Transition Plan



Transition PlanSheila MahaneyFerris State UniversityAbstractThis paper details the experiences that I have had since receiving my associate degree in nursing. It will cover the knowledge that I have learned, the skills that I use and the attitudes that I have experienced during my nursing career. This paper also describes the metaparadigm of nursing, which includes: person, environment and health. The writer will define the ANA professional practice standards and how they enhance the role to a professional nurse.Keywords: SCIP, peri-operative nursing, assessment, planning, communication skills, person, health, environment, QSEN, ANA professional nursing standards Transition PlanThis paper encompasses my nursing experiences over the last 20 years. It will include the areas I worked with antidotes from each area. The content of the paper is the knowledge I have gained, the skills I have used and the attitudes that I have developed in my current position in outpatient surgery. The paper also talks defines nursing philosophy and the foundations of nursing, which are person, environment and health. The paper will also reflect on the American Nurses Association (ANA) professional nursing standards that were learned in the transition to a professional nursing role.Current PracticeAs I reflect over my nursing career, it is often overwhelming to me. I started working as a nurse’s aide while going to college. After graduating with an associate degree in nursing, I accepted a position at Metro Hospital on their pediatric unit. I learned the dynamics of working with children and their families and how illness and disease can affect a family unit. I then accepted a position on a medical-surgical unit, which I worked for four years. This was an eye-opening experience for me. I learned to prioritize and be a patient advocate especially since I worked the night shift. I then transferred to the Childbirth unit. I learned patience in teaching new and experience moms the art of breast feeding and caring for their infants. I encountered many different cultures and language barriers. I learned I needed to “be educated and be aware and respectful of cultural difference…”(Black, 2014, p. 45). There was often sadness on the unit, with a fetal demise. This was a difficult time for the parents. I showed compassion and learned empathy in these situations. I was ready for a change and had the opportunity to work on the Out-Patient Surgical unit. This is where I currently work. The remainder of this paper will focus on the knowledge, skills and attitudes needed to work in outpatient surgery.KnowledgeWorking in the outpatient surgical unit over the last six years has been a great learning experience for me. Entering this department, it was evident that the cultural of safety played a very important role. Safety is one of the core competencies of the Quality and Safety Education for nurses (as cited in Black, 2014). The goal, in providing safe care, is to “minimizes the risk of harm to patients and providers through both system effectiveness and individual performance” (Cronewell, etl. 2007). One way we achieve this goal is by identifying the correct patient with the correct surgery being performed (The Joint Commission, on Accreditation of Healthcare Organizations [JACHO] 2013). JACHO endorses and safeguards that specific standards are maintained in hospitals and other health care facilities. We also use the safety measure guidelines of Surgical Care Perioperative Project (SCIP) (JACHO, 2013). Health care personnel use SCIP to help reduce the number of preventable surgical complications. There are many protocols associated with SCIP. One of the measures utilized is antibiotic prophylactic therapy. This is to decrease the risk of infection at the surgical site (JACHO, 2013). My responsibility as a nurse is to make sure the antibiotics are ready for the operating nurse to hang. If Vancomycin is ordered, this needs to be given within two hours and I need to start the infusion. (Metro Health, 2013)Prophylactic Venus thromboembolism is another measure we use. This is done to reduce and alleviate blood clots. These are primarily used for orthopedic surgeries because of the immobility (Rothrock, 2012). My responsibility is to have the patient wear compression stockings and wear intermittent pneumonic compression devices and to educate them the reason for implementing this measure.( JACHO, 2013) In accordance with SCIP, the beta-blocker protocol was initiated. (JACHO, 2013) Patients are directed to take their medication prior to coming in. This is used to decrease the incidence of myocardial infarctions and decrease the incidence of cardiac events. If our patients don’t take the beta-blocker we need to inform the physician. Infection control is another measure that our department has instituted. Antiseptic wipes are used to clean the operative area prior to the surgery. Our pre-surgical testing nurse also instructs the patient to clean the area with dial soap two days prior to their surgery. This is done to prevent any unwanted infections during the operation (Metro Health, 2013).Change is occurring almost everyday in the surgical unit. New doctors coming, new protocols, each bring a sense of learning new concepts. It is my responsibility as a surgical nurse to stay current with the changes and embrace them to so our quality of care to our patients remains the best.Identifying resources and specific needs of patients becomes an opportunity for teaching and learning. A patient has a need for home care. It is my responsibility to encourage and empower my patient and give them resources and information that they can be readily used. Informing my patients where to get free or reduced medication is also a great way to utilize the resources that are available.My responsibilities as a nurse are to know what the scope of nursing include and stay within those guidelines. I will be a patient advocate and evaluate the effectiveness of the care that I provide for my patients.SkillsThe skills that I have acquired in this job are great. I need to start intravenous therapy (IV) on our patients, this is often a challenge because our patients are dehydrated from not having anything to eat and drink. Our anesthesiologists prefer IV’s started in the hand or wrist; this is the most stable position during the surgery. My prior experience was minimal in this area; it took lots of practice to master this skill. When starting IV’s we may also need to obtain blood for labs. We have surgical protocols that establish if we need a complete blood count or a basal metabolic rate or a type and screen this is also a skill that I have mastered after much practice. I have learned that patience is needed for this skill. One clinical skill, I use daily is administration of medications by using the six rules (right drug, dose, patient, time, route and reason). Assessing patient allergies is part of this process to decrease any harm to the patient. Interdepartmental communication, education, and teaching patients are also a part of the critical skills that I use. Communication and teaching allows me to listen to my patients and gain their respect and trust.Attitude When I first went into nursing, I wanted to make sure that I was honest and ethical in my approach to nursing, and the care that I deliver to my patients. I wanted to act and look professional. I believe that teamwork and working to resolve conflict and conflict resolution is a part of my nursing care (Black, 2014). Establishing the best quality of care to the patients is very important. I want to be able to provide a trusting and respectful relationship with my patients and co-workers. Having a shared vision for the department is valuable to the quality care that we give to our patients. I also want to remain current to what nursing will be doing in the future. I can do this through joining an organization and continuing my education. Obtaining continuing education every two years is allowing me to maintain my current license (as cited in White and O’Sullivan, 2012). PhilosophyMerrier-Webster’s dictionary defines philosophy as “a particular set of ideas about knowledge, truth and the meaning of life” (Merrier-Webster on line (n.d). What then defines a nursing philosophy? Black describes it as “statements of beliefs about nursing and expressions of values in nursing” (Black, 2014. p. 262). Philosophies are based on the foundations of the nurses’ beliefs and values. My nursing philosophy is one of compassion and empathy. As a nurse I want to deliver and provide optimal care to the patient. I achieve this by respecting, listening, and being an advocate for my patient. Empowering, the patient by providing education and resources to help meet their needs and goals are vital to the care that is provided. These are part of the concepts or foundations of nursing: person, environment and health (Black, 2014.). Each of these will be detailed in the following sections.Person“The term person is used to describe each individual man, woman and child” (Black, 2014, p 242). This is one of the foundations of nursing. The person is made up of many components. They each have individual human needs and how they fulfill them are each different and unique to their particular situation. Their needs may include physical, cultural, and spiritual components. Each of these combined makes them a whole person and how they adapt to their situation is unique. Maslow developed the concept of hierarchy of needs, “the most basic level of needs consist of those necessary for physiological survival: food, oxygen, rest, activity, and shelter. are common to all human beings.” (as cited in Black, 2014. p.243). “When a person’s needs are not met, homeostasis is threatened” (Black, 2014, p.244). There needs to be a healthy balance or stability in the life of an individual.EnvironmentEnvironment “includes all the circumstances, influences and conditions that surround and affect individuals, families and groups”(Black, 2014, p. 245). Environment includes the place where a person lives and works. Some communities or environments may not be conducive to learning or the ability to receive adequate health care that individuals need. The place where a person lives may be in a high crime neighborhood and therefore, safety can be a concern. Lack of transportation and financing may also be a determent to ones’ environment. Individuals are not able to make scheduled doctor visits if they have limited access to transportation. This may cause, a decline in their health. Families are a huge component of the environment. Is there family support? What defines a family is often the question. Black states that it may not “necessarily involve ‘blood relatives’. The way the family functions with and within the environment and the dynamic between various members of the family constitute the family system”(Black, 2014, p. 245). Cultural plays a very important role in the environment. Understanding the diversity in cultures is needed. “Effective nurses learn to be aware of and to respect cultural influences on patients”(Black, 2014, p. 246). As nurses we need to acknowledge their culture and therefore collaborate with them for the best outcomes that will fit their personal needs.HealthThe World Health Organization (WHO) defined health, as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”(Black, 2014, p. 250). Health is a holistic concept; it involves the entire person and the environment that they exist in (as cited in Black, 2014, p.250). It is can also be seen in the lifestyles that each individual has. Maintaining a balance of physical as well as mental and spiritual needs is important in the over all health of an individual. Individuals need to feel empowered to make the choices that best fit their life style. “ When individuals are empowered, they have the self-efficacy, knowledge, and competence to take proactive actions to reach their health promotion goals”(Pender, Murdaugh, & Parsons, 2011, p. 275). Nursing TheoryWhat is a nursing theory? A theory is formed from thoughts, ideas and is based on knowledge from clinical and scientific research. There are many theories on nursing. Florence Nightingale originated the first nursing theory and many have followed in her footsteps. The theory that I identify with the most is the Orlando theory. This theory focuses on meeting the individual needs of the patient and collaborating with them to find the best outcome for that individual. This is accomplished by using evidence-based research to provide the best quality interventions that are consistent with the persons immediate needs.TransitionIn continuing my education to receive a Bachelors degree in nursing, I have gained knowledge and information related to the nurses’ code of ethics and ANA professional standards of nursing (White & O’Sullivan. 2012). I have learned how to apply the standards to better understand my role and how they can be applied to my nursing practice. Transitioning to the role as a professional nurse has been an empowering experience. Since transitioning to the role of a professional nurse, I recognize the importance of understanding the reasons behind the care that I give to my patients.Knowledge. Ethics is professional standard from ANA (White & O’Sullivan, 2012). I realized that my thoughts and values reflect my critical thinking and judgment skills. Ethical situations occur on a daily basis. As a competent nurse I need be cognizant and respect the values that my patients have and not allow personal thoughts conflict with the care that I deliver. The nurses’ code of ethics states “the nurse practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual…” (Black, 2014, p. 96). As a bachelor prepared nurse, I need to portray ethical principles of generosity, autonomy, nonmaleficence, fairness, loyalty, and authenticity (as cited in Black, 2014, p.96).Nurses are constantly learning and engaging in opportunities for continued growth and development to provide quality care to patients. Understanding current, safe and effective practices in nursing requires a unique body of knowledge (as cited in White & Sullivan, 2012.p.123). Knowledge is obtained from formal and informal learning. Opportunities for growth can be acquired in the clinical setting or by attending educational seminars. The ANA states that education is a professional standard and is vital to the nursing profession and makes a great impact to its practice (as cited in White & Sullivan, p.128).My transition to a professional nurse will include becoming a leader, an ANA professional standard. Leaders are role models that exhibit qualities of purpose, values and self –discipline. The quantum theory of leadership examines the changes in the healthcare environment and how they can be better understood. Leaders need to address and resolve conflict effectively. This leadership style encourages identification of common goals, opportunities for growth and empowerment to make decisions (as cited in White & O’Sullivan, 2012, p. 165). “ Leadership in nursing is demonstrated when registered nurses’ commit to ongoing learning, seek competency-based education, and track their professional contributions” (White & O’Sullivan, 2012, p. 166). Leaders are constantly learning and use EBP to support their practice.I have learned the importance of providing a culture of safety in nursing, which is an ANA professional standard (White & O’Sullivan. 2012). In 2003 an organization defined this and QSEN or quality and safety in education of nurses was established (as cited in Black, 2014, p.148). One of the core competences of QSEN is providing patient centered care. I can improve the quality of care by communicating with other disciplines and by using evidence based research. The opportunities for identifying areas of improvement are a daily occurrence (as cited in Black, 2104, p 146). Nursing has the responsibility and the accountability for the quality care that they provide for their patients (as cited in White & O’Sullivan, 2012, p.146). “Through quality improvements efforts, nurses – as the key caregivers in hospitals significantly influence the quality of care provided and ultimately the effectiveness of treatment and patient outcomes”(White & O’Sullivan, 2012, p. 147).SkillsDuring this journey of continued learning, I have learned the importance of research and how that relates to evidence based practice (EBP). Research is an ANA professional standard that is expected in the nursing profession (White & O’Sullivan. 2012). The connection between scientific research and clinical experiences are vital to understanding new concepts and benefits the care that I provide for my patient. Research enhances my critical thinking and judgment skills as a competent nurse (as cited in Black, 2014. p.227). The professional nurse needs to have resources about clinical practices readily available to them either from a hospital library or in the department that they work on, so they can remain current and effective in their specialized practice. In the unit I work on, we use Medscape nursing. I have also reviewed research from databases such as PubMed and CINAHL; these are both reliable and scholarly munication and Collaboration, which are ANA professional standards, are skills that I will need as I transition into the role as a professional nurse. I need to be conscious of the way I communicate with patients and colleagues. “Effective interpersonal communication is necessary to perform an assessment and to make an accurate diagnosis…”(White & O’Sullivan, 2012, p. 153). Effective communication involves the ability to listen and acknowledge what is said and then to form a mutual plan of action. Communication takes many forms from verbal, non-verbal, written and spoken. “Nurses must be proficient in communication as they are in clinical skills”(White & O’Sullivan, 2012, p. 157). Collaboration with other disciplines is vital to problem solving and making decisions that will achieve the best outcome for the patient. QSEN reaffirms that nurses must “function effectively within nursing and interprofessional teams, fostering open communication, mutual respect and shared decision making to achieve quality patient care”(White & O’Sullivan, 2012, p.177).Evaluation is a skill that I have developed in the transition to this professional role. In my current job we have yearly evaluations. My performance is based on my clinical skills, leadership skills, patient satisfaction, and attendance. I need to adhere to a code of standards that apply to my job description. I need to be responsible and accountable to myself, but also to the unit as a whole. I need to continue to foster professional growth and development (as cited in White & O’Sullivan, 2012, p.187). I accomplish this by accepting constructive feedback from my managers and my peers. Another ANA professional skill I have achieved and continue to pursue is the utilization of the resources on the unit that I work on. I use my critical judgment skills and knowledge of the patient and their needs to provide safe and effective care. Safe and effective care is achieved by being fiscally responsible with the services that are provided. Being aware of quality improvement and cost effective measures are ways of maintaining quality in the healthcare environment (as cited in White & O’Sullivan, 2012, p.193).AttitudesIn the role of becoming a professional nurse, my attitude to environmental health and how that impacts the health care facility where I work has changed. I have become aware of the importance of working in a healthy and safe environment. The interventions that we have implemented in our department is recycling of plastics and disposing of hazardous materials in the appropriate waste bags. We have a protocol when using therapeutic chemicals and drugs. Nurses play a vital role in “reducing the ecological footprint of the healthcare industry and in mitigating the impact of the disposal of medical waste, including pharmaceuticals on communities and the global environment” (White & O’Sullivan, 2012, p. 202). As a professional nurse we can impact the environment by promoting a positive working environment. The acoustic environment can also have an impact on health care and patient outcomes. I try to minimize the noise and lighting in our patient’s room to create a safe and positive outcome for the patient. The hospital where I work takes a positive outlook on environmental health and innovative ways to protect the planet. The roof on our facility has a green roof. This green roof provides low maintenance, increases greater insulation and provides a healing and relaxing environment for families and patients (as cited in Metro Health, 2013). The hospital also promotes a healthy environment by hosting a farmer’s market that supports the local business and farmers in the area.ReflectionIn writing this paper and reviewing the nurses’ code of ethics and the ANA professional standards, I have developed a new outlook on what it means to be a professional nurse. Over the last 20 years of nursing, I have utilizing some of these standards without comprehending or understanding the motives behind the care I provide.I have developed an appreciation for these ANA standards and how it relates to the care that I provide for my patients. The ANA standards that I have identified the most with are evidence based practice, communication and collaboration. I have learned the significance of researching and how that can improve my daily nursing practice. I have realized the importance of being a patient advocate and how interdepartmental communication is vital to my responsibility to my patient in helping them achieve the best outcome for their care.I have learned the importance of accountability, autonomy and how understanding the scope of my practice can make me a more effective leader. I have learned that knowledge is powerful and I can be a role model in empowering my patients to be active participants in the care that is given to them.ConclusionOver the last couple decades of working as a nurse, I have worked in three different specialty units. I have had many clinical experiences that have helped mature the nurse that I have become today. I have gained knowledge, developed skills and learned many unique attitudes related to nursing and the patients that I care for. I have developed an understanding of the fundamentals of person, environment and health and how they help guide the care that I provide for my patients.In transition to becoming a bachelor prepared nurse, I have continued to nurture my knowledge in nursing and have welcome the opportunities for growth as I continue my life long learning. I have become acquainted with the nurses’ code of ethics and the ANA professional standards and how they can enhance my knowledge of nursing as a whole. ReferencesBlack, B. P. (2014). Professional nursing: Concepts and challenges (7th ed.). Maryland, Missouri: Saunders.Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., & Warren, J. (2007). Quality safety education for nurses. Nursing Outlook, 55(3), 122-131.Joint Commission of Accreditation of Health Care [JACHO] (2012). Surgical care improvement project. Retrieved September 19, 2013 from Health, (2013a). Antibiotic pre surgical criteria. Metro Health policy 2013Metro Health, (2013b). Green roof. Retrieved from http:://Metro Health, (2013c). Preparing the skin before surgery. Metro Health policy 2013Philosophy, (n.d.) (2013). Merrier- Webster’s on-line dictionary (11th ed.) Retrieved from http:://dictionary/philosophyPender, N., Murdaugh, C., & Parsons, M. A. (2011). Health promotion in nursing practice (6th ed.). Upper Saddle River, New Jersey: Pearson.Rothrock, J. C. (2012, June 13). What Can Perioperative Nurses do to Prevent DVT? Retrieved October 13, 2013 from , K. M., & O’Sullivan, A. (2012). The essential guide to nursing practice: Applying ANA’s scope and standards in practice and education. Washington D.C.: American Nurses Association [ANA]. ................
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