The community wellness model relies on an evidence based decision making strategy. Critical care nurses are aware that their decisions have important implications on patient treatment outcomes. Recent developments are seeing nurses increasingly being placed in situations where they are active decision makers rather than passive decision makers. Additionally, nursing standards task nurses with the important task of breaking down barriers between the nursing and medical profession. Therefore, nurses have the responsibility of accessing, evaluating, and incorporating current research evidence into their clinical decision making and professional judgement.
Evidence based decision making revolves around combining research evidence with the knowledge gained from the nurses experience and patient preferences within the given ICU context and resources. Nurses and other professionals utilizing this strategy make their choices based on all the available information. The decision may also include a wait and see strategy if the evidence and context support it. However, while it encourages the use of recent evidence, the evidence based decision making strategy empowers nurses to give appropriate weight to the various factors involved rather than taking evidence at face value or adhering to it uncritically. The process of integrating research evidence into a clinical decision making situation requires searching for the appropriate evidence in recognition of an information need, critically evaluating the acquired evidence and then adding the evidence into a strategy for action.
However, this strategy has some limitations in that information needs are unobservable and the information need is only a construct existing in the mind of the individual in need. Other people can only hypothesize on the needs of a patient based on what they say and the observable characteristics of the patient. What is important in the case of critical care nurses is how one goes about handling a perceived information need. An evidence-based strategy requires that all decisions have evidence from research or past cases supporting the decisions. The application of this strategy serves to reduce clinical uncertainty as nurses and other medical practitioners can have a reasonable degree of certainty that a certain course of action will lead to the desired outcomes.
Vision for Health Action
Health and Community Well Being
The selected health action aims to maximize the community health and well-being by empowering people to make better decisions based on the available resources and evidence.
Equity in the provision of health care
It also aims to increase equity in the provision of health care as disadvantaged groups are often ignored in health care owing to the prevalence of the traditional hierarchical model of decision making.
Values, benefits, and advantages accruing from this approach
A community capacity development approach is concerned with the larger community as a focus and mechanism for change rather than the community remaining as a setting for health practice. it also differs from traditions models of community involvement in pre-determined health initiatives. Some of the values developed by this approach include the identification of needs, priorities, and an agenda for change which is led by those experiencing a disadvantage and agree with others on the change strategy. It is also characterized by a community wide focus as compared to a focus at the individual level employed by many traditional strategies of community health development.
Another benefit coming from this approach is developing an empowerment approach to change where leaders involve all the stakeholders in the process of strategy development and increasing the participants ability to influence individuals, group, or community circumstances. Traditionally, the medical profession has been strictly hierarchical where nurses and doctors opinions are weighted based on their academic qualifications, job experience, and position in the leadership hierarchy in an organization. However, community development is expected to empower the disadvantaged parties, in this case, critical care nurses, in communicating their needs and capacities to the doctors and also encouraging them to give timely and accurate information to patients which would enable them to make better decisions regarding their treatment options.
Additionally, nurses and other medical professionals will have increased integrity which involves earning the respect and trust of those that they server by being accountable in maintaining high professionalism standards. Community development encourages participants to become responsible and accountable for their actions. In this way, it facilitates clear division of labor allowing increased focus on the provision of health services. One of the factors cited as causing job dissatisfaction and decreased quality of care is lack of clear guidelines on the expected roles of nurses in the ICU which may cause overload and eventually result in increased health issues. Increased responsibility and accountability makes an individual and the medical procedures more trustworthy since one professional can be confident in another professionals skills in a particular specialty thus allowing for the provision of well-rounded care.
A community led approach also develops the value of teamwork where the health professionals collaborate with each other and with their patients to provide optimal health care. Teamwork is important as todays health care environment has evolved to require the involvement of several specialists in achieving the targeted outcomes. Additionally, teamwork and collaboration with the patient and their families or authorized surrogates helps in determining their values, culture, and beliefs all of which are instrumental in deciding the best approach to treatment.
Enhanced social conditions is the main benefit offered by a community driven approach to health improvement. This involves making the social conditions in which people live and work supportive to health and wellbeing. While the community capacity development approach increases the possibility of beneficial social conditions, it is also subject to much wider economic, cultural, and political policy trends that are not in the critical care nurses control. In this expected outcome, there is also improved social cohesion, access to formal and informal support and increased social capital all of which have been proven as social determinants of health and wellbeing.
Another benefit that critical care nurses expect from this approach is continued professional development. Increased teamwork in the health care environment has already been proven to improve service delivery and consequently, achieving better health outcomes. Through consulting with others, nursing professionals get the change to increase their knowledge base which is critical in implementing evidence-based decision making strategies in the provision of quality care. This continued learning increases the nurses job satisfaction since they have additional chances of attaining greater responsibility in the organization or community.
How Community Participation Development Supports These Values and Benefits
Past studies have identified the psychosocial work environment, especially exposure to job stressors, as factors determining the performance of nurses. The demand-control model of job stressors argues that the combination of low control levels and high psychological demands lead to psychological strain among workers hence leading to the onset of disease such as hypertension, cardiovascular disease, and in some cases burnout.
In recent years, collaboration has emerged as an effective strategy to reducing health care issues for both critical care nurses and other medical professionals in a healthcare setting. Collaboration in this setting involves working with others including the patients, their families or surrogates, and other healthcare providers to encourage contributions towards the achievement of optimal patient goals. Due to the multi-faceted nature of patient care today, it also involves inter and intra-disciplinary work with professionals from other health specialties and the community. MacDonald et al, (2008) defines Interprofessional collaboration as a partnership between a team of health providers and a client in a participatory relationship by multiple health care givers thus facilitating shared decision making. The existing body of knowledge provides conclusive evidence that Interprofessional collaboration has positive effects on quality of patient care, job satisfaction, and patient treatment outcomes.
Additionally, collaboration offers a long term solution to most of the issues by facilitating change from the inside and motivating the participants to initiate and want change. McKnight and Kretzmann (1997)conclude that significant community development requires the participants to invest themselves and their resources in the efforts for change. Therefore, in order to implement change in the nursing profession and work environment, health professionals have to be taught the importance of interprofessional collaboration which will then motivate them to facilitate change.
Chinn (2013) presents the peace and power process for facilitating group and team decisions with minimal conflict and inclusion of different perspectives. This process involves the use of different kinds of power depending on the specific context and desired outcomes. Integral to this process is the power of solidarity where all participants in a group share responsibility for decision making and implementing those decisions in the network. In a nursing context, all the health professionals involved in a patients care should collaborate on decision making by accepting the diverse viewpoints that others may have or bring from other specialties. In this way, as all participate in decision making, it provides an opportunity for a patient to get the best possible care from multiple collaborating professionals rather than multiple professionals undertaking uncoordinated treatment procedures.
For collaboration to work and provide effective treatment outcomes, the participants must accept the power of diversity that encourages alternative views, flexibility, and creativity. All points of view are considered when making decisions (Chinn, 2013, p.20). As Chinn argues, sustainable agreements in a team can only be forged through unity in the group as whole. Therefore, organizations should have frameworks that allow team members to articulate their opinions on a matter and others to understand the unique perspectives offered by different people.
The third principal in Chinns Power and Peace process is the power of trust which is described as building human relationships where employees are open to air their view and the ideas proposed and decided on are followed by consistent action. Many times, physicians and doctors may assume that nurses do not have the technical skills to contribute to a discussion on patient needs and treatment options but as research shows, this may actually hinder productivity and effectiveness as the nurses feel excluded in decisions affecting their work. Community development allows nurses and other practitioners to gain trust from and in other professionals
The critical care nursing community has several capacities available on both the individual level and community level. The Canadian Community Health Nursing Standards and Chinns Peace and Power process both encourage evaluating the existing capacities of the community in order to design effective health reform strategies that would help in building both the groups and individuals capacity to solve problems.
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