Nurses are expected to acknowledge and react to a overplus of new demands that arises critically due to the outgrowth of modern nursing enlargement. The nursing profession is confronting new developments in wellness attention puting where alterations in the health care bringing have impacted upon the development of the wellness profession where coaction of professions in wellness and societal attention between physicians and nurses are involved.
As profession comes together, nevertheless, misconceptions about the several functions or duties have become a boundary in order to supply a better and excellence service and attention to the patients. Distler ( 2006 ) acknowledged that patient ‘s intervention have been replaced by the modern health care services where the physicians are the primary function in the wellness attention pattern. Even though physicians are the primary supplier, it is renowned that nurses by and large are going more accountable and be the ‘front line drive ‘ in the new function of development in impacting on the professional functions boundaries. As stated by Abigail ( 2002 ) , nurses are taking over the topographic point of the physicians in many countries of attention ensuing misdirecting the patterns which is on their ain right without supervising. Hence, it causes a professional cross-boundary in clinical pattern.
Nursing is a caring profession and it encompasses empathy and connexion with people. Nursing boundaries was foremost addressed by Florence Nightingale in sequence to “ keep the criterion of nursing profession and refer to criterions of boundaries that are related to the nurses ‘ duty ” . Boundary issues, in fact, exist everyplace for nurses, irrespective of the professional scene. Therefore, the potency in professional boundary crossing and misdemeanors are an occupational jeopardy in nursing.
The ability to make and keep intervention boundaries within the nurse-patient relationship is one of the most of import competences required in nursing professions. The acquaintance and trust that develop between a nurse and a patient is the most complexness. Boundaries in nursing are defined as “ bound which protect the infinite between the professional ‘s power and the patient ‘s exposure ” , Peterson ( 1992 ) . In assorted, phrases such as ‘crossing the line ‘ or over ‘stepping the grade ‘ has been described as ‘boundaries ‘ , Karen & A ; Steven ( 2007 ) . As for the Malayan Code of Professional Conduct ( 1998 ) , it stated that nurses should move as a professional and have recognizes and maintains boundaries all the clip.
Most of the nurses are confronting many types of boundary such as dynamic boundaries, blurred boundaries and traversing boundaries which at times nurses have to traverse or go against the professional bounds for the patient ‘s demands. Due to that, I realized that boundaries are existed in my current pattern puting such as disposal of chemotherapy drugs. I am presently working as a nurse practician in a multidisciplinary ward who has been administering the chemotherapy drugs without any qualified certification or go toing any oncology class or survey. The ‘vertical permutation ‘ of disposal of chemotherapy drugs is the extension of function within ain professional boundary where undertakings are usually performed by other wellness service supplier and perpendicular permutation by and large increases the range of pattern of a profession, but the position or rubric will be vary, Susan & A ; Alan ( 2005 ) . In this paper, I will drastically analyse and understand the constructs of boundary in switching wellness professional ‘s functions and duties. Besides that, I will utilize the constructs as the tool for analysis in my pattern puting based on the literatures happening and understand the result of traversing the professional boundaries.
Each profession has provided a different attack to the patient ‘s attention from a different educational base. Harmonizing to the Malayan Code of Professional Conduct ( 1998 ) nurses are allowed to hold the particular function of maps if have undergone a certain educational degree and have been certified clinically by the authorities before set abouting the process. Hayes ( 2000 ) supported that the place of the non- certified nurse in giving the chemotherapy drugs were non lawfully licensed in transporting the medical intercession and it is seen as a ‘forced ‘ nursing duty which is traversing the professional boundary. Nurses in my pattern puting have been traversing the boundary in disposal of chemotherapy drugs are because there is none trained oncology nurse and the physician has the trust on the nurses ‘ accomplishments in sharing the cognition. However, Holmes ( 2006 ) emphasized that it is non right in set abouting the activities that used to be preserve on the qualified profession and patient has the right to kick if equal services are non provided. In such instances, nurses are making these undertakings of drug prescription, ECGs, venepuncture, male catheterisation, interpolation of chemo port acerate leaf, canulations and disposal of chemotherapy because physicians were happy for nurses who can take over the ordered intervention in order to assist patient to acquire a prompt intervention, Davina ( 1997 ) .
The dilution and readying of the chemotherapy drugs will merely acquire prepared by a trained and certified druggist. However, the disposals of chemotherapy drugs have to be given in the general ward by a general nurse practician who is a non- trained oncology nurse. A trained oncology nurse has to undergone a preparation theory class of six months and a clinical preparation for another six months. Basically, the drugs will be checked by two qualified nurse practician to forestall medicine mistake. Even though nurses in my pattern puting are taking all the bravery to transport out the intervention, in world chemotherapy is still a cytotoxic drugs that may do injury to other warded patients. Spillage of chemotherapy could be one of the harmful incidents during the procedure of disposal. Nurses, who really without any official rubric, are exposing themselves to a harmful environment and this environment, will do danger to themselves and other patients which the personal protection equipment such as protective gown, mask, goggle and proper places are non provided. In add-on, Ford & A ; Turner ( 2001 ) explained that traversing boundaries as of import and honoring to patients but non without any jobs to happen within the profession.
In Malaysia, there is no specific codification leting general nurse practician in administering the chemotherapy drugs. Reflecting on the intervention by the physician in my current pattern scene, consent must be signed and agreed by the patient in order to acquire a prompt chemotherapy intervention in the infirmary. Harmonizing to the Malaysia Ministry of Health ( 2008 ) it concerns that consent of single is important before carry out any intervention in the infirmary as it is an act in jurisprudence. The Malaysia Nursing Board ( 1998 ) stated that nurses must esteem patient in the determination about the intervention. A clear account is important in order to give opportunities to the patient to make up one’s mind and pass on with the nurses and physician in order to derive patient ‘s trust and better apprehension.
The ward nurse must get down the prescribed chemotherapy drugs or trickle every bit shortly as possible in order to forestall patient from waiting excessively long and to keep continuity intervention. Nurses in my pattern scene is left with no pick but to give the prescribed chemotherapy drugs because they have the troubles in acquiring the physicians to the ward and no oncology nurse about. This action has conveyed a demand on the codification of moralss where nurses are to be answerable and be responsible on the actions, Malaysia Nursing Board ( 1998 ) . And so, it reflects this boundary state of affairs greatly increased the loads on nursing staff where nurses are assisting to supply much sort of services to the wellness attention development. Therefore, nurses are working with no liberty.
McCance ( 1999 ) explained that collaborative or inter professional attention requires many accomplishments and non merely affect one function but besides other function of professionals. Nurses in my pattern puting have overlapped the function of professional boundary and this really brings in a collaborative working environment. As clarified by Jeanie ( 2001 ) , the collaborative working environment will assist to clear up the functions and duty by understanding on communicating between members in order to help their apprehension on each other ‘s function. And so, it helps nurses lessen the spread and emphasis between patients. Therefore, it helps to increased patient quality attention and satisfaction. Besides that, it maintains the intimacy working relationship. Therefore, the inter professional attention would enable the staff to experience sceptered and committed in the work in supplying greater possible for working as a spouse with patients and household members.
Though the nurses in my pattern puting have been administering the chemotherapy for patients but the function bring in a batch of challenges and emphasis. The nurse have to do certain the government of the fluids that traveling into the patient ‘s organic structure is right or are they doing the complication such as chemotherapy spillage, extravasations of the endovenous site due to the chemotherapy drugs or uncertainness of the side effects of the chemotherapy drugs due to miss of cognition. The general nurse practician who is really administering the chemotherapy drugs could merely easy portion the job with the druggist in order to clear up the uncertainnesss. Therefore, the collaborative or inter professional attention at the same clip increases the patient quality, safety attention and satisfaction where it gives a clear apprehension of how the each profession roles able to suit in with others, Department of Health ( 1997 ) . Besides that, nurses should hold the degree question base larning before making any process even though simply all the process will be learn from the senior nurses and it is non sufficient and it might be wrong. However, Rushton ( 1996 ) & A ; Totka ( 1996 ) argue that nurses must larn from errors and attention for each other, including sharing the experiences in order to ease acquisition in others. The less experient nurses can larn by interacting with and following illustrations of co-workers with more experience in order to accomplish an ideal result.
Nurses are urged to heighten the cognition continuously. One of the methods in heightening the cognition is through the grounds based acquisition. As Roche ( 2004 ) suggests that the best pattern in the clinical country is through experience. But at the same clip, self directed larning such as reading is an of import method to construct cognition, Knowles ( 1984 ) . For an illustration, most of the malignant neoplastic disease patient for chemotherapy would anticipate a prompt intervention from the nursing staffs because they are sick. However, due to the deficiency of cognition ab initio doing the nurse to be low self esteem whereby it will go a barrier in communicating. Thus, educational intercession is important and will assist increased assurance and enhances their ability to talk with patients, Stuhlmiller ( 2004 ) . Freiburger ( 2002 ) and Twycross ( 2002 ) suggest that assurance is a characteristic of competency in nurses, and an of import facet of supplying attention. Hence, knowledge entirely is non plenty but with a confident mind, will assist the head to excite and believe critically before a determination is made.
Therefore, Gordon ( 2000 ) emphasized that critical thought is every bit of import in order to supply a quality attention. However, Alexis ( 2002 ) argues that using critical thought without grounds could be harmful. In add-on, Burton ( 2000 ) emphasized that nurses are directed to reflect efficaciously and pattern reflectively in supplying attention. As if the current boundary in my on the job topographic point happens such as patient developed terrible allergic reaction due to the chemotherapy drugs the critical thought nurse would hold merely to keep back the extracts and carry out the necessary intercession such as obtaining critical marks and cardiorespiratory resuscitation if the patient were prostration and administrate the atropine and adrenaline injection for the interest of salvaging patient ‘s life. This scenario could non be questioned where the intercessions that carried out were non consented by any physicians. Hence, an exigency squad is important to stand by to steer the state of affairs.
Bettering the wellness and good being of the patients hence is important. Although the part of nursing to patient ‘s attention is hard to specify nevertheless, it is clear that the function enlargement in nursing and the traversing the boundary is good for all even though nurses in pattern will be confronting a batch of challenges in future. Therefore, an experiencing of traversing boundaries or being involved can supply a valuable acquisition chance and towards patient ‘s attention instead being seen entirely as a negative experience.