Kaitlyn Coon



American Nurses Association Scope and Standards of Practice and Ethics for NursingKaitlyn R. CoonFerris State UniversityAmerican Nurses Association Scope and Standards of Practice and Ethics for NursingThe American Nurses Association (ANA), a professional organization for all registered nurses (RNs), has developed scope and standards of practice in order to advance the nursing profession. These 16 standards encompass all duties that RNs are expected to be able to adhere to competently (American Nurses Association [ANA], 2010). With only seven months until I graduate as a registered nurse, it is essential to reflect on my proficiency with these standards. A self-assessment of the competencies I have gained as a student nurse will be completed by reflection on experiences and gained knowledge in the past five semesters. The nine ethical obligations of the nurse, as outlined by the ANA (2001), will also be reflected on. Goals and plans on how to maintain, or attain, competency will be stated specifically under each section. ANA Scope and Standards of Nursing PracticeStandards of PracticeAssessment. The first step of the nursing process, assessment, involves the nurse’s collection of all relevant data regarding the patient’s health and situation (ANA, 2010). This includes not only the physical domain of health, but also many others such as psychosocial, emotional, and cognitive. The data collected reflects, “how health functioning is enhanced by health promotion or compromised by illness and injury” (Taylor et al., 2011, p. 222). It is crucial that the nurse knows how to perform both comprehensive and focused assessments in order to understand the patient’s concerns.I have met this standard fully in the last five semesters. During the first semester’s Nursing Assessment class, I was taught the basics of how to perform an assessment on a patient. I worked piece by piece each week in order to perform a full head-to-toe assessment on a lab partner the last week as the final. As clinical began, I had the skills necessary to perform compressive assessments on patients each day. This skill has only grown with each clinical experience, as the process becomes smoother and faster, and I have gained the ability to perform focused assessments based on the chief concerns of the patient. I will maintain competency in assessment by performing head-to-toe assessments on each of my patients at the beginning of the shift, as well as individualized focused assessments throughout the day. Diagnosis. Following along the nursing process, diagnosis is the second step. According to the ANA (2010) standards, diagnosis involves analysis of collected assessment data to determine the issue at hand. Approved nursing diagnoses are used to begin the organization of the patient’s plan of care. I have met this standard through experiences both in clinical and in the classroom setting. I have learned to identify nursing diagnoses for specific patients’ needs. Resources such as Mosby’s Guide to Nursing Diagnosis (Ladwig & Ackley, 2008) have helped to ensure the use of approved diagnoses by North American Nursing Diagnosis Association (NANDA). These have been incorporated into care plans for clinical paperwork, as well as into multiple assignments and papers. For example, in an obstetric assessment paper, I identified a diagnosis of “Disturbed sleep pattern” for an uncomfortable patient in late pregnancy that stated she was having trouble sleeping comfortably. I will maintain competency in the standard of diagnosis by continuing to use accredited resources, such as Ladwig et al.’s (2008) guide, to identify NANDA approved diagnosis specific to the patient’s assessment needs. Outcomes Identification. Registered nurses perform outcomes identification by establishing expected outcomes for the patient based on his or her specific situation (ANA, 2010). These outcomes must be measurable and specific. This is the third step of the nursing process, and helps the nurse to work in partnership with the patient and family to establish priorities, identify and write expected patient outcomes, select evidence-based nursing interventions, and communicate the plan of nursing care (Taylor et al., 2011, p. 264). This is a standard that I have met once again with the completion of care plans in both the clinical and the classroom settings. When first taught about the nursing process in Nursing 240, Professor Barnes had us write outcome identification statements by focusing on the necessary structure with use of a subject, verb, conditions, performance criteria, and target time (Taylor et al., 2011, p. 271). It is necessary that the patient is the main focus of the outcome, and that it is reasonable, specific, and time oriented. I have been able to transfer this knowledge to the clinical experience with real patient care plans and the specific needs that they have. For example, when working with an older patient who sustained rib fractures, it was important to identify an outcome of “Patient will use his incentive spirometer for ten repetitions at or above 900 every hour until discharge”, in order to prevent pneumonia. I will maintain competency in outcomes identification by working with the patient to set specific and attainable goals for his or her care plan. Planning. Once patient goals are identified, planning is initiated. Planning refers to development of an individualized plan that gives strategies and alternatives to attain the expected outcomes (ANA, 2010). This plan must be updated in conjunction with the patient’s needs in order to be effective.I have met the goal of planning only to some extent. Review of the Kardex has been made a priority each morning when I receive a patient assignment at clinical. This gives me the outlined care plan for the patient, directing me how to care for the patient throughout the day. I am able to follow the listed interventions in order that outcomes are met. For example, I oriented my patient, who had impaired memory due to fluid and electrolyte imbalances, to person, place, and time each visit into the room, as well as made fluid infusions a priority. However, I have never actually planned these interventions myself. I will meet this standard further by planning specific and effective interventions for the patient’s unique nursing diagnosis myself. I will collaborate with my clinical instructor and the nursing staff to make this happen while still in school. I will then feel confident in completing this standard individually by the time I am a professional practicing RN.Implementation. Implementation involves setting the plan of care into action (ANA, 2010). It is the nurse’s responsibility to implement the plan of care timely, safely, and with prioritization. The ANA (2010) also specifies that implementation be sensitive to the needs of diverse populations. I have met this standard in clinical practice by understanding the patient’s diagnosis and recognizing his or her established goals and plan of care during report. For example, when the patient’s daily whiteboard says, “ambulate three times” and “sit in chair for meals”, I ensure that I am helping the patient to implement these actions during the day. Therefore, identified goals based on the patient’s diagnosis from assessment, are being acted upon in order to fulfill the plan of care. I am also able to prioritize the implementation of patient care plans in order that they are acted on timely and safely. For example, a patient with a high-grade small bowel obstruction had immediate orders for magnesium sulfate, potassium chloride and piperacillin-tazobactum. However, all three of these medications could not be infused at once, as they were not compatible with each other. I was able to prioritize the administration of the medications based upon the time each took to infuse, as well as the patient’s current levels of the electrolytes and need for the antibiotic. I will continue to exemplify competency in implementation by physically helping patients to fulfill his or her goals, as well as prioritizing patient interventions, so that they may be acted upon safely, timely, and appropriately. Evaluation. The final step in the nursing process is evaluation. This standard allows the nurse to measure the patient’s success, or lack thereof, in achievement of the outcomes specified in the plan of care (ANA, 2010). As with every step of the nursing process, both the nurse and the patient must complete this together. Decisions to terminate, modify, or continue with the plan of care can then be made. I have met this standard principally by charting in the electronic medical record (EMR). Recording how a patient performs with a certain intervention helps in collaboration with other healthcare professionals involved in the patient’s plan of care. Each caretaker of the patient can be on the same wavelength of the patient’s progress and can modify the care plan accordingly. I also evaluate patients more intimately, by writing down my own notes on how they perform. For example, when the psychiatric patient with obsessive-compulsive disorder performs his or her ritual 100 times, I note this and challenge him or her to try only 95 times the next day. The outcome of “minimizing the time spent on rituals” is then being worked towards. I will continue to use evaluation in practice by piecing together my notes and charting to evaluate the patient’s responses to the care plan. Standards of Professional PerformanceEthics. The first standard of professional performance is ethics. To practice as a professional nurse, one must “deliver[s] care in a manner that preserves and protects healthcare consumer autonomy, dignity, rights, values, and beliefs” (ANA, 2010, p.54). This is considered ethical care and is further outlined in the Code of Ethics for Nurses with Interpretive Statements (ANA, 2001), which will be reflected upon in more detail later in the paper. Education. The standard of education requires the registered nurse to achieve a level of “knowledge and competence that reflects current nursing practice” (ANA, 2010, p. 56). Education is a standard that I am in the process of attaining, by completing nursing school. I, as well as all registered nurses, should always be fulfilling this standard, as the ANA (2010) requires the registered nurse to maintain lifelong learning. Personally, I plan to continue acquiring new competencies reflective of current nursing research by attending in-service presentations and going to conferences, as well as by returning to nursing school to pursue a Doctorate of Nursing Practice (DNP) to become a nurse practitioner. Evidence-based practice and research. The third standard of professional performance correlates directly to the previous standard of education. According to the ANA (2010), this standard holds the registered nurse accountable for using evidence-based nursing knowledge that is current and published in research to guide his or her practice. Additionally, advanced practice nurses are called to take this standard further by promoting a climate of research that will help him or her to disseminate findings, or even conduct new research him or her self (ANA, 2010). Evidence-based practice and research is a standard that I have gradually gained competence in each semester of nursing school. I met the standard most completely during the fourth semester, in Nursing 350, when Professor Singleterry taught the meaning of nursing research and the importance of having that research inquiry that the ANA (2010) mentions in the advanced competency of this standard. Despite having knowledge of what evidence-based practice and research are, and using these principals to write papers and analyze current practice, I still have far to go in fully reaching this standard. My goal to further obtain competency in this standard is to continue onto a higher level of education for an advanced practice degree where I will synthesize my own research. Quality of practice. The registered nurse must actively contribute to the improvement of nursing care in order to meet the fourth standard of professional performance, quality of practice (ANA, 2010). I have not met all of this standard’s components thus far in my nursing career. During multiple clinical rotations, I have been able to participate in team huddles, which “evaluate(d) clinical care or health services” (ANA, 2010, p. 59). The floors talk about what has been working and what has not, in order to ensure quality practice and make positive, innovated enhancements to nursing care. However, it will take time in order to meet the more specific components of this standard, such as collecting data and leading efforts in change (ANA, 2010). I plan to maintain competency in quality of practice by identifying and analyzing quality care issues in my place of employment. To further achieve competency in the standard, I plan to work with management in collecting data for quality improvement on the unit. Communication. The registered nurse is required to have communication skills that are transferrable to a variety of settings, with multiple participants, and that effectively convey healthcare information (ANA, 2010). Communication is a standard that I meet. One example is when I had the opportunity to communicate with both the pharmacist and the physicians on the trauma team about my patient. During the patient’s morning assessment I was informed that she had not been taking the prescribed Flexeril because “it did nothing for her in the past”. I talked with the trauma team about this as they were rounding, and also called the pharmacy for an alternative muscle relaxant that could be prescribed. I was able to confirm the medication with the physicians so that they put in an order and the patient had the medication she needed to help improve her condition and shorten her length of stay in the hospital. I will maintain competency in the standard of communication by ensuring interaction with other nurses, interdisciplinary team members, and patients throughout the days of clinical and in my career, in order that I contribute my “professional perspective in discussions with the interprofessional team” (ANA, 2010, p. 61). Leadership. The ANA (2010) expects registered nurses to be leaders, and with that, they have multiple, specific provisions. I have not met all of the ANA’s (2010) expectations for the standard of leadership, however, I do often act as a leader to my classmates, and my learning, in both the classroom and clinical settings. To further my competency in this standard, I plan to seek out leadership opportunities on my floor, such as becoming a charge nurse, where I will “oversee the nursing care given by others” (ANA, 2010, p. 62). Furthermore, as already mentioned, I plan to pursue an advanced practice degree, which “demonstrates a commitment to continuous, lifelong learning and education for self and others” (ANA, 2010, p. 62). Collaboration. Collaboration holds nurses accountable for partnering “with others to effect change and produce positive outcomes through the sharing of knowledge of the healthcare consumer and/or situation” (ANA, 2010, p. 64). I have met this standard both in the classroom and clinical setting. There has been a lot of group work assigned where collaboration is paramount to success of the project. In Nursing 340, Professor Dood assigned a seven person group project that analyzed a specific county’s health care strengths and needs. The group was able to create “a documented plan focused on outcomes and decisions related to care and delivery of services” (ANA, 2010, p. 64). In the clinical setting, I was able to collaborate with the rounding physicians about a patient’s plan of care. During the patient’s morning assessment, I noticed diminished lung sounds, large doses of scheduled pain medication, and still no mobility on the eighth day post operative. I recognized these as signs of risk for pneumonia and other complications, so I made a note to talk with the doctor. The team rounded shortly after my assessment, and I was able to “share(ing) knowledge of the healthcare consumer” so that together we were able “to effect change and produce positive outcomes” (ANA, 2010, p. 57). I will continue professional practice in collaboration by staying involved with the interdisciplinary team, in order that I am an effective advocate for patients’ care. Professional practice evaluation. In order to meet the ANA’s (2010) standard of professional practice evaluation, the nurse must critically evaluate his or her individual practice and performance in comparison with the professional practice standards and guidelines, as well as rules and regulations. Self- evaluation helps the nurse to identify strengths in his or her practice, as well what can be done to improve care. I have met this standard both formally and informally throughout the last five semesters. Weekly, as well as formative and summative, clinical evaluations have helped me to assess my own progress in meeting clinical objectives. Furthermore, I am able to obtain feedback from instructors with these evaluations. I have also been able to offer peers constructive criticism, both formally and informally, about his or her work performance through use of peer reviews for class assignments, as well as when acting as a charge nurse in clinical (ANA, 2010). I will maintain competency in this standard by continuing to take my clinical evaluations seriously, as well as by evaluating myself in a similar fashion each month once employed as an RN (Appendix A). Resource utilization. By using resources appropriately, the nurse is able to give care that is safe, efficient, and economical (ANA, 2010). I have met the standard of resource utilization, as I am given many opportunities to use resources appropriately each day at clinical. For example, when I have a patient who is in isolation, I ensure completion of all tasks possible each visit into the room, in order that I do not overuse the gowns, gloves, and masks. This is not only financially responsible by minimizing supply use, but also groups my care together, making it efficient. Furthermore, the need to enter the room un-gowned is minimized, protecting safety of both the patient and myself. I will maintain proficiency in this standard by being familiar with available supplies on the unit, and what can and cannot be re-used. Environmental health. According to the ANA (2010), the registered nurse has met the final standard of professional performance when he or she is able reflect on, and identify, potential health risks in practice, and act upon them in a healthy and safe way. Both classroom activities, as well as clinical have helped me to meet this standard. In both Nursing 250 and 340, I was able to “participate(s) in strategies to promote healthy communities” (ANA, 2010, p. 69) by creating presentations focused on health promotion and community health. In the community health clinical rotation, I was able to follow an environmental health worker. He helped me to identify health hazards in the community. I will maintain this standard by further educating myself on environmental hazards, and the appropriate nursing interventions. I will use research articles, and my graduate level classes mentioned earlier to do this. Furthermore, I will ensure knowledge of specific policies and procedures for dealing with environmental threats at my future place of employment, so that I will be able to respond to such hazards competently. Code of Ethics for NursesEthical Provision OneAccording to the first ethical standard, “the nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems” (ANA, 2001, p. 3). I have met this ethical provision with each opportunity I have to take care of patients at clinical, along with interactions with the nurses, other healthcare team members, and my peers. My parents taught me since I was young that the uniqueness of every individual needs to be respected. I have carried this value throughout my life and am able to apply it in my nursing care. One example is when I had a drug abuser as a patient. Despite the fact that this client had essentially caused his own hospitalization, it was my ethical duty to care for this individual just as I would any other patient. To maintain competency in this provision, I will assess my own values and beliefs each day before shifts so that I can deliver holistic care, and have respectful relationships with all individuals keeping his or her dignity at the forefront. Ethical Provision TwoAccording to the ANA (2001), the patient is expected to be the primary focus and commitment of the nurse. This provision ensures that the patient’s number one advocate is the nurse. I have met this provision by actively carrying out my reason for choosing the nursing profession – to care for others. I am not afraid to stay on the floor into lunch hour, or post conference in order to finish up a patient’s bath, help with his or her meal, or any other task. The patient and his or her needs are my main concern while in the nurse role. At the same time, I also make sure to “establish(ing) appropriate limits” (ANA, 2001, p. 6) in my nurse-patient relationships, so that interactions stay professional and focused on the relationship’s “purpose of preventing illness, alleviating suffering, and protecting, promoting, and restoring the health of patients” (ANA, 2011, p. 6). To maintain competency in this provision, I will continue to selflessly care for all of my patients so that his or her concerns are the forefront of my focus, and are advocated for in all circumstances.Ethical Provision Three The third ethical provision states, “the nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient” (ANA, 2001, p. 6). This is done by maintaining privacy, confidentiality, and informed decision-making by the patient. Furthermore, nurses must be competent in practice standards and have the audacity to report all actions that do not meet the profession’s standards. I meet this provision by only performing tasks in clinical that I have professional knowledge about from nursing school. Additionally, I stay sensitive to patient privacy and confidentiality by keeping charts closed and avoiding conversation to anyone uninvolved in the specific patient’s care. I will maintain competency in this provision by being knowledgeable about the Code of Ethics and Standards of Practice so that I may incorporate theses regulations into everything I do in practice. Ethical Provision FourEthical provision four requires that “the nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care” (ANA, 2001, p. 8). I have met this provision by taking responsibility, and holding myself accountable, for all of my actions, both in the classroom and in clinical. When I know that there will be a quiz in class, I make sure to read the chapters and listen to the lectures before arriving. Similarly, in clinical, before performing an intervention, such as inserting a Foley catheter, I make sure to familiarize myself with the supplies, as well as go over the proper steps with my clinical instructor. Furthermore, I chart all my interventions and interactions with the patient in the EMR. By doing this, I am holding myself accountable, and therefore, providing the best care to the patient. To maintain competency in this standard, I will be cognizant of my scope of practice, performing care fully, but also only to, the degree I am professionally capable of. Ethical Provision FiveTo meet the fifth provision, “the nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth” (ANA, 2001, p. 9). I meet this provision through both education and self-awareness. When I encounter diseases, surgeries, or medications at clinical that are new to me, I look them up in order that I understand the care I give fully. This engagement in self-study helps me maintain competence as well as ensure safe and fair care to the patient. Furthermore, the knowledge that I have gained, and am continuing to gain, in nursing school, attributes to professional growth. I will maintain proficient in this provision by continuing to take initiative in expanding my knowledge base. Furthermore, I will achieve a higher level of competency in this provision by continuing onto graduate school for my DNP, as previously mentioned. Ethical Provision SixThe sixth ethical provision states, “the nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action” (ANA, 2001, p. 11). I meet this provision through actions carried out in clinical. When finished with an intervention in a patient room, I make sure to clean up after myself by throwing away trash and getting rid of unnecessary supplies in the room, to make the atmosphere advantageous to healing. This is a gesture of respect to both the patient and other interdisciplinary team members, ensuring both improved health care environments as well as conditions of employment. To maintain a positive environment, I also communicate with peers in a friendly and respectful manner. Furthermore, I help with other nurse’s assignments if they are behind, showing respect and support. I will maintain competency in this provision by continuing my parts in improving the healthcare environment. Ethical Provision SevenTo display proficiency in the seventh provision, “the nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development” (ANA, 2001, p. 12). I have not yet met this provision as the Bachelor of Science nursing program at Ferris State University prepares only a generalist nurse. Therefore, the knowledge and skill level I currently have does not have implications to advance the profession of nursing. Nonetheless, through my ambition to continue to graduate school for my DNP, I am certain to meet this provision in the future. Ethical Provision EightAccording to ethical standard eight, “the nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs” (ANA, 2001, p. 12). I met this standard on the international level by engaging in a medical mission trip to Guatemala last winter. I was able to collaborate with nursing professionals in rural Guatemalan clinics to give care to underserved populations. The area’s health needs consisted primarily of distribution of birth control, pre-natal care, and infant growth and immunizations. On the last day, I climbed to isolated villages atop the city to give immunizations to individuals who cannot meet his or her health need by coming to the clinic. I plan to attain proficiency in this provision at a community level by educating myself with health needs pertinent to the community I will be involved in upon employment. Ethical Provision NineThe final ethical provision states, “The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy (ANA, 2001, p.13). I have begun to meet this provision by being a member of the Ferris State Nurses Association (FSNA), and by supporting social policy related to nursing by being an active voter. However, I am not part of any other larger professional organizations, which would provide greater competency in this provision. My goal is to become an active member of a professional nursing organization, such as the ANA, when employed as an RN. I will then have greater opportunities to collaborate with nursing professionals in order to shape social policy. ConclusionSelf-assessment provides the nurse with an opportunity to reflect on both positive aspects, as well as weaknesses, of his or her current practice of care. This evaluation creates opportunities to further strengthen and improve care. Throughout this paper, I have reflected on the competencies I have achieved, as outlined by the ANA (2001, 2010), in my current nursing care. Furthermore, goals were stated of how to continue, and also improve, in being a successful contribution to the nursing profession. As evidenced in this paper, I have confidence that I am ready for practice. However, there is always room for improvement. Using the Nursing: Scope and Standards of Practice and The Code of Ethics for Nursing as my guide, I will devote myself to always critically analyzing my practice so I can be the best nurse I can be.Appendix AMonthly Self-EvaluationTable A1 will be reviewed every four weeks to assess competency in each standard and provision for the month. I will reflect after each shift, or any type of involvement in the nursing profession (i.e. classes, organizational meetings), and write what I did in the appropriate box. Each month, I will be able to see what I have done, or failed to do, in meeting these professional obligations in order to strengthen and improve my nursing care. Table A1Standard 1Standard 2Standard 3Standard 4Standard 5Standard 6Standard 7Standard 8Standard 9Standard 10Standard 11Standard 12Standard 13Standard 14Standard 15Standard 16Provision 1Provision 2Provision 3Provision 4Provision 5Provision 6Provision 7Provision 8Provision 9ReferencesAmerican Nurses Association (2001). Code of ethics for nurses with interpretive statements.Silver Spring, MD: American Nurses Association. American Nurses Association. (2010). Nursing: Scope and standards of practice. Silver Spring MD: American Nurses Association. Ladwig, G. & Ackley, B. (2008). Mosby’s guide to nursing diagnosis (2nd ed.). St. Louis, MO: Mosby Elsevier.Taylor, C. R., Lillis, C., LeMone, P., & Lynn, P. (2011). Fundamentals of nursing: The art and science of nursing care (7th ed). Philadelphia, PA: Lippincott William & Wilkins. ................
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