency In Nursing Practice Nursing Essay

What Is Professional Competency In Nursing Practice Nursing Essay Introduction Why is professional competence a fundamental requirement in nursing practice? In satisfying this query, one must reflect on ones functions as a nurse. From this, one can realise the undeniable fact that nurses play a crucial role in the delivery of health care services. The very lives of people are at stake and so one must practice competently. Professional competence is a must in nursing practice. In line with this thought, this essay will explore ones practice of nursing in relation to the Australian Nursing Midwifery Council (ANMC) and the Australian Nursing Federation (ANF) competency standards. This essay will also explore what competence is all about and what it means to be a professionally competent nurse. Main Body The ANMC (2006, p.14) defines competence as the combination of skills, knowledge, attitudes, values and abilities that underpin effective and/or superior performance in a profession or occupational area. Competency in nursing is very well acknowledged and sought by all health care institutions. There is always an inherent desire on the part of health care institutions to determine and improve the competence level of their nurses. In fact, Zuzelo (2009) relate that numerous healthcare institutions are investing time and money into systems that can assess competency of nursing professionals. In highly industrialised nations, competency of nursing professionals is sought after and achieved through competency based approach training (Cowan, Norman Coopamah, 2005). The idea of competence seems to have skills at its core, in particular clinical skills, that is ones essential to best practice (Roberts, 2009). However, skills without knowledge is dangerous, according to Roberts (2009). A pr ofessionally competent nurse does not neglect the important aspect of nursing as a caring profession. Being competent does not only imply that one is very knowledgeable and skilled. It also connotes ones genuine care to patients. It is worthy to declare that caring and competency are not exclusive concepts but are naturally intertwined (Masters, 2005). To be professionally competent is to be properly qualified, capable, adequate for the purpose, and sufficient. As professional nurses, we are competent to practice nursing by virtue of our education and licensure as registered nurses. To be competent however, we must meet additional criteria. The ANMC (2006) competency standards for the registered nurse comprises of 4 domains, namely professional practice, critical thinking and analysis, provision and coordination of care and collaborative and therapeutic practice. From among the sub-classifications of the first domain, what can be considered as most striking in relation to ones practice include the need to practice in accordance with legislation affecting nursing practice and health care as well as the need to practice within a professional and ethical nursing framework (ANMC, 2006). These two sub-classifications are worthy to note because of the fact that moral and legal conflicts often complicate decision making in nursing practice. Nurses are typically confronted with conflicting scenarios which are often both important things to consider. The only dilemma is which of the two must be the top priority. For instance, taking care of a patient who refuses any form of treatment poses a legal dilemma on the part of the nurs e. This is especially true because the ANMC (2006) competency standards direct nurses to recognise and accept the rights of others. On one side, there is the professional desire of the nurse to help the patient by initiating treatment. On the other hand, legal ethics dictate that patients have the right to refuse treatment. In ones personal experience, taking care of a patient whose religion does not allow blood transfusion is a real dilemma. In this particular scenario, the nurse was torn between educating the patient to eventually accept treatment or simply respect the refusal of treatment and just relate to the patient the possible consequences of such refusal. It was clear in the nurses mind that the ANMC (2006) dictates one to accept individuals or groups regardless of race, culture, religion, age, gender, sexual preference, physical or mental state. Furthermore, there is the need to practise in a manner that acknowledges the dignity, culture, values, beliefs and rights of indi viduals or groups (ANMC, 2006). Unfortunately, this is easier said than done especially when one of the above mentioned factors goes against or impedes a crucial treatment that may actually save a patients life. It is true that religious faith is often invoked by patients when their health and wellbeing is threatened. According to Andrews and Boyle (2008) religion is especially crucial to patients during periods of health crisis. Although, adhering to a particular religion is mostly viewed as a positive concept for patients; unfortunately, such adherence does not always result into a positive outcome. It can hinder the patients acceptance to treatment and care. This points out to another important aspect of competence and that is, a deeper understanding of cultural diversity. In line with this, Cherry Jacob (2005) state that health professionals which naturally include nurses, need to respond to the consequences of an increasing cultural diversity of nursing clientele in order to s afeguard the welfare of all health care consumers. Different values and beliefs are adhered to by patients. Community, social and kinship ties, language, religion, food and cultural perceptions of health and wellness are all matters of importance that need to be understood by the nurse when working with culturally diverse patients (Daniels, 2004). Cultural diversity challenges nurses to triumph over cultural gaps with patients by providing culturally appropriate care (Daniels, 2004). Cultural competence is the process whereby a nurse provides care that is suitable to the clients cultural context (Daniels, 2004). In essence, cultural competence is important in the practice of nursing. A nurse is only truly competent if he or she can knowingly handle patients whose entire value system is different from his or her own but still manages to establish and maintain a therapeutic relationship that paves way for effective implementation of nursing actions. Another important issue within the sphere of the first domain of professional practice implies the need to question and/or clarify orders and decisions that are unclear, not understood or questionable (ANMC, 2006). Moreover, there is the necessity to question and/or clarify interventions that appear inappropriate with relevant members of the health care team (ANMC, 2006). In following this directive, a nurse may often hesitate to question the validity of a particular intervention whether it was given by a fellow nurse or by some other health care professional such as a doctor. In ones own practice, hesitation comes from the desire not to create a conflict and bad blood with colleagues and fellow members of the health care team. Unfortunately, in abiding the directive of questioning particular actions of another when deemed inappropriate will more often than not cause some form of disagreement or clash between the professionals. Inter-professional conflicts have been documented since the time of Florence Nightingale (Kalisch Kalisch, 1977 cited in Coombs, 2004). In ones personal experience, the common escape route for this possible conflict is to question an order by way of politely suggesting an alternative which in reality is not an alternative but a recommendation to abolish the questioned order. For example, in questioning a doctors order, the nurse would typically suggest to the doctor the need for the latter to also consider some other assessed patient data with the hope that the doctor will realise that he or she made a mistake instead of directly asking the doctor why he or she prescribed such seemingly inappropriate order. It is an extremely rare scenario where a nurse openly recommends to the doctor to change what the latter has ordered. The subservience of nurses over doctors is a scenario that is very common especially in areas where doctors and nurses are in constant interaction with each other which if pondered upon occurs in almost all areas of a health institution. This particular doctor-nurse type of interaction is referred to as a doctor-nurse game (Stein, 1967 cited in Stein-Parbury, 2008). The doctor-nurse game described over 30 years ago persists in the communication patterns of some doctors and nurses ( Knox Simpson, 2004). In line with this issue, a truly competent nurse knows how to play the game well. He or she is able to question other professionals actions if necessary without causing unhealthy disagreements among them. Effective team behavior operates when health care providers communicate openly and courteously with each other ( Wolf, 2006). The second domain focuses on the implications of researching for evidence based practice (ANMC, 2006). This domain also points out the obligation to participate in ongoing professional development of self and others (ANMC, 2006). In ones own practice of nursing, continuing professional education has always been ones primary goals. It is a way of empowering oneself to be able to keep up with the trends in the practice of nursing. Attending formal and informal lectures and orientations makes one feel more competent. In essence, competence entails seeking out continuing professional education in order to build up a well founded source of knowledge and skills that will be necessary in coping with the dynamic changes in healthcare. Continuing education is intended to ensure health care practitioners knowledge is current (Griscti, 2006). In the advent of modern technology and skyrocketing increase for the demand of high quality care, nurses must be keen in upgrading or at least maintaining the current accepted level of competency required upon them. The high competency required upon nurses is only natural considering the fact that nurses are at the forefront of health care delivery. Nurses who stay abreast of new information and apply evidence-based theory to their practice will be able to provide competent, quality care to their patients (Valloze, 2009). This is the reason why competence is such a crucial issue in the practice of nursing. The salient component of the third domain relates the significance of the nursing process which naturally includes conducting a comprehensive and systematic assessment, planning and implementing safe and effective evidence based nursing care, and then evaluating the expected outcomes (ANMC, 2006). To simply describe it, the nursing process is a problem-solving technique (Carpenito-Moyet, 2007). It is a step by step strategy utilised by a nurse in solving patient problems that come within the scope of nursing practice. In ones own practice of nursing, the tricky part of nursing process is the nursing assessment. Nursing assessment may be defined as the systematic and continuous collection and analysis of information about patients (Rosdahl Kowalski, 2007). It is difficult to confidently say that one has thoroughly assessed a patient. It is because one needs to consider a wide array of factors. There is also the burden to ensure that ones assessment is comprehensive in as much as it b ecomes the basis of nursing and medical interventions. In connection to this, competency in nursing comes when one is able to collect and distinguish which patient information is important and which can be discarded. The care of patients is dependent upon the competency of the nurse is assessing those signs and symptoms that are related to the patients medical condition. For the fourth domain, what is most relevant to ones practice are the need to establish and maintain therapeutic relationship with patients and the necessity to collaborate with other health care professionals in providing comprehensive nursing care (ANMC, 2006). As a nurse, building and sustaining a therapeutic relationship with patients is important. It is the initial step in obtaining patients trust and confidence. Dossey Keegan (2009) declare that it is an important part of nursing care. In an effective therapeutic relationship, patients feel the genuine support of nurses while the nurses feel a certain degree of satisfaction in his or her role (Dossey Keegan, 2009). Initiating a therapeutic relationship with patients is in compliance the ANMC (2006) requirement of undertaking assessments which are sensitive to the needs of individuals or groups. Competency standards in this domain includes that a nurse has the ability to address the physiological, psychological, physical, emot ional and spiritual needs of patients and significant others as well as to optimize the physical and non-physical environment ( Dunn, Lawson Robertson, 2000). A competent nurse always begins his or her interventions by establishing a therapeutic relationship with patients that will increase efficacy of succeeding interventions. The ANF competency standards consist of 3 domains namely conceptualises practice, adapts practice and leads practice (ANF, 2005). As an experienced practitioner, one can meet these competency standards by reflecting on ones own experiences and placing these experiences in correct perspective for future reference. One can learn how to better provide nursing care for a particular scenario by reflecting on previous experiences that are similar to the one currently confronted with. What is required in order to meet the competency standards contained within the first domain is self-reflection. Self-reflection activities are an essential component of expert nursing practice (Dossey Keegan, 2009). This self-reflection; however, must be coupled with formal continuing development or education plus implementation of researches of relevant issues in nursing practice. This is because of the fact that this domain requires use the best available evidence and health and/or nursing models (ANF, 200 5). Research in nursing will help in identifying evidence-based nursing practice (Polit Beck, 2004). For the second domain, one can satisfy the competency standards contained within by being dynamic in finding out possible reliable sources that will support a particular method of rendering nursing care. This is because the second domain directs nurses to draw on a wide repertoire of knowledge and processes to tailor nursing practice in complex and challenging clinical situations (ANF, 2005). Furthermore, as an experienced practitioner, one needs to further upgrade ones technical skills in handling subordinates if any and in abiding by institution policies more strictly. One must also develop how to predict possible scenarios which may result from interventions implemented. The third domain of the ANF competency standards relates the concept of promoting and improving nursing practice through leadership. Definitely, as an experienced practitioner there have been many instances when one has asserted oneself as the leader of the group in order to smoothly direct patient care. For an experienced practitioner to successfully meet the third domain, one must hone ones leadership skills. Honing ones leadership skills does not necessarily mean that one should always act as the team leader. In becoming a leader one must also experience being a member and under the authority of another professionals leadership. The leadership often invoked in this domain is one that solicits active participation of the members. This implies a collaborative leader. Milstead Furlong (2006) state that a collaborative leader is what is most sought in todays health care system. Conclusion To sum up, true professional nursing competence requires accumulation of evidence based knowledge and skills. It also entails understanding cultural diversity and how it affects the kind of care that must be provided. Competence is also equated with genuine care. The ANMC competency standards are crucial in directing the way nurses must think and act. In the same light, the ANF competency standards help experienced nurses to become even better. These competency standards may be idealistic but it is certainly realistic and attainable if only nurses give more of their time reflecting on their own practice and in trying to assimilate through actions these competency standards.

Impact of Trade Liberalization of Bangladesh Essay

Introduction: There exists a wide range of theoretical and empirical literature on the relationship between foreign trade and economic growth in both developed and developing countries. The early literature focused mostly on the role of export in economic growth. The spectacular success of the outward oriented policies in the East Asian countries provided a basis for the adoption of such polices in developing countries like Bangladesh. Accordingly, the literature tried to support or reject the logic of universal application of export led growth policy in developing countries. The dynamic linkages between export and import or import and income did not receive much attention in this literature. But experience shows that in many countries export is highly dependent on import of capital goods and intermediate inputs as well as raw materials giving a case of bivariate causality between trade (export-import) and economic growth. The relationship between foreign trade and economic growth has long been discussed by different school of thought. The theoretical standpoints can be summarized in terms of technological know how, market expansion, resource allocation, ease of balance of payments, employment generation and income creation. (Hossain & Salim 2009). Karl Marx focuses on the role of exchange in economic growth. In his opinion, the expansion of production needs a growing market which will promote production continuously (Chen 2009). The classical school treats the foreign trade as a means of optimal distribution of resources and increasing productivity that stimulate economic growth. In similar vein is Alfred Marshall and his other neoclassical followers and they dictum that trade enhances growth because of the benefits of comparative advantage, full capacity utilization, greater economies of scale and increasing rate of investment and technological change (Krueger, 1978; Kavoussi, 1984). This school identifies five different ways in which foreign trade affects macroeconomics performance of a country: the revenue effect, capital accumulation effect, substitution effect, income distribution effect and the effect of the weighted elements. All these effects together imply that trade strengthens economic growth over time as an economy develops (Chen, 2009). The structuralist school led by Sir William Arthur Lewis (1915-1991) holds that in the dual economy model if the modern industrial sector produces export goods and the traditional agricultural sector produces import substitutes, then foreign trade would expand the market and lead to increase in production. The new growth theories which consider increasing returns to capital put more focus on trade as an argument of growth. According to these theories, international trade leads to technological diffusion that affects the medium and long term output growth of the developing countries by improving productivity. The new trade school (led by Paul Krugman) emphasizes the role of trade in economic growth through economies of scale and improving the optimal allocation of resources. It is claimed that international trade enables countries to specialize in goods and services by stimulating competition and promoting technological change based on â€Å"comparative and competitive advantage†. As a result, consumers would be able to consume more products of better quality at cheaper prices and therefore human welfare would be increased (Gupta at al. , 1997, World Bank, 2002). Economic growth is mainly depend on physical and human capital, technological progress, high rate of savings, macroeconomic stability, capital mobility, trade liberalization and so on. Trade plays important role on economic growth. There is a growing volume of empirical literature on the relationship between foreign trade and economic growth. In the 1970s and 1980s a number of studies examined the relationship between export and growth. Many such studies (see for example, Balassa, 1978; Feder, 1983; Heller & Porter, 1978; Kavoussi, 1984; Michaely, 1977; Ram, 1985; Tyler, 1981) supported the view that export growth promoted overall economic growth. Thus, there is a general question arises in mind: What are the impacts trade liberalization (from inwardness to the outward orientation) on economic growth? What are the dynamics and causality among export, imports and income? Bangladesh is striving hard to boost up its exports in order to meet the import payments, foreign debts, internal expenditure, maximize domestic welfare and also to reduce the country’s dependence on foreign aid grants. Therefore, since independence Bangladesh has experienced different policy regimes to enhance its foreign exchange earnings and rapid economic growth. Bangladesh has pursued a proactive policy of trade liberalization, characterized by removal of Quantitative Restrictions (QR), rationalization of tariff rates, a flexible exchange rate policy and active incentive structure for promoting the export sector and enhancing export sector performance. The objective of this paper is to examine the trade policy (from Inwardness to Openness), structural changes and performance of foreign trade and also examine the causality among export, imports and growth in Bangladesh. After analyzing these issues, some policy suggestions have been put forward to boost up the foreign trade sector so as to enhance foreign exchange earnings. 2. An Overview of Foreign Trade Polices of Bangladesh: From Inwardness to Openness/Trade Liberalization: In the current era of globalization, trade liberalization emerges as one of the most effective policy concerns for governments all over the world, especially for developing countries. Trade liberalization is believed to enhance economic growth and development through specialization and technological advances. In the post-war period, in line with the mainstream thinking, many developing countries adopted in inward-looking strategy of development. This strategy, particularly when it went beyond the easy first stage, led to distorted incentive and misallocation of resources. It favored import-substitution (advocates replacing imports with domestic production) at the cost of export. It also involved undue governmental intervention in the working of the market. Because of the widespread â€Å"government failure† to ensure adequate growth, and because of the successful example of export-led growth in South-East Asia, pendulum began to shift to trade liberalization and greater openness since the late 1970s and early 1980s. According to the World Development Report 1987, an outward-oriented strategy is defined as one in which the incentive structure is neutral between import-substitution and export production. Thus, an export-led growth strategy does not require a favored treatment for exports in the form of subsidies or other incentives; only a eutral policy regime which does not discriminate between domestic and export production. In a nutshell, the main requirements of this strategy would be moderate tariffs (preferable a uniform rate of tariff), dismantling of quantitative restrictions such as import licensing or quotas, a market-oriented exchange rate regime (as overvalued exchange rate would discriminate against exports and favor imports) and market-friendly laws and rules rather than discretionary controls. After independence in 1971, Bangladesh like her neighbors in South Asia pursued an inward-looking import-substitution strategy of growth. This was mainly characterized by the nationalization of all heavy industries and financial institutions. Import substitution policy (a trade and economic policy that advocates replacing imports with domestic production. It is based on the premise that a country should attempt to reduce its foreign dependency through the local production of industrialized products) was the basic premise of such state intruded and controlled development strategy where the role of the private sector was shriveled. The result of such a strategy was so painful that Bangladesh faced balance of payments (BOP) disequilibrium, foreign exchange shortage, and relatively low growth rate of national income and micro inefficiencies like inefficient import competing enterprises producing low quality products. Furthermore, the debt crisis in the early 1980 provided an important argument for trade reform. Consequently, since 1982 on being advised by the developed countries, along with the General Agreement on Tariffs and Trade (GATT), International Monetary Fund (IMF) and World Bank (WB), Bangladesh has started to shift its trade strategy to a strong outward looking one as part of market oriented economic reforms (structural adjustment packages) particularly after the year of 1985.

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Developing A Self Care Plan - 888 Words

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