The field of nursing is not just about clinical skills and patient care; it also encompasses a wide array of competencies that ensure nurses are well-rounded professionals. PALMER, which stands for Professional Adjustment, Leadership and Management, Ethics, and Research, represents these crucial aspects of nursing. This article delves into each component of PALMER, highlighting their importance and how they contribute to the overall effectiveness and professional growth of nurses.
Professional Adjustment
Professional adjustment in nursing refers to the process of adapting to the dynamic and often challenging healthcare environment. This adjustment is vital for new nurses transitioning from academic settings to clinical practice and for experienced nurses adapting to new roles, technologies, or specialties.
Continuing Education: Nurses must engage in lifelong learning to keep up with advancements in medical knowledge and technology. Continuing education helps nurses stay current with best practices and improve their clinical skills.Adaptability: The ability to adapt to change is essential. Nurses must be flexible and open to new ideas, policies, and procedures. This adaptability enhances their ability to provide high-quality patient care in diverse situations.
Professional Development: Engaging in professional development activities, such as attending workshops, joining professional organizations, and pursuing advanced degrees, can help nurses grow in their careers and take on leadership roles.
Leadership and Management
Leadership and management are critical components of nursing that ensure the efficient and effective delivery of healthcare services. These skills enable nurses to inspire and guide their colleagues while maintaining high standards of patient care.
Leadership Skills: Effective nursing leaders possess strong communication skills, emotional intelligence, and the ability to inspire and motivate their team. Leadership involves guiding, supporting, and advocating for both patients and staff.
Management Skills: Nursing managers are responsible for planning, organizing, staffing, directing, and controlling healthcare services. They ensure that resources are used efficiently, policies are followed, and patient care standards are maintained.
Conflict Resolution: Leaders and managers must handle conflicts effectively. This includes mediating disputes, fostering a collaborative work environment, and promoting a culture of respect and professionalism.
Strategic Planning: Successful nursing leaders and managers engage in strategic planning to set goals, develop policies, and implement practices that enhance patient care and improve organizational performance.
Ethics in Nursing
Ethics is a cornerstone of nursing practice. It involves making decisions that align with moral principles and professional standards to ensure the well-being of patients and the integrity of the nursing profession.
Autonomy: Respecting patients' autonomy involves honoring their right to make informed decisions about their care. Nurses must provide patients with all necessary information and support them in their choices.
Beneficence: This principle requires nurses to act in the best interest of their patients, promoting their well-being and providing compassionate care.
Non-Maleficence: Nurses must avoid causing harm to patients. This principle guides nurses to carefully consider the potential risks and benefits of treatments and interventions.
Justice: Ensuring fairness and equality in healthcare delivery is essential. Nurses must advocate for equitable access to care and work to eliminate disparities in the healthcare system.
Confidentiality: Protecting patient privacy is a fundamental ethical responsibility. Nurses must handle patient information with the utmost care and only share it with authorized individuals.
Research in Nursing
Research is a critical component of nursing that drives evidence-based practice and contributes to the advancement of healthcare. It involves systematic investigation to develop new knowledge and improve patient care outcomes.
Evidence-Based Practice: Utilizing research findings to inform clinical decision-making ensures that nursing practices are based on the best available evidence. This approach enhances the quality and effectiveness of patient care.
Research Skills: Nurses should be familiar with research methodologies, data collection, and analysis techniques. These skills enable them to critically evaluate research studies and apply relevant findings to their practice.
Participation in Research: Nurses can contribute to the body of nursing knowledge by participating in research studies, either as investigators or as collaborators. Engaging in research activities fosters a culture of inquiry and continuous improvement.
Dissemination of Findings: Sharing research findings through publications, presentations, and conferences helps to spread new knowledge and innovations within the nursing community and beyond.
Conclusion
PALMER—Professional Adjustment, Leadership and Management, Ethics, and Research—encompasses essential aspects of nursing that contribute to the development of competent, ethical, and effective nurses. By focusing on professional adjustment, nurses can successfully navigate the evolving healthcare landscape. Leadership and management skills ensure that nurses can guide their teams and manage healthcare services efficiently. Adherence to ethical principles upholds the integrity of the nursing profession, and engagement in research fosters evidence-based practice and advances healthcare. Understanding and integrating these components of PALMER into daily practice will not only enhance the quality of care provided but also promote the growth and professional development of nurses.
FREE PALMER Practice Questions with detailed rationales
Question 1:
Charge Nurse Sharmaine is planning patient assignments for the following night shift staff. Which task can be safely delegated to a nursing assistant?
A. Obtain a stool specimen from a client with diarrhea
B. Assist client with a new colostomy in practicing his first colostomy irrigation
C. Evaluate the voiding pattern for a client who had a urinary retention catheter removed
D. Obtain a dietary history from a client with peptic ulcer disease.
Answer: A
Rationale: The assignment in A has the most specific guidelines for performance. The other procedures require assessment and judgment and should not be assigned to a nursing assistant.
Source: Illustrated Study Guide for the NCLEX-RN Exam by JoAnn Zerweck, 6th edition, page 614
Question 2:
RN Lia, a pediatric nurse, is an excellent role model for her colleagues. She encourages them to participate in the unit’s decision-making process and helps them improve their clinical skills. This nurse is functioning effectively in which role?
A. Manager B. Autocrat C. Leader D. Authority
Answer: C
Rationale: A leader doesn’t have formal power and authority but influences the success of a unit by being an excellent role model and by guiding, encouraging, and facilitating professional growth and development.
Source: NCLEX-RN Questions and Answers made Incredibly Easy, 2nd edition, 2003, page 778
Question 3:
Luisa is a nurse manager on an oncology unit and has been informed that she must determine which nursing care delivery system is the best for efficient client care, client satisfaction, and cost reduction. Knowing that 2 or 3 registered nurses and 5 nursing assistants are generally on duty on each shift and that the clients can be grouped fairly easily by geographic location and client care needs, the nurse-manager and her staff appropriately decide to implement which nursing care delivery system?
A. Functional nursing C. Team Nursing
B. Case management D. Primary Nursing
Answer: C
Rationale: Team nursing is efficient and cost less to implement than primary or case management systems. Because the staff members know each other well, they can function effectively as a team. Although functional nursing is the most cost effective, care is commonly fragmented and client satisfaction decreased. Case management and primary nursing require more registered nurses than are available.
Source: NCLEX-RN Questions and Answers made Incredibly Easy, 2nd edition, 2003, page 779
Question 4:
Iza is the outgoing charge nurse of the morning shift. She is planning assignments for the nursing staff for the incoming shift. She was told that one of the staff nurses is pregnant. Which patient would not be appropriate to assign to this nurse?
A. Child with brain tumor being treated with radiation
B. Infant with respiratory syncytial virus receiving ribavirin
C. Toddler who is HIV+ and has an opportunistic respiratory tract infection
D. Child with leukemia who is receiving Oncovin (Vincristine) and Zyloprim (allopurinol)
Answer: B
Rationale: Involves contact with a medication that is teratogenic and is classified as Pregnancy Risk category X. The other clients do not pose a risk to the pregnant nurse.
Source: Illustrated Study Guide for the NCLEX-RN Exam by JoAnn Zerweck, 6th edition, page 615
Question 5:
A nurse-manager appropriately behaves as an autocrat in which situation?
A. Planning vacation time for staff
B. Directing staff activities if a client has a cardiac arrest
C. Evaluating a new medication administration process
D. Identifying the strengths and weaknesses of a client education video
Answer: B
Rationale: In a crisis situation, the nurse- manager should take command for the benefit of the client. Planning vacation time and evaluating procedures and client resources require staff input characteristic of a democratic or participative manager.
Source: NCLEX-RN Questions and Answers made Incredibly Easy, 2nd edition, 2003, page 781
Question 6:
Robina is a newly registered nurse and is attending a hospital orientation regarding the nursing model of practice implemented in the health care facility. The nurse is told that the nursing model is a team nursing approach. The nurse understands that planning care delivery will be based on which characteristic of this type of nursing model of practice?
A. A task approach method is used to provide care to clients
B. Managed care concepts and tools are used in providing client care
C. An RN leads nursing personnel in providing care to a group of clients
D. A single RN is responsible for providing nursing care to a group of clients
Answer: C
- In team nursing, nursing personnel are led by a registered nurse leader in providing care to a group of clients. Option A identifies functional nursing. Option B identifies a component of case management. Option D identifies primary nursing.
Question 7:
Nurse Manager Allan has implemented a change in the method of the nursing delivery system from functional to team nursing. A senior staff nurse is resistant to the change and is not taking an active part in facilitating the process of change because she feels like it is just a waste of time and the latter approach was okay. Which of the following is the best approach in dealing with the senior staff nurse?
A. Ignore the resistance and focus on those who committed
B. Exert coercion with the senior staff nurse since Allen is still the nurse manager
C. Provide a positive reward system for the senior staff nurse to provide motivation
D. Confront the nursing assistant to encourage verbalization of feelings regarding the change
Answer: D
- Confrontation is an important strategy to meet resistance head on. Face-to-face meetings to confront the issue at hand will allow verbalization of feelings, identification of problems and issues, and development of strategies to solve the problem. Option A will not address the problem. Option B may produce additional resistance. Option C may provide a temporary solution to the resistance but will not address the concern
Question 8:
Nurse Manager Cassandra is planning to implement a change in the nursing unit from team nursing to primary nursing. Cassandra anticipates that there will be resistance to the change during the change process. The primary technique that the nurse would use in implementing this change is which of the following?
A. Introduce the change gradually
B. Confront the individuals involved in the change process
C. Use coercion to implement the change
D. Manipulate the participants in the change process
Answer: A
- The primary technique that can used to handle resistance to change during the change process is to introduce the change gradually. Confrontation is an important strategy used to meet resistance when it occurs. Coercion is another strategy that can be used to decrease resistance to change but is not always a successful technique for managing resistance. Manipulation usually involves a covert action, such as leaving out pieces of vital information that the participants might receive negatively. It is not the best method of implementing a change.
Question 9:
Nurse Noli has recently been assigned to manage a pulmonary progressive unit at a large urban hospital. The nurse's leadership style is participative, with the belief that all staff members assist in decision making and the development of the unit's goals. The nurse is implementing which leadership style?
A. Democratic
B. Laissez faire
C. Auticratic
D. Situational
Answer: A
- Democratic leadership is defined as participative with a focus on the belief that all members of the group have input into the decision making process. This leader acts as a resource person and facilitator. Laissez faire leaders assume a passive approach, with the decision making left to the group. Autocratic leadership dominates the group, with maintenance of strong control over the group. Situational leadership is based on the current events of the day.
Question 10:
The Comprehensive Dangerous Drug Act of 2002 challenges the nurse in his/her role as a/an:
A. Advocate B. Therapist C. Counselor D. Health educator
Answer: C.
Nurses are considered counselors and facilitators for addicted patients.
Question 11:
Nurse Roanna is conducting Parent Education Classes. With her awareness of the scope of nursing practice, she recognizes the necessity to network with other agencies to discuss this area:
A. Communication skills appropriate for different ages
B. Constructive discipline
C. Normal and deviant child and adolescent behavior and development
D. Legal implications of illegal drug use
Answer: C.
The most appropriate to discuss with parents.
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