Clinical nurse specialists and other critical nursing care concepts

EDITORIAL

Clinical nurse specialists nursing care concepts Recently

an

international

mainly

from Europe,

consider

‘the profile

at diff‘rrent sider

(and

Europe

to prepare

lurther

exploration

their

tics,

in

North

in the 1 nited of

parts

National Health

has been since

part)

first by the Joint

for and

in I !%I0comparatively

Royal

few nurses

the and

College

affect

many

sarily

take

physical

in critical a holistic

papers

in this journal

ognise

that

nursing

of the people

of the

mind-body

nursing tion

to time

and

care-planning

problems

leaving

ha\~

thts title.

So it is good with

anti promoting

to see international

a view

appropriate

of the reasons

nursing

to sharing

resources

education

for CNSs,

tual

more

education

as well

nursing routines

of treatment

in the specialty.

cedures

any

(>nr of‘ the issues raised nurses

should

address continue

sation.

especially

should

b(~ providing

~Auld

cited

incompatible anslyer from this iournal

along

when

in Casey with

by Margaret

at the meeting

the path

you consider holistic 1990).

holistic

care

Auld

in

was ‘whether ofspecialithat

nurses

to patients.’

So is specialisation nursing

care?

The

most of those who read or write in is likely to be a resounding ‘no’.

medical

considered nurse’. sensory tion,

thinking patients with

the

lif‘e-threatening

care

effectively

and plan-

nursing holistic

pracis that

at the concep-

practice

level.

training)

conditions

care

U’hilc

rmphasised

or injuries.

standard

and care and technical

other

considerations

secondary

and

just

pro-

tendrd ‘being

to hat a

nicts

As nurses lrarn about concepts such deprivation or overload, drprrsonalisasocial

complement base

nursing

for thinking

critical

(or

mainly

critical

is it so in rcla-

for thrse

is increasingly

education

consrqut~nt

be very import-

perspective,

as technical

which must necessarily be beyond the level of post-basic. courses which prepare nurses to work

her kc);notc

Arc and

no room

tice is becoming

spiritual

and

for short-term

appropriately

also take

and

not least because

may

time

also rec-

must

But while

with

to a short

One

of

in these respects

ning for the future?

c~ollaboration

concerned;

perspective?

concern

to

social

ill people.

is holistic

in relation in the variety

patients

which

bodies.

must neces-

care nurses

interactions

effects

essential

many

such

aspects

1975). But

to do so, though

critical

or Mayo

of their

perspective

as

patients

are affecting

care nursing

and

such

units,

parts

of psychological,

the rolr l’ull~-, as described in the RCN document I%& or <:hambrrs et al (1987), and few are prepared

ones

care. As is demonstrated

limited

have developed

which

or all different

working

a small (RCN,

suffer from conditions

ant in critically

by

provoke

care units,

specialist

or neurosurgical

in other

Midwifery

organised

sprrialisation

early

should

or critical

in more

cardiovascular

physiological

recently

Nursing,

intensive

extent

of Clin-

Board

in 1975 The

(RCN)

on clinical

more

to some

account

a variety the

/or the equivalent

UK I and

in

slower

For example

there

Boards

of Nursing

longer.

courses

\,‘isiting;

but

has been

clinical Studies

01 the

(CNS) in prac-

Canada,

it is an issue which

thought.

So a specialist

1990).

Kingdom

107Os,\,alidatrd ical Nu~sirlg

and

has taken

post-basic

co-

nurse specialists

of its value

and development

in

with a view to

well-developed

Amc*rira

recognition

Nevertheless In general

to con-

of international (Casey,

ofclinical

to

available

such specialists,

is not IWLV. It is already Europe

and

content)

of ways

nurses,

nurse specialist

levels’,

and collaboration

‘1‘1~ concrpt

of

Netherlands

of the clinical

post-registration

courses

opc.ration

group

met in The

and other critical

balance,

isolation knowledge

and

interdependrncy

of concepts

cardiovascular

failure.

as to

such as acidnutritional

deficits and negative nitrogen balance it becomes possible to take all these factors into considrration to the extent relr\rant in carr-planning.

58

INTENSIVE

But

CARE NURSING

concepts

moving

out

such of

example),

normalcy

movement

away

human

and

patients’

due to disease,

wholeness’

(Orem,

sometimes

forgotten

a

future

uncertain

and this must

attention

to these

may

could

at

a later

havre been

cessive

dependency.

pliance’

and

avoided;

many

opportunity

more.

to fulfil

‘normal’

for them

between

individuals)

them

problems

pressure

For some

their

(and

full

what

may

It could

to be

international

varies

credit

to those

after

the meeting

in giving their

sur-

\L’ell-prepared develop

CNSs

management

grounded

and

and dissrminatr

particular

situations,

families.

Nursing

knowledge

to defend

context

of such con-

where area,

professional

and justify provides

management in every

strong

nerds

of patients,

resources

for society,

non-nurses

positions.

No-one

but

CNS

any

leaders,

may

well

for the ser-

particularly be

in

in key

can be an expert should

in The

as developments

and

and thrsc

interdependent. open

How

involved

countries

and

devclop-

to a number

of’

opportunity

for

will we use it? All

in collaboration K&et-lands. proceed

at and It is to be

nurses

will be involved PAT

from too.

iZSHWOK?‘H

to

they can best be used kinds of clients or in

to the benefit

that

European

theory.

can help

and staff.

vices nursing a

in

research

crpts and the way in which in practice with particular

able

hoped

and

to the survival

come

with

contacts?

the full de-

ill patients;

recently

countries,

area in div-ided

as is the use of some of

mentioned

are to some extent

E:uropean

other

practice,

in Europr

has

specialist we stand,

said that

are

speaking

of CNS in practice

of critically

Freedom

excellence

to the survival

concepts

concepts

potential

be legitimately

of-nursing

the other

as exthr

and their in nursing

is as critical

development

viva].

thrir

theory

and

be such leaders,

of the concept

which

is ‘normal’ promotes

velopment ment

of

‘noncom-

be crucial

the ‘will to live’ which

we fall. )

is

patients

knowledge should

are

patients

such

sores,

So CNSs

(United

But early

problems

specialist

built.

in general

and discomfort

stage

which

particular.

patients

save

too, that is, have a sound broader in nursing as a firm foundation on

for nursing

recognised

be rccognised.

generalist background

or

normalcy

rehabilitation

(and staff j from the difficulties overcoming

for ‘a

or unsound

of

for some

concepts

for

of normal

or not sufficiently The

(on

area

desire

injury

goal

1985)) and

care.

anxiety care

the restriction

towards

in plannin
transfer

intensive

from

activity

relationship

as

the

be a good

References C:asrv S. 18-19.

1990 I‘hc spc&li\t drhatr. Nursinq Standard 41 FiI: April 25 ChambersJK ct al 1987 CIinical Nurw Specialist cc~llaboration: Dcvclopmcnt ofa gcncric job dcscriptiorr and standards ofp~rfbrmancc. (Iinical Sursc Sprcialist 1831:

Owm

I24

127

1) 198.5 Nursins+ ~~mc‘ep~\ ofpractiw. McGraw-Hill, NVWYork. (Third edition‘ p 184 Kq ;11(~ollcgc ofSursiq 1975 New Horizons in Clinical Nursing. Rrport ofa seminar a~ Lrrds Castle, Or~olwr 1975. Royal <:ollcgc ofNursing.London Royal C:ollrg~ of Nursing 1988 Sprcialtirs in nursing. Rrport of a working par,!, RI@ C:ollcyr of Nursing,London