Nursing is an applied health discipline that includes theoretical knowledge and skills. It has gone through a complete evolution process until today, having experienced many changes in terms of education and practices, job descriptions, professional functions and roles. The only thing that has not changed in nursing since its existence is the service of providing care to individuals. Within the contemporary health system, nursing continues to exist as a profession that provides health services to individuals, families and society. Among the reasons for the opinion that nursing uses information obtained from other health disciplines and does not have a special competence in its own field are the fact that until recently nursing practices were not based on research results and evidence, nursing education was at various levels and was not standard. In addition, it is under the dominance of medicine, it takes time to develop professional awareness, and the professional knowledge and experience of the majority of nurses are not sufficient at the level of professionalism of the profession. Today, nursing, like other professionals, is a profession acquired through undergraduate and graduate education programs.
In a time when we live in the information age, they are not expected to be perceived as having the least education among the team, to follow what is said without thinking, objecting or criticizing, or to remain in the role of the doctor's right-hand man or angel. If nursing, as traditionally perceived, were a profession consisting solely of the functions of administering the treatment planned by the physician and assisting and supporting the physician, we would have to talk about nursing not as a profession but merely as a job. Nursing is a profession with dependent, semi-dependent and independent roles. Today, the most important element that distinguishes the nursing profession from being a profession and a job is our independent roles.
The transition of nursing from the traditional model to the modern model is due to developments in science and technology, migrations, population growth, increase in the elderly population, patient and consumer rights, health promotion approach, genetic research, increasing awareness of disease protection, human rights movements, women's rights movement, and the increase in the importance given to ethical principles. Various factors affect it, such as changes in nursing education and practices. These developments have led to the definition of nursing roles. Nursing has ceased to be a job aimed at meeting the limited and immediate needs of the patient, and has become a profession that carries out large-scale planning and regulation and benefits from standard care plans in these matters. From a profession based on subordination to other health professionals to an autonomous profession; from a profession practiced only in hospitals to a profession practiced in a variety of settings; from a limited duty to a significant social responsibility; from a profession focused on disease to a profession focused on health; From a profession that adopts a paternalistic approach to a profession that cooperates with its patient and respects the patient's decisions; From a profession that focuses only on the physical care of the patient, to a profession that deals with the patient as a biopsychosocial whole, from a job-centered profession to a patient/individual-centered profession; It has transformed from being a women's profession to a profession without gender discrimination. Nursing roles are divided into three categories: dependent, semi-dependent and independent roles. So what are these categories?
Dependent roles of nurses ; intended to implement physician directives; Their duties include applying therapeutic procedures and assisting in diagnosis and treatment procedures. The characteristic element in dependent roles is that the decision maker and the implementer are separate people. Therefore, he does not share the responsibility for deciding his work; Its responsibility is limited to the technical execution of the work as required. Another important determination to be made in the context of dependent roles is that the dependence, especially today, is not absolute and unconditional; It does not disable the rights of inquiry and objection. In particular, it is not possible to blindly comply with the instructions that are against medical-scientific-rational principles, and if these are followed, the nurse will be responsible for the undesirable consequences.
Although there is still a physician's directive in the semi-dependent role of nurses , the issue of whether this directive should be fulfilled or not is for the nurse to take initiative by taking into account the developments in the patient's condition. In other words, if the nurse can evaluate the patient and modify the directive in line with her knowledge and experience, while applying the treatment planned by the physician or assisting with the diagnostic procedures, she plays a semi-dependent role. For example, in a patient for whom the physician is prescribing digitalis treatment, it is a semi-dependent role for the nurse to check the symptoms of digitalis toxicity before giving each new dose of medication and, if there are any symptoms, to not administer the medication and notify the physician. As seen in the example, semi-dependent roles are a safety mechanism that prevents situations where the physician's directive may lead to undesirable results due to changing conditions.
The independent roles of nurses are aimed at nursing care problems that nurses can solve with their profession-specific knowledge, skills and experience, and are the most important dimension of contemporary nursing. Supporting the healthy individual to develop and maintain his health, supporting the sick individual in daily life activities that he cannot do himself, and providing the necessary assistance to regain his health and independence are the independent roles of the nurse. In the context of independent roles, the nurse first evaluates the data collected about the individual and reaches a "nursing diagnosis", then plans and implements the "nursing practice" that will solve the problem he diagnosed. He personally makes the final evaluation of this care process, in which the individual also participates. Ideally, all of this is laid out in writing in the form of a “nursing care plan”.
As a result of the literature review; A total of 13 roles have been identified, brought together in different ways, in basic books and articles dealing with the principles of nursing and the intellectual dimension of the profession. Six generally accepted nursing roles: care, education, research, management, decision making and patient advocacy. The seven nursing roles that have been adopted to a more limited extent are communication and coordination, rehabilitation and treatment; career development, being autonomous and responsible; counseling and therapeutic roles. Now, let's examine the nursing roles one by one.
- Caregiver Role
It is the oldest role that forms the basis of modern nursing roles and traditional practices before modern nursing. It is possible to say that other roles of modern nursing are derived and developed from this role. On the other hand, among nursing roles, this is the role where independence is most strongly realized. The nurse contributes to the treatment and care process of the patient by helping him or her protect his personality, physical and psychosocial integrity, and better tolerate the negative effects of his problem and the medical process. While performing this role, the nurse works individually/patient-centered and uses her decision-making skills. While the physician adopts an approach that focuses on the problematic part of the organism, the nurse undertakes a mission to ensure the integrity and continuity of the organism and even beyond it, the individual. One of the most important indicators of the effectiveness of nursing care is the absence of preventable secondary diseases and complications.
- Educator Role
One of the basic roles of the nurse is to provide planned education to protect and improve the health of the individual, family and society, to heal in case of illness and to provide correct health behaviors. As an educator, the nurse conveys information to both the patient, the patient's family, and the general public about health, illness, special periods such as child-pregnancy-old age, treatment and changes in lifestyle. Determining whether the patient understands the information given and ensuring that he/she learns it at the highest level possible, evaluating the progress of the patient's condition in relation to health care goals, and choosing the education and methods to be used while fulfilling this independent role are also parts of this role. She is also responsible for the education of prospective colleagues, colleagues and other healthcare professionals. The training he is responsible for can be given informally to individuals or groups in the clinic during the procedure, as well as formally in in-service training programs or a planned training program.
- Researcher Role
The researcher role, which is among the independent roles of the nurse, emerged after gaining academic qualifications, which is the last stage in the evolution of the profession. Conducting research to increase the field-specific scientific knowledge load in nursing, as in all scientific fields; These should be carried out by nurses who have received/are receiving postgraduate education and especially those in academic positions. As a result of research, the increase in scientific knowledge specific to the profession ensures the advancement of nursing and paves the way for more effective and efficient care. Nurses undertake the role of independent researchers within the framework of nursing sub-disciplines and conduct theoretical studies and field research. He also takes part in teams that conduct interdisciplinary research in the clinic, laboratory and field. While nurses work entirely in line with their own decisions in research specific to their field, they also work in collaboration with members of the healthcare team in research carried out together with other health disciplines and in diagnosis-treatment initiatives.
- Manager Role
In the contemporary world, the concept of management has expanded its meaning; It has gone beyond its traditional meaning of directing and managing a small or large number of people towards a concrete purpose. In the context of this new and broader meaning, management not only directs people but also refers to the regulation of the flow of processes, events and relationships. Crisis management, disaster management, project management, hope management, pain management in medicine and patient care management in nursing can be listed as a number of examples of this use. The level of autonomy of management activities in the contexts of care, education and communication is high. In other words, the decisions that determine these administrative processes belong to the nurse. In the operation of the clinic, the nurse is sometimes autonomous and sometimes the transmitter of the rules of the institution or the instructions of the institution and clinic managers.
- Decision Maker Role
Before the nurse personally performs a professional practice on the patient or has it done, he or she must carry out a mental process that shapes the practice. In this process, the patient should take into account his/her medical condition, the expectations and possibilities of both him and his family, and the opinion and approach of the team he is a member of; Must use critical thinking and decision-making skills. The first stage of nursing care delivery is to plan the best care pattern for each patient. In the decision-making role, the nurse does not make decisions on behalf of the patient alone, but primarily involves the individual and, when necessary, his family in the care plan and treatment decision. On the one hand, decision-making is one of the autonomous roles of nursing; On the other hand, it is a sub-element of all other nursing roles. It is possible to evaluate being a decision maker as a sub-element of a role as an indicator of the extent of independence in that role. The decision-making role naturally and inevitably requires bearing responsibility and being accountable for the decision and the professional action taken in line with the decision. In connection with this situation, part of decision-making is to carry out a second thought process after implementing the decision; retrospective situation assessment and self-control.
- Patient Advocate Role
In the advocate role, the nurse performs functions such as informing the patient, helping him make decisions, acting as his spokesperson when necessary, and protecting him from the side effects and complications of diagnosis and treatment procedures. In the patient advocate role, the nurse helps protect the rights of the patient who cannot express himself. The nurse's advocate role is closely related to autonomy, just like the decision-maker role. The basis of the advocacy role is that the nurse, who is responsible for the care and treatment of the patient, is the team member closest to the patient, communicates intensively with the patient, knows the patient's needs and is the most suitable person to protect the patient from injustice.
- Communication and Coordination Provider Role
It is of critical importance that the nurse successfully uses advanced communication skills in the context of basic duties such as understanding the patient, identifying and meeting the needs that the patient cannot meet on his own, and making the patient feel good. The nurse uses nonverbal communication skills as well as verbal communication.
- Rehabilitative Role
Within the scope of its rehabilitative role, the nurse helps the patient individual and his family in situations where there is structural or functional loss due to reasons such as trauma or disease, by ensuring that the individual can use his full potential at the highest level and cope with the changes that occur as a result of the loss. In the context of this role, which aims to maximize the autonomy of the patient by restoring lost functions as much as possible, facilitating daily life activities and providing psychological support, the nurse's degree of independence is high.
- Comfort Provider-Relaxing Role
Within the scope of the comfort provider-reliever role, the nurse's role is to identify and meet the needs of these patients while providing treatment and care, and to support and comfort those patients who cannot meet their needs with their own means. In medical environments, the goal is to promote healing.
- Therapeutic Role
It is the duty of medical doctors to determine, plan and implement medical treatment according to medical diagnosis. Nurses, on the other hand, generally only take responsibility for the implementation of the treatment and carry out medical directives. Nurses are independent in non-drug treatment procedures such as hot and cold applications, massages, breathing exercises, and postural drainage. When it comes to drug treatments and surgical practices, therapeutics are one of the dependent roles of nurses, but it is seen that nurses who have participated in some special certification programs since 1990 act independently in their own fields of expertise. First, in their therapeutic role, there were stoma and wound care-management nurses, who independently fulfilled the role of determining the medical products needed by the patients they were responsible for, writing prescriptions for these products, and providing consultancy and education services to the patient about the products.
- Career Developer Role
Today, nurses learn career development methods in order to provide the best care and treatment to patients and healthy individuals and consciously constantly improve and perfect themselves in professional practices. The formation of this unlimitedly progressive role is related to the increase in educational opportunities for nurses, the professionalization of nursing and the expansion of work fields. This role is integral to nurses' roles as educators, administrators, researchers, consultants, quality developers, and overall ownership of the profession, and is among the independent roles of nurses.
- The Role of Being Autonomous and Responsible
Autonomy is an important concept, a sought-after quality and an ethical value in the modern world, and it comes to the fore in two ways, specifically the autonomy of those who receive health services and those who provide health services. Autonomy for those receiving the service; It is defined as the individual's decision on medical practices that will affect his body and health, in line with his own values, judgments, beliefs and preferences, and the autonomy of those who provide the service emerges as them taking decisions regarding professional practices on their own initiative, within the framework of their determined authorities and responsibilities. Autonomy, which is one of the main criteria for a continuous and income-generating activity to be a profession rather than a job, is directly related to independent nursing roles in the nursing profession.
- Advisor Role
Nursing advises the general public to recognize and use their own opportunities and resources regarding protecting and improving health, increasing the quality of life, and coping with disease-related problems.
In this section, let's briefly consider critical thinking. Critical thinking, one of the basic skills, has become an increasingly important concept in nursing literature today. According to nurse educators and researchers, critical thinking is a method of problem analysis. Professional decision-making process that affects both the individual's quality of life and the quality of nursing care; It requires nurses to think in different ways and to have a certain accumulation of nursing knowledge. Watson and Glaser define critical thinking as a general process that includes stages such as problem solving, questioning and research, and examine it as both a skill and an attitude in five dimensions. These dimensions; It can be summarized as recognizing the problem, collecting and selecting appropriate information for the solution of the problem, recognizing structured and unstructured assumptions, selecting and formulating relevant and conclusive assumptions, drawing valid conclusions, and discussing the validity of inferences.
It seems that Watson and Glaser's definition of critical thinking is parallel to the steps of the nursing process. These can be listed as follows; identification of the problem, solution of the problem and description of the situation with selection of appropriate information (planning), selection and formulation of appropriate hypotheses (nursing diagnosis-implementation), determining the outcome of the decision and deciding on the correctness of the intervention (evaluation).
According to the results of the study conducted in our country, it can be said that the critical thinking tendency level of nurses is lower than in other countries. Nowadays, nurses need to be healthcare professionals who no longer just do what they are told, but rather take responsibility by using their critical thinking and decision-making skills .
- Manager Role
In the contemporary world, the concept of management has expanded its meaning; It has gone beyond its traditional meaning of directing and managing a small or large number of people towards a concrete purpose. In the context of this new and broader meaning, management not only directs people but also refers to the regulation of the flow of processes, events and relationships. Crisis management, disaster management, project management, hope management, pain management in medicine and patient care management in nursing can be listed as a number of examples of this use. The level of autonomy of management activities in the contexts of care, education and communication is high. In other words, the decisions that determine these administrative processes belong to the nurse. In the operation of the clinic, the nurse is sometimes autonomous and sometimes the transmitter of the rules of the institution or the instructions of the institution and clinic managers.
- Decision Maker Role
Before the nurse personally performs a professional practice on the patient or has it done, he or she must carry out a mental process that shapes the practice. In this process, the patient should take into account his/her medical condition, the expectations and possibilities of both him and his family, and the opinion and approach of the team he is a member of; Must use critical thinking and decision-making skills. The first stage of nursing care delivery is to plan the best care pattern for each patient. In the decision-making role, the nurse does not make decisions on behalf of the patient alone, but primarily involves the individual and, when necessary, his family in the care plan and treatment decision. On the one hand, decision-making is one of the autonomous roles of nursing; On the other hand, it is a sub-element of all other nursing roles. It is possible to evaluate being a decision maker as a sub-element of a role as an indicator of the extent of independence in that role. The decision-making role naturally and inevitably requires bearing responsibility and being accountable for the decision and the professional action taken in line with the decision. In connection with this situation, part of decision-making is to carry out a second thought process after implementing the decision; retrospective situation assessment and self-control.
- Patient Advocate Role
In the advocate role, the nurse performs functions such as informing the patient, helping him make decisions, acting as his spokesperson when necessary, and protecting him from the side effects and complications of diagnosis and treatment procedures. In the patient advocate role, the nurse helps protect the rights of the patient who cannot express himself. The nurse's advocate role is closely related to autonomy, just like the decision-maker role. The basis of the advocacy role is that the nurse, who is responsible for the care and treatment of the patient, is the team member closest to the patient, communicates intensively with the patient, knows the patient's needs and is the most suitable person to protect the patient from injustice.
- Communication and Coordination Provider Role
It is of critical importance that the nurse successfully uses advanced communication skills in the context of basic duties such as understanding the patient, identifying and meeting the needs that the patient cannot meet on his own, and making the patient feel good. The nurse uses nonverbal communication skills as well as verbal communication.
- Rehabilitative Role
Within the scope of its rehabilitative role, the nurse helps the patient individual and his family in situations where there is structural or functional loss due to reasons such as trauma or disease, by ensuring that the individual can use his full potential at the highest level and cope with the changes that occur as a result of the loss. In the context of this role, which aims to maximize the autonomy of the patient by restoring lost functions as much as possible, facilitating daily life activities and providing psychological support, the nurse's degree of independence is high.
- Comfort Provider-Relaxing Role
Within the scope of the comfort provider-reliever role, the nurse's role is to identify and meet the needs of these patients while providing treatment and care, and to support and comfort those patients who cannot meet their needs with their own means. In medical environments, the goal is to promote healing.
- Therapeutic Role
It is the duty of medical doctors to determine, plan and implement medical treatment according to medical diagnosis. Nurses, on the other hand, generally only take responsibility for the implementation of the treatment and carry out medical directives. Nurses are independent in non-drug treatment procedures such as hot and cold applications, massages, breathing exercises, and postural drainage. When it comes to drug treatments and surgical practices, therapeutics are one of the dependent roles of nurses, but it is seen that nurses who have participated in some special certification programs since 1990 act independently in their own fields of expertise. First, in their therapeutic role, there were stoma and wound care-management nurses, who independently fulfilled the role of determining the medical products needed by the patients they were responsible for, writing prescriptions for these products, and providing consultancy and education services to the patient about the products.
- Career Developer Role
Today, nurses learn career development methods in order to provide the best care and treatment to patients and healthy individuals and consciously constantly improve and perfect themselves in professional practices. The formation of this unlimitedly progressive role is related to the increase in educational opportunities for nurses, the professionalization of nursing and the expansion of work fields. This role is integral to nurses' roles as educators, administrators, researchers, consultants, quality developers, and overall ownership of the profession, and is among the independent roles of nurses.
- The Role of Being Autonomous and Responsible
Autonomy is an important concept, a sought-after quality and an ethical value in the modern world, and it comes to the fore in two ways, specifically the autonomy of those who receive health services and those who provide health services. Autonomy for those receiving the service; It is defined as the individual's decision on medical practices that will affect his body and health, in line with his own values, judgments, beliefs and preferences, and the autonomy of those who provide the service emerges as them taking decisions regarding professional practices on their own initiative, within the framework of their determined authorities and responsibilities. Autonomy, which is one of the main criteria for a continuous and income-generating activity to be a profession rather than a job, is directly related to independent nursing roles in the nursing profession.
- Advisor Role
Nursing advises the general public to recognize and use their own opportunities and resources regarding protecting and improving health, increasing the quality of life, and coping with disease-related problems.
In this section, let's briefly consider critical thinking. Critical thinking, one of the basic skills, has become an increasingly important concept in nursing literature today. According to nurse educators and researchers, critical thinking is a method of problem analysis. Professional decision-making process that affects both the individual's quality of life and the quality of nursing care; It requires nurses to think in different ways and to have a certain accumulation of nursing knowledge. Watson and Glaser define critical thinking as a general process that includes stages such as problem solving, questioning and research, and examine it as both a skill and an attitude in five dimensions. These dimensions; It can be summarized as recognizing the problem, collecting and selecting appropriate information for the solution of the problem, recognizing structured and unstructured assumptions, selecting and formulating relevant and conclusive assumptions, drawing valid conclusions, and discussing the validity of inferences.
It seems that Watson and Glaser's definition of critical thinking is parallel to the steps of the nursing process. These can be listed as follows; identification of the problem, solution of the problem and description of the situation with selection of appropriate information (planning), selection and formulation of appropriate hypotheses (nursing diagnosis-implementation), determining the outcome of the decision and deciding on the correctness of the intervention (evaluation).
According to the results of the study conducted in our country, it can be said that the critical thinking tendency level of nurses is lower than in other countries. Nowadays, nurses need to be healthcare professionals who no longer just do what they are told, but rather take responsibility by using their critical thinking and decision-making skills .
0 Comments