I am a professor at a university School of Nursing but I also continue to work part time as a nurse practitioner in a primary health care centre.\u00a0 It\u2019s important for me to practice for many reasons. I really enjoy the type of work and the pace of the clinic setting.\u00a0 Additionally, I need to maintain competency to keep my NP license, but more than that, students can spot a fraud in a second. The murky \u2018real world\u2019 provides the best examples of the complexity of nursing practice and promotes learning in a way that guidelines and textbooks cannot.<\/p>\n
An issue that I\u2019ve seen often over the years is with cases where patients refuse to follow treatment plans. I\u2019ve seen several different types of responses from health care providers.\u00a0 Some people think that it is sufficient to indicate in the chart that the patient was informed of the issues\/risks etc. and made the choice not to follow the treatment plan. Others have gone as far as to say that the patient should be discharged from the practice for refusing the recommended treatment.<\/p>\n
The underlying issue to me is that of informed consent. The dictionary defines consent as \u201cto permit, approve, or agree; comply or yield\u201d.\u00a0 Nurses are taught that it is important to educate, answer questions and inform in order for patients to fully understand their health issue and the recommendations for care.\u00a0 However, the expectation that goes along with the practice of \u2018informing\u2019 is that the patient will then do what we say and will automatically consent.<\/p>\n
There are clear laws in most jurisdictions about the response of health care providers to specific situations such as child abuse or threatened suicide.\u00a0 Yet, there are multiple more situations where the boundary of accountability of the nurse is blurry.\u00a0 I don\u2019t have answers to this question, but I do believe that at the core is the nurse\/patient therapeutic relationship including mutual respect. \u00a0Each situation is different and requires reflection and communication.<\/p>\n
This is the type of issue that nursing and NP students find most challenging.\u00a0 They are uncomfortable with clinical questions for which there is no easy answer and I tell them that it doesn\u2019t necessarily get easier, even when you are an experienced clinician. In fact, this issue is also one of the reasons that I continue to practice\u2026.to remind me that I need to learn each and every day.<\/p>\n
Roberta Heale<\/p>\n
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I am a professor at a university School of Nursing but I also continue to work part time as a nurse practitioner in a primary health care centre.\u00a0 It\u2019s important for me to practice for many reasons. I really enjoy the type of work and the pace of the clinic setting.\u00a0 Additionally, I need to […]<\/p>\n