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Nursing Health Care Framework


Discuss about the Nursing Health Care Framework.



Nursing is one of the most significant roles in the health care framework. Nurses are responsible for working with physicians, diverse range of patients and other medical staffs in a wide range of medical and community settings. The Nursing care is mainly concentrating on the protection and promotion of physical and mental health of patients and other community members. The art and science of the modern nursing include fundamental nursing concepts of health, illness, and stress and health promotion. However, the nursing job is not only based on the health an illness concepts, rather, nurses have to deal with many other concepts in their professional field including cultural concepts, power, values, behavioral attitudes, relationship, partnership, indigeneity, ideology, racism, communication, power and many other related aspects. A nurse, who is working with a diverse range of aged care residents, with different cultural background and concepts of health and illness, the nurse has to work with heir concept in their community (Gulanick & Myers, 2013). For being a nurse in the multidisciplinary team and working with a diverse range of patients, one should have a good knowledge in nursing concepts; especially they should be familiar with the cultural concept.

Nurses should show respect towards the patients from every dimension to make a positive relationship with the patients. This essay argues that the concepts of nurse-patient relationship and the role of communication as well as culture in the development of nurse patient-relationship are essential for enhancing the quality of nursing practice. In addition, the role of communication and cultural safety related concepts also has significant contribution in enhancing the nursing performance and quality of care services delivered to the patients. In this literature review, the nursing concepts would be discussed along with their impacts upon the aged care facilities. The most relevant nursing


Culture is one of the important aspects in nursing care facilities, thus in this paragraph, the relevance of culture in nursing would be discussed. Nurses have to deal with patients from diverse cultural background. It has been addressed by Purnell (2012) that working with the older patient is not only dealing with their physical or mental health, rather it always includes a holistic concept, where nurses have to think about their emotional and behavioral status also. As the older people have completed the major part of their life cycle, they needs additional care through their rest of the life. Thus, nurses who are in charge of the older patients should have additional competence about their satisfaction. The nurses should be more competent about handling patient’s cultural aspects especially. It is because, geriatric patients are mostly very much conscious about their cultural background. On the other hand, the nurses should provide equal treatment to the patients, irrespective to their cultural, socio-economic, sexual or racial background. Badger et al. (2012) found that nurses should develop a respectful understanding of the cultural aspects of their patients for providing meaningful and relevant patient education, which was the similar finding as Purnell (2012). It has also been found that the patients from native cultural background needs high emotional support in their health promotion plans or health related education. Thus, nurses have to provide a cultural sensitive education to the elderly patients, for satisfying them in all aspects.  

In this part, the impact of culture upon nursing care would be discussed. Thomas et al. (2012) claimed that nurses having diverse knowledge of culture has high professional competence and can assist diverse range of patients, especially in aged care facility. Culture can have a significant impact on patient’s satisfaction. It can include verbal and non-verbal communication, body language, food and other factors. In this context, providing cultural sense to the patient enhances their self-esteem and they feel valued in the health care organization. Evidences showed that enhanced self-esteem and enhanced cultural safety has a significant link with faster recovery of the patient. Especially, when the patient is older, the cultural requirement enhances, compared to the other age groups.

The next concept, which would be explored here, is attitude of nursing staffs towards the elderly people. Levin and Feldman (2012) aimed to explore the attitudes of nursing staff in geriatric care towards factors of importance for nutritional nursing care. The results showed that 53% RNs and nurse aids working at a geriatric rehabilitation, resident homes and medical care clinics showed positive attitude towards factors of importance for nutritional nursing care and others showed negative attitude. In addition, dealing with nutritional problems, management interventions and other dimensions showed positive attitude, shown by 71% nursing staffs. The study also found that the registered nurse shown more positive attitude towards the geriatric patients, compared to the nurse aids. Therefore, the study interpreted that the positive attitudes hindered the development of undernourishment in older patients.

The attitude related issue of nurses towards aged population would be discussed here.  Aging population is one of the major issues in the international health care systems. It has been claimed by Antoinette Bargagliotti (2012) that, with advanced age, people tend to develop complex health issues along with chronic disorders, therefore, with aging, the demand for contemporary health needs are increased, which has an impact on hospitals and long-term care facilities. Previous literatures reveled that young nurses have a negative attitude towards the older patients, which is affected by their personal values belief, culture, observation or previous experience. Therefore, from this evidence, it can be interpreted that there is a strong relationship between cultural belief and individual’s attitude. These negative attitudes have a significant negative impact upon the chronic patients. There are a number of ways identified in different cross-sectional studies, which can improve the positive relationship within the young nursing staffs and older patients. Henderson et al. (2012) identified that negative attitudes towards older people’s care can affect care procedures adversely, in contrast to the findings of Antoinette Bargagliotti (2012). Thus, the organizations, dealing with older adults, should recruit people with excellent interpersonal skills to work with older people.

Partnership is one of the most important concepts in nursing; thus, the importance of partnership should be reviewed thoroughly. According to the Nursing competency standards in Australia by Nursing and Midwifery Board of Australia, a registered nurse should be able to work in a collaborative framework with patients and other members of health care team. A nurse has to work in a health care team, specific for a patient. In modern art of nursing, person-centered or patient-centered nursing is one of the mostly known concepts of care delivery, as highlighted in both the articles by Granger et al. (2012) and Munhall (2012). Partnership is the core element of person-centered nursing. In geriatric care, partnership or establishing therapeutic relationship is the basic way to achieve success. Working in partnership with patient, especially, when the patient is older, helps to enhance patient’s self-esteem, as it helps the patient to feel valued. In this way, partnership can enhance patient’s autonomy and self-dependence (Munhall, 2012). In most cases, geriatric patients suffer from grief and loss, isolation and loss of independence related issues at the end-stage of life cycle. Thus, effective partnership strategies implemented by the nursing staffs, which enhance the positive relationship with patient and nursing staffs, helps patients to feel valued as well as helps in reducing their feelings related to isolation.

In addition to a therapeutic partnership with the patients, several previous literatures have proved the importance of professional partnership of nurses in health care systems, which would be explored here. It has been reviewed in previous literatures that the teamwork or partnership is the hidden key of success in health care system. An effective team has been proved to enhance the performance efficiency significantly. There are several models and theories followed by the nurse professionals for working efficiently in a team (Granger et al., 2012). Working in a team has both pros and cons, but the positive impact of teamwork overwhelms the drawbacks of working in a team. However, nurses should have specific skills for working in a team. Teamwork ensures quality nursing care facilities towards the patients through a mutual relationship between individuals founded on the principles of honesty, trust and respect. The person-centered care revealed on such relationships and principles needs the development of a unique partnership between the patient, nursing professionals, other care providers and patient’s family members. The nurses are responsible to contribute their best performance to enhance the overall performance of the team. In the mental health nursing, therapeutic relationship is build based on the trustworthy relationship within the nursing staff, the patient, therapist and the patient’s family members (Fowler et al., 2012). These kinds of partnerships are important for enhancing patient’s self-esteem and reducing the psychological issues, through the provision of a friendly environment.

Teamwork is one of the crucial part of healthcare, thus, teamwork should be demonstrated, while talking about nursing practice. Dossey et al. (2012) reported enhanced job satisfaction and patient care outcomes are achieved through the implementation of teamwork in nursing. Teamwork also helps to enhance the communication skills of the team members and reduces the rate of therapeutically errors. Gardiner, Gott and Ingleton (2012) argued “there is no ‘I’ in nursing!” Therefore, nursing is all about effective teamwork. Handing a patient with complex health care needs always requires more than one professional, having specific role in enhancing the patient’s health outcomes. It is more common in the case of geriatric care. It is because, with advanced age, the immunity system of an individual weakened, which promotes adherence of more than one complex health issues, which requires long-term care. In addition, while getting care facilities in long-term care, the mental stability of the patient deteriorates due to isolation and loss of autonomy. The combined contribution of all the above mentioned factors makes the patient’s health status more complex; thus, dealing with the patient needs more than one professional. It is the reason, why teamwork and partnership is so important in the geriatric care.

From the above discussion, it has been revealed that partnership and teamwork needs some other essential aspects; these are trust, respect, communication, leadership and power. These aspects would be described briefly in this part. While reviewing the previous literatures, it has been revealed that communication is the most important part in the therapeutic relationship with patient as well as the professional teamwork in health care framework. As nursing is all about providing quality health care facilities to needy people, nurses should have excellent communication skills for interacting with the patients effectively. In health care system, nurses have to deal with diverse range of patients, coming from different cultural background, who might have different linguistic background also (Gerlach, 2012). Thus, nurses should be competent to communicate with all the health care users efficiently. For enhancing their communication related competence, they undergo proper training sessions.

Communication needs include both verbal and non-verbal communication skills, which should be discussed in the context of nursing care. While working with older patients, nurses should always show positive non-verbal communication skills. For example, nurses should always show respect through eye contact and use low pitch of voice, while working with geriatric patient. It helps them to feel valued. Laschinger et al. (2012) argued that while working in a multidisciplinary team, nurse leaders or the team leader is responsible for dealing with communication barriers within health care workers in a team. Therefore, leadership skills are also important for the nurse managers and RNs, who directs other subordinate healthcare workers. Holmberg, Valmari and Lundgren (2012) reported in the study that the effective leadership skills of a leader can enhance the efficiency of the entire team entirely. In this context, leaders should work on making the team’s environmental favorable for the team members, which can promote the intra-team interaction within the health care workers as well as within the leader and a team member. It hs been revealed from the study of Bobbio, Bellan and Manganelli (2012) that, the democratic leadership style has a significant positive impact on the team’s performance by encouraging team members to provide their best performance. However, there are a number of barriers, identified in several literatures, including environment, fear and anxiety, internal conflict, cultural, racial or gender discrimination. The leaders are responsible for ensuring the elimination of these communication barriers in the health care environment.

Respect and trust are two other concepts, which are significantly related with positive communication, these aspects should be demonstrated in this essay. In the geriatric care, there are many patients, who have suffered from grief and loss, social isolation and discrimination, thus having lowered self-esteem. To enhance their self-esteem, showing respect and dignity is very important. On the other hand, building a trustworthy relationship with the patients helps to enhance patient’s trust towards the nursing staffs. Trust has a very important role in enhancing patient’s positive health outcomes. Patient’s positive health outcomes are ensured with trustworthy relationship within the patient and health care providing nurses (Mkandawire-Valhmu & Doering, 2012).

As nursing is oriented towards public health, thus, the concept of cultural safe and secure environment would be discussed here. According to the Code of ethics in nursing, developed by the Nursing and Midwifery Board of Australia (NMBA), nurses have to ensure a culturally safe and secure environment, where the care facilities are provided. Nurses have to deal with people from diverse cultural background and thus they have to ensure the absence of cultural discrimination in the health care provision. There are major principles of cultural safety in nursing documented in Treaty of Waitangi, which are followed by the nurses. These are “participation, protection and partnership”. It has been revealed in the study of Stievano et al. (2012) that the there were a significant gap in the health status of native new Zealanders, Maori and the non-Maori population, based on which principles of cultural safety were developed, however, a significant gap in the indigenous population and the non-indigenous population has also been observed in other nations. Thus, the principles of cultural safety have broadened for encompassing a wide range of cultural determinants. Mcsherry et al. (2012) noted that, cultural safety is one of the basic step of implementing nursing intervention. It provides the identification of the indices of power inherent in any interfaces and the potential for inequality within any health care relationship. Therefore, health care providers have to develop knowledge regarding the diverse culture, for providing unbiased health care facilities to all the health care users, irrespective to their cultural or racial background, as argued by Dignam et al. (2012). Therefore, instead of promoting monocultural concepts, nursing is a multicultural concept.

The review of above information revealed a strong interrelation between all the concepts discussed above. For example, teamwork is needed for establishing a trustworthy relationship between the health care team members. On the other hand, an effective team can be built with strong leadership skills of the team leader. An efficient leader can communicate with the patient as well as the team members in an effective manner and empower them to enhance their internal skills, which is important for building a strong relationship with the patient (Dignam et al., 2012). In a positive environment, health care workers can be promoted to provide a culturally safe and secure environment to the patient. When a health care team is working for a patient’s wellbeing, through the provision of cultural safety, the health care workers will show respect and dignity towards the patient. In this way, a successful intervention can be implemented for patient’s well being.

However, a gap in literature has been identified regarding the choice of multicultural or monocultural concept in nursing. In one article, it has been revealed that instead of monocultural concept, the nursing concept should be multicultural. However, in which circumstances, the monocultural concept should be implemented and what are the benefits of multicultural against monocultural concept in nursing, have not been explored fully in this literature review. Thus, further research in this topic is required.


From the above discussion, several nursing concepts has been identified and discussed. The important skills required by the nursing staffs, RN and the nurse leaders has also been highlighted. The literatures revealed a strong link between the nursing concepts identified in the literature review. The importance culture, cultural safety and security in the health care system and the role of health care providers to ensure cultural safety have also been discussed here. On the other hand, how to build a positive and trustworthy relationship with the patients and other health care workers has also been revealed through the literatures reviewed. However, further investigation is needed for detailed knowledge of monoculturism and multiculturalism in health care sector.

Reference List

Antoinette Bargagliotti, L. (2012). Work engagement in nursing: a concept analysis. Journal of advanced nursing, 68(6), 1414-1428.

Badger, F., Clarke, L., Pumphrey, R., & Clifford, C. (2012). A survey of issues of ethnicity and culture in nursing homes in an English region: nurse managers’ perspectives. Journal of clinical nursing, 21(11‐12), 1726-1735.

Bobbio, A., Bellan, M., & Manganelli, A. M. (2012). Empowering leadership, perceived organizational support, trust, and job burnout for nurses: A study in an Italian general hospital. Health care management review, 37(1), 77-87.

Dignam, D., Duffield, C., Stasa, H., Gray, J., Jackson, D., & Daly, J. (2012). Management and leadership in nursing: an Australian educational perspective. Journal of Nursing Management, 20(1), 65-71.

Dossey, B. M., Certificate, C. D. I. N. C., Keegan, L., & Co-Director International Nurse Coach Association. (2012). Holistic nursing. Jones & Bartlett Publishers.

Fowler, C., Rossiter, C., Bigsby, M., Hopwood, N., Lee, A., & Dunston, R. (2012). Working in partnership with parents: the experience and challenge of practice innovation in child and family health nursing. Journal of clinical nursing, 21(21-22), 3306-3314.

Gardiner, C., Gott, M., & Ingleton, C. (2012). Factors supporting good partnership working between generalist and specialist palliative care services: a systematic review. Br J Gen Pract, 62(598), e353-e362.

Gerlach, A. J. (2012). A critical reflection on the concept of cultural safety.Canadian Journal of Occupational Therapy, 79(3), 151-158.

Granger, B. B., Prvu‐Bettger, J., Aucoin, J., Fuchs, M. A., Mitchell, P. H., Holditch‐Davis, D., ... & Gilliss, C. L. (2012). An Academic‐Health Service Partnership in Nursing: Lessons From the Field. Journal of Nursing Scholarship, 44(1), 71-79.

Gulanick, M., & Myers, J. L. (2013). Nursing care plans: nursing diagnosis and intervention. Elsevier Health Sciences.

Henderson, A., Cooke, M., Creedy, D. K., & Walker, R. (2012). Nursing students' perceptions of learning in practice environments: a review. Nurse Education Today, 32(3), 299-302.

Holmberg, M., Valmari, G., & Lundgren, S. M. (2012). Patients′ experiences of homecare nursing: balancing the duality between obtaining care and to maintain dignity and self‐determination. Scandinavian journal of caring sciences, 26(4), 705-712.

Laschinger, H. K. S., Leiter, M. P., Day, A., Gilin-Oore, D., & Mackinnon, S. P. (2012). Building empowering work environments that foster civility and organizational trust: Testing an intervention. Nursing research, 61(5), 316-325.

Levin, R. F., & Feldman, H. R. (2012). Teaching evidence-based practice in nursing. Springer Publishing Company.

McSHERRY, R. O. B. E. R. T., Pearce, P., Grimwood, K., & McSherry, W. (2012). The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care. Journal of Nursing Management, 20(1), 7-19.

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