Though to ensure best practice, valuing feedback from patients and professional opinions is essential.
When on the wards, the best evidence is regularly transcribed into policies, protocols/procedures and guidelines. Policies are: statements that guide decision making and require employees of an organisation to work within certain parameters.
Guidelines are: systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances (NHSE 1995- cited in Kenworthy et al 2002)
An example of a guideline would be the amount of room the individual patient has around their bed space.
Policies and procedures should be readily available on request for nursing staff to take a look. For example while on placement in an elderly care setting each patient had their own individualised care plans and risk assessments each reflecting the different needs of the individual. As the individuals needs changed so did their care plans. Nursing staff should be well informed and have an understanding of the local policies and procedures to ensure clinical practice is therapeutic and is recommended by previous research and literature to ensure that they are giving their patients a high standard of care. The nursing process provides a framework for organizing individualized nursing care that focuses upon identifying and treating unique responses to actual or potential alterations in health. It consists of four steps: patient assessment, planning care, implementation of interventions and evaluation of the process and patient status.
It is important that nurses do not see patients as just a collection of body parts, but to try and understand their patients as a whole. Patients should be seen as members of communities and within a network of family roles and relationships. This view underscores the values and principles of holism. Holism is a concept centred on the needs of the patient and the nurse works with the patient from a basis of concern and mutual understanding. (Richards 2006)
It is a human trait to have the ability to care, to which everyone has. Nurses are within a profession where they are expected to be caring. Simone Roach (1992) developed a concept known as the 5 C’s – compassion, competence, confidence, conscience and commitment.
Compassion may be defined as a way of living born out of awareness of ones relationships to all living creatures. (Tschudin 1992)
Nouwen (1982) writes that - compassion asks us to go where it hurts, to enter into places of pain, to share in brokenness, fear confusion and anguish. Compassion challenges us to cry out with those in misery, mourn with those who are lonely, to weep with those in tears. Compassion requires us to be weak, vulnerable with the vulnerable, and powerless with the powerless. Compassion means full immersion in the condition of being human.
Churchill (1977 cited in Tschudin1992) states – “we cannot study it; no programme in sensitivity will give it to us. We can only be compassionate because compassion has been shown towards us. Compassion is all about the sharing of your feelings and a showing of understanding”. This is also known as personhood. Kitwood and Bredin (1992) suggest that personhood refers to the human being in relation to others. The concept of personhood has ethical implications because to be a person is to “have a certain status, to be worthy of respect”.
Competence is another one of the 5 C’s in which according to Roach a nurse should possess. Roach defines competence as “having the knowledge, judgement, skills, energy, experience and motivation required responding to the demands of one’s professional responsibilities”. (Roach 1992 p61 cited in Hunt 1999).
Competence has also become a political issue in recent years. Clause 4 of the UKCC Code of Conduct states that a nurse who is asked to carry out any delegated functions should acknowledge the limitations and refuse to carry out any such instructions if she or he is not competent. This ensures the protection of both the patient and the nurse, however the nurse should then ensure that she becomes competent through education, training and evidence based practice. As part of the NMC, section 6, also states you must keep your knowledge and skills up to date, you also must possess the knowledge, skills and abilities required lawful, safe and effective in your practice without direct supervision. We also have a responsibility once we have qualified to facilitate students of the health profession to develop their competence.
Confidence is defined as the quality which fosters trusting relationships. (Tschudin 1992)
Most nurses would agree that at the basis of caring lies a trusting relationship without that the whole ethics of caring is lost.
Confidence is reciprocal; both parties in a relationship need to trust one another, but when one of the parties is in a professional position, then the other needs to be really sure that the professional can be trusted. As part of the NMC we are required to protect all confidential information.
Conscience – can be defined as a state of moral awareness; a compass directing ones behaviour according to the moral fitness of things. (Tschudin 1992)
Conscience is at the basis of ethical behaviour. Roach (1987) has a number of aphorisms – like – statements which help to explain the concept.
Conscience is an intentional response, deliberate, meaningful and rational.
It is also the caring person attitude to the moral nature of things. Conscience is also the call of care and manifests itself as care. Professional caring is reflected in a mature conscience.
Conscience is the faculty within which is learnt from early childhood onwards and grows and develops. Parents and teachers instil a sense of right and wrong and this eventually forms the value basis on which judgements and decisions are made.
Commitment, for the other C’s to be affective, you need this. As in the same as it confirms them. You also need commitment for them to be possible. Once a commitment is made either through a conscience decision or through chances it last through the duration of time with that person (Tschudin 1992). Showing that you’re committed to someone’s cause or case helps to build up trust and confidentiality. Commitment also allows for practitioners competency to improve as they have the drive to constantly update their knowledge base either about new techniques or updating their knowledge on new/different policies. The commitment that practitioners show also leads to a good insight into compassion as there determination to improve a patient’s health derives from their commitment to do the best for their patient.
According to Roach (1992) “commitment is a complex affective response by a convergence between one’s desired and one’s obligations and by a deliberate choice to act in accordance with them”. (Tschudin 1992)
There are three levels of care in health care; these are known as primary, secondary and tertiary care.
The WHO International Conference on Primary Health Care in Alma-Ata (1978) defined primary health care as: “Essential health care... made universally accessible to individuals and families in the community …It forms an integral part both of the country’s health system, of which it is the central function and main focus, and of overall social and economic development of the community”. (cited in Ewles 2003)
Primary health care teams are the first point of contact with the NHS. The NHS plan confirmed the government’s vision of robust primary care services, with GP’s and PCT’s taking a lead in meeting people’s needs. To be able to do this, the primary care role has been enhanced, with policies and investment to improve services through, for instance more flexible arrangements about the way GP’s can provide services, NHS Direct, and NHS walk-in centres. Some roles are also being developed, such as nurse practitioners, who are now able to undertake some tasks previously done by a doctor. There is also a move to encourage GP’s to develop special areas of expertise, so that other GP’s can refer patients to them rather that to a hospital specialist.
Secondary Care often follows from primary care where further investigation is needed to determine what the patient is suffering from. This level of care is normally given in hospital or treatment centres. As an example someone suffering from carpal tunnel syndrome would have first gone to the doctor, primary care, who then would have referred them to a specialist, secondary care, who would then have made the decision whether or not to operate. All of this would have happened in a hospital or local treatment centre. (Ewles 2003)
Tertiary care may well be provided in specialist units and is often for those who need to be rehabilitated back to their usual ways, for example, physiotherapy, occupational therapists, aromatherapy, osteopathy and psychologists. These professions all fall into the tertiary care field as they are the last profession you will need to meet in order for you to get back to your normal healthy state. (Ewles 2003)
An important development for the UK in the early 1990’s was the advent of national strategies for health. . The Health of the Nation in England, and comparable strategies for Wales, Scotland and Northern Ireland. These were welcome, as they were the first national strategies to focus on health and gain rather than illness and health services. More strategies were published later in the 1990s. In 2002, the most recent of these for England were:
1999: in England, the Department of Health published Saving Lives: Our Healthier Nation.
A further major improvement was that in 2001 the government published national targets to reduce inequalities in England. The targets are:
By 2010, to reduce by at least 10% the gap in infant mortality between manual workers and their families and the population as a whole/
By 2010, to reduce by at least 10%, the gap between one fifth of health authorities who have the lowest life expectancy at birth and the population as a whole. ()
In order to be able to maintain and improve standards clinical governance should be used. Scally and Donaldson (1998) defined governance as “a framework through which organizations are accountable for continually improving the quality if their services and safe guarding high standards if care by creating an environment in which excellence in clinical care will flourish.” ()
Clinical governance encompasses the following –
Education and training, health care professionals must continue their professional development.
Research and development concerns, not only carry out research but, by using it develops guidelines, policies and protocols.
Openness is an essential part of quality assurance. Health care organizations have to show they are meeting the needs of the population.
Risk management involves such things as a safe environment, vaccinations for employees and complying with statutory regulations in order to protect patients. ()
In conclusion to this essay I have outlined the importance of Evidence Based Practice in providing valuable therapeutic, patient-centred care, where to find the evidence and the significance of evaluation. Nursing staff should provide holistic care and use Roach’s 5 C’s in order to achieve this. A good knowledge of current policies and procedures is a must in nursing. They are set in place to ensure that nurses provide competent therapeutic care. The strands discussed in this essay are very important, as a good knowledge of it will enable a nurse to be able to practice to her best ability taking into account a holistic and therapeutic approach.
REFERENCE
Alexander, F., Fawcett, J and Runciman P (2006) Nursing Practice, Hospital and Home 3rd edition Churchill Livingston London
Brown, J and Libberton, P., (2007) Principles of Professional Studies in Nursing, Pelgrave Macmillan Oxford
Burnard, P and Chapman, C., (2006) Professional and Ethical Studies in Nursing, 3rd edition, Bailliere Tindall Oxford
Clinical Governance, (2007) Wikipedia, available at:
(Accessed 16th April 2007)
Department of Health, (2007) Choosing Health, available at: (Accessed 11th April 2007)
Department of Health, (2007) what is Clinical Governance? Available at
Ewles, L and Simnett, I., (2003) Promoting Health, A Practical Guide. 5th edition, Bailliere Tindall Oxford
Fitzpatrick, J., (2007) Finding the Research for Evidence Based Practice. Parts 1 & 2, Nursing Times, Vol 103 No 17 & 18 pp 32-33
Fox, M.., (1979) Spirituality Named Compassion. Minnesota: Winston Press
Hunt, J., (2007) An examination of Two models of Professional Nurse Caring, available at: (Accessed 25th April)
Kenworthy, N., Snowley, G and Gilling, C., Eds, (2002) Common Foundations in Nursing, 3rd Edition, Churchill Livingston London
Richards, A and Edwards, S (2006) A Nurse’s Survival Guide to the Ward Elsevier Churchill Livingstone London
Tschudin, V., (1992) Ethics in Nursing the Caring Relationship, 2nd Edition, Butterworth Heinemann Oxford
