Professional nursing boundaries Essay

Nurses known as a cargongiver and provide close family relationship not only mingled with affected role of and the hospital but withal for new(prenominal) healthcare profession such as bushels and assistant medical police officer and also between communities. Their services are very important and therefore they performing heart in the medical and healthcare service provision in Malaysia.Due to the rapidly changing in Malaysia healthcare environment, the guards are required to provide care through their extended roles and provide services rendered by other healthcare overlord in order to complement the health service to the population. Therefore, Malaysian values down become aware for legal and ethical issues that find wedge on their pr doise and recognised the importance of trust that vex legal and ethical principle thus promoting competency and decision making.In Malaysia itself, most of the study population still choose to get treatment from government. It is becau se government hospital provides good quality service in healthcare, provide an advances technologies, provide skilled provide, school equipment beside the cheapest service that they get. In the healthcare service nowadays, professional boundaries are important issues and have been a quite popular topic. Basically, if we search an internet pertaining to professional boundaries we eer often get the result are brinyly about interactions between treasures and patient or node. fit to College of Registered Nurse of British Columbia (no date), urged that within the absorb and client relationship, the client relationship are often vulnerable because the foster has influenced, access to information, and specialized acquaintance and skill. If the nurse does not use her judgement cautiously they tend to misused their power.2(wrds count 263)Like other health care service, nurses layabout cause harm to patient if they do not full necessitate their needs. To provide a safest care to pa tient, nurses must know the concepts of professional boundaries. This boundary also outlined as a professional relationship are sacramental manduction or gave other profession or nurse their work based on cooperation and team work among them. Professional boundaries in breast feeding are defined as limits which protect the space betweenthe professionals power and the clients vulnerability stated by (Nursing & Midwifery Board of Australia, 2010 p1). However, also quoted by Nursing and Midwifery Council (no date, p1) that boundaries in nursing also define as the limits of behaviour which allow a nurse or midwife to have a professional relationship with a person in their care. Within this assignment I intend to explore the problem encountered in both(prenominal) relationship and professional boundaries between the perioperative nurse and the general anaesthesia nurse (GA nurse).This assignments objective are also to gain knowledge and experience between the Ga nurse and perioperativ e nurse. I am a trained staff nurse currently work as a general anaesthetic nurse for virtually 10 years in the tertiary hospital situated in Kota Kinabalu. I have my institutionalise staple fibre in advance diploma of anaesthesia after I finish my 1 year course in anaesthesia field. I noticed that there is a boundary in my oeuvre between the perioperative nurse and the general anaesthesia nurses, the boundaries are mainly traditional boundaries. But even though the work task is different but the main purpose is for patient safety and quality of work.Basically perioperative nurse are working in the operate theatre.Their roles are to assist surgeon in unhomogeneous surgical procedure, and also helping patient comfortable before surgery. Scope of perioperative work also widening by helping patient after and post operatively. This nurse helps the smoothness of the surgical procedure. A scrub nurse and circulating nurse is specially trained nurse who work with surgeon in the in o peration(p) room. most of our scrub nurse and circulating nurse are very experienced, skilful nurses and most of them already had their advance diploma in perioperative nursing. In my workplace I identified a traditional blurred boundaries pertaining to my practice area. The blurred boundaries are identified in some operating room setting between the circulating nurse and general anaesthesia nurse. In my workplace the general anaesthesia nurse will be allocate in each of operating room setting.The general anaesthesia nurse will assists the anaesthesia doctor during the induction of anaesthesia, giving medication, setting intravenous line, anchoring endotracheal tube also to keep patient calm and safe before the induction of anaesthesia. Normally, the GA nursetends to have an advance training in anaesthesia such as certificate in anaesthesia where we will get after 1 year attend post basic in anaesthesia. In Malaysia, we had to have the certificate before we can work in the operatin g theatre as a GA nurse. As quoted by Lukosius et al (2004, p523), to be a good nurse in practice, the organization must have legislation and protected titles for clinical nurse specialist, nurse midwives, and nurse anaesthetist, so they can work according to their shopworn practice.Working in the operating room is about team work among the various types of healthcare such as nurses, assistant medical officer, surgeon, anaesthetic doctor and also hospital attendance. Each of them plays their roles in the operating theatre by providing service direct and indirectly. This team work among the health care services are the strength of all organizations but the boundaries within this working area a still been taking care and are respected. Blurred boundaries that I identified continue in my workplace are due to some problem such as deficit of staff and because of an ineffective inter-professional working. The Ga nurse and the perioperative nurse have tried to worked together and share task based on common practice or skill, but the job description are still run unclear. Both of them are still not understands about their placing parameters.Because of the unclear job description and not understanding the role ambiguity is created and misunderstanding can arise. As quoted by Rushmer et al (2005,p.80) said, when the limits (boundaries) of sharing are ignored, nothing is clear and certainty is lost, the ability of collaboration to prepare realistically for their work together is g whizz where one of the parties ends up doing all the work, or all the unpleasant parts of the work. Miers et al (2009) revealed, that the nurses are key to the success of inter-professional team. The effective of inter-professional also mentioned in the NMC codification of conduct (2008), where the competencies that set by a mentor able to maintained professional boundaries and coordinate learning in an working environment and in an inter-professional working.Because shortage of staff espec ially nurses, some of the general anaesthesianurse are need to cover more than one operating room at the alike time. When GA nurse are needed in the other operating room, the circulating nurse who worked in that particular operating room will had to act as a GA nurse. At the other hand GA nurse also can act as a circulating nurse when the job is compromised. As stated in NMC code of conduct (no date), a nurse had to have advance skilled as well as increase knowledge. Even though the circulating nurse does not have experience and skill as a GA nurse, it is they responsibilities to learn and gain knowledge and skill as a GA nurse. In Malaysia Nursing code of conduct (1998.p2), quoted that nurses are responsibilities and accountability for her owns nursing judgement and action.When delegating work, the nurse anticipate accountable for the work done and appropriate supervision and support and guidance to be given to her. The circulating nurse needs to be supervised and drill by the s enior nurse who had the experienced or qualified as a GA nurse before she act and helped as a GA nurse. Also quotes by Nursing and Midwifery council (no date), nurses must al modalitys be aware of their limits and ability and role boundaries, acknowledge their professional limitation and make accountable for their decision making and ability to work in a safe and effective manner. This is reflected in the following paragraph of the Code of Conduct (2008), which states that the nurse must have the knowledge and skill for safe and effective practice when working without direct supervision, recognise and work within limit, keep knowledge up to date and take part in learning and practice that maintain and develop your performance and competencies.Although the nurses considering working in the berth not related to their job, they have to fulfilled their task even though their do not have required registerable in that possess. For example although a registered nurse may work in operating theatre as a GA nurse or circulating nurse, they must not necessary to have a post basic course and qualified anaesthesia course. The environment also influenced the role of professional boundaries in my workplace. The nurses who work in operating theatre are abiding by nursing policies and regulations. In the operating theatre we also have our standard of practice called standard operating procedure where all thenurses will follow the standard of practice procedure while performing their job.According to Brown (1998), Read (1999), Hamric (2000), Styles & Lewis (2000) cited in Lukosius et al (2004, p522), quotes that environment influence the development boundary in nursing roles, including work environment, policies and procedure, scope of practice, work schedule and work practice can influence the new roles in nursing practice. Creating boundaries is a good way to keep professional relationship among the GA nurse and the perioperative nurse. The professional relationships are bas ed on trust, respect, meeting the need of client and the appropriate use of power. According to National Council of State Boards of Nursing (no date) quotes, that the power of a nurses comes from his/her professional position. According to Retzklf (2012), when nurses show respect to each other, professional task, patient safety and nurse feeling of being part of the team are improved. However study has done by Lowe et al (2013), he suggest that once other staff familiar with the task given and their role, they are more comfortable working with other colleagues.Convesly, when nurse do not acknowledge of each other, competence or disregard their suggestion , unhealthy competitive attitudes can develop, colleagues can began to mistrust each other and the nurses can lose their interest in the nursing profession. Most nurses are aware of of blurring boundaries in professional practice but they still need to touch other professional discipline with permission and with clear steering due to the role uncertainty and role ambiguity. As quotes by Alberta Association of registered nurse (2005, p.3),that a registered nurse in any role can understand that professional boundaries are respected by applying the following guideline to their nursing practice as appropriate for their role. This happen in my workplace where the perioperative nurse and the Ga nurse will work according to our nursing practice standards.Health providers can choose to change or develop new disciplinal boundaries after identified new areas of work according to their interest of work such as an advance practitioners nurse in anaesthesia or as a clinical nurse to gain more knowledge and skill in their own field. According to Chang et al (2011,p3), that the advance practice nurse position is a result of changing healthcareneeds and positive effects from this new roles have been widely document, improve patient out came and increased patient satisfaction. But in Malaysia there are still challenges in d eveloping and implementing of advance practice nurse role. I hope there will be implement in the future. However, according to Witz (1992) cited in Nancarrow et al (2005) revealed his theory working in workforce in four direction diversification, specialization, horizontal substitution and steep substitution allow any healthcare provider to change their disciplinary boundaries and identified a new areas of work.Boundaries are important in successful professional project. It is good to have boundaries among health care workers but it is has to be in the positive way and within limits. Boundaries are also important for staff public assistance , staff can develop wider expertise, gain knowledge of the new role and skills, contribute actively to new development, provide cross over and for effective client service.