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Self-Assessment of Standards of Professional Nursing PracticeRhonda Jones Ferris State UniversityAbstractThe American Nurses Association (ANA) provides nurses with standards of professional nursing practice and have published the information in the Nursing: Scope and Standards of Practice. The ANA identifies sixteen standards that act as a guide for nurses to incorporate into professional practice. The standards are divided into two sections: Standards of Practice that include six standards and Standards of Professional Performance that include ten standards (ANA, 2010). The ANA is widely recognized as a leader and voice for the nursing profession. The standards provided by the ANA have become the gold standard for professional nursing accountability. It is this reason that all nurses must be knowledgeable of the standards for professional nursing practice to improve patient care and direct professional development. Utilizing the ANA’s Standards for Professional Practice (ANA, 2010) I have reviewed, reflected, and analyzed each of the sixteen professional standards to identify my competency, develop an action plan to correct or improve my professional development, and creates measureable goals with an evaluation plan. Self-Assessment of Standards of Professional Nursing PracticeAll professions are directed by standards that act as a guide for professional performance and development. The ANA is a nursing organization that has developed standards to guide professional nursing practice and work in conjunction with specialty organizations to further delineate specialty standards. At the present time the ANA has not published the current specialty standards for home health care nursing. Therefore the information provided will be from the generic standards used by the entire nursing profession. The ANA, founded in 1896, first published a set of nursing standards in 1973 and has continuously provided guidance and revisions to these standards with the most recent edition being published in 2010 (ANA, 2010, p. 87-89). These standards guide all nurses in professional practice and inform the public of the standards that a professional nurses “are expected to preform competently” (ANA, 2010, p. 31). The ANA has developed six Standards of Practice and ten Standards of Professional Performance (ANA, 2010). Just as the ANA periodically reviews and revises standards for the nursing profession it is the responsibility of individual nurses to review their professional standards to critically reflect, analyze, and evaluate personal performance in order to maintain and improve on competency for each standard. I have performed such reflection, analysis, and evaluation on each of the sixteen areas identified by the ANA for the Standards of Professional Nursing Practice (ANA, 2010). Based on my findings I have developed a professional development plan to identify goals, an action plan to achieve the goals, and identify how evaluation of the action plan will be monitored to improve and guide my professional nursing practice. Standards of PracticeStandard 1: Assessment Assessment is the collection of “comprehensive data pertinent to the healthcare consumer’s health or situation” (ANA, 2010, p. 32). Competencies provided by the ANA (2010) for this standard state the importance of a comprehensive and holistic assessment that include patients, families, the environment, identification of barriers, prioritizing care based on needs, using evidence-based practice, and integrating the data for each individualized case. As practicing registered nurse (RN) for over eighteen years I continuously improve on assessment skills with patients and families. As a home care nurse I have been trained and provide training to new nurses on a comprehensive computerized assessment mandated by Medicare. This assessment is an evidence-based program that incorporates all areas defined by the ANA. The information obtained is used to develop an individualized care plan for each patient that includes their environment. This information is discussed with all applicable team members to provide the best care for each patient. Subscription to The Journal Home Healthcare Nurses has provides me with continued education that improves my assessment skills for home care patients to remain competent in this standard. Standard 2: DiagnosisThe ANA (2010) defines diagnosis as analysis of “the assessment data to determine the diagnoses or the issues” (p. 34). Home care has provided me with the opportunity to provide care to patients in their home and work closely with patients to identify issues that are important to not only the health care team but to the patient, family members, and caregivers in an environment that is unique to each individual. I regularly include patients, family members, and interdisciplinary team members to identify diagnoses and issues for each case that I manage. To maintain competency in this standard I plan to continue frequent assessment and communication with all of the health care team to identify diagnoses and issues that are pertinent for the care of the patient that result in positive outcomes. Standard 3: Outcomes IdentificationOutcome identification is the process of identifying “expected outcomes for a plan individualized to the healthcare consumer or the situation” (ANA, 2010, p. 35). Outcomes are developed by an interdisciplinary health care team that includes patients and families (ANA, 2010). Outcomes need to be culturally sensitive, consider the values and ethics of the patient, and evaluate the risks, benefits, cost, and scientific evidence in the development of outcome measures (ANA, 2010). Outcomes need to include measureable goals with a time frame for completion, a way to evaluate the outcome, and be modifiable to address the needs of the patient (ANA, 2010). Upon admission to home care every patient has a plan of care initiated in conjunction with the patient and an interdisciplinary team that is measureable and time sensitive. In my practice I review the plan of care at each visit with the patient and revise the plan as needed in collaboration with the patient and the interdisciplinary team. I also participate in bi-monthly team meetings to discuss issues and needs of the patient with other health care team members. I plan to continue my competency in this standard with continued interactions with patients, family members, caregivers, and team collaboration to achieve positive outcomes for each patient. Standard 4: PlanningThe ANA (2010) states “the registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes” (p. 36). The plan is an integral part to obtain the best possible outcomes for patients. The plan is formulated with the patient and a healthcare team that addresses diagnoses and issues relevant to the patient, is time specific, considers the cost factors, incorporates evidence-based practice, and provides direction for all team members (ANA, 2010). Upon admission to home care I develop a plan of care with the patient that reflects the needs and expectations of each patient. This plan of care is communicated to all members of the healthcare team to provide continuity of care and considers organizational protocols. I plan to maintain competency in this standard by continuing to communicate with healthcare team members and patients to implement and adjust the plan of care as warranted by changes in the patient’s condition or situation. This is performed with full awareness of my scope of practice, organizational guidelines, and State regulations. Standard 5: ImplementationThe ANA (2010) states “the registered nurse implements the identified plan” (p. 38). This also includes “coordination of care delivery” (p. 40) and to utilize “strategies to promote healthy and safe environment” (p. 41). Implementation of the plan is performed by recognizing the uniqueness of each individual and family and providing a compassionate, caring, therapeutic environment. In my current practice I must evaluate the needs of the patient, provide referrals to community resources, and evaluate barriers to achieving outcomes. I need to be aware that not every patient and every situation can be treated in the same manner and continually strive to acknowledge that each case may need to be managed in a different format. I plan to remain competent with this standard by reviewing current literature, researching evidence-based practice guidelines, and obtain from each patient experience. Standard 6: EvaluationThe ANA (2010) defines evaluation as the ability of the nurse to “evaluate progress toward attainment of outcomes” (p. 45). Evaluation of interventions and goals is an ongoing process that includes the patient and healthcare team members to determine if the progress toward goals is being met or if the goals need to be revised (ANA, 2010). Frequent evaluation ensures that the interventions have the ability to provide positive outcomes and allow for revision in the plan of treatment as needed. My home care agency utilizes electronic documentation and communication for all patients. Information is disseminated to all members of the health care team. This provides the entire team the ability to constantly evaluate the patient’s reaction to interventions and progress towards goals. I plan to maintain competency in this standard by reviewing journal articles that relate to team collaboration and remaining current with all evidence-based instruments and practices. Standards of Professional PerformanceStandard 7: Ethics The ANA (2010) states “the registered nurse practices ethically” (p. 47). Every patient has the right to be respected and treated with dignity incorporating their values and beliefs (ANA, 2010). Nurses must deliver care that respects the rights of the patient that includes confidentiality and includes the patient as a member of the healthcare team (ANA, 2010). Nurses must be an advocate, assist patients in making informed decisions, and maintain a therapeutic relationship with all patients (ANA, 2010). I value the individuality of each of my patients but I am aware that I must personally assess my own values and morals to be able to accept each patient as a unique individual. My organization does have an ethics committee that can be consulted on issues that cannot be resolved with patient interactions or concerns that have been identified with patient care. I would like to further my knowledge on this subject by observing a case that is brought to the ethically committee. I will maintain competence in this standard by reviewing professional journals on literature that discuss providing ethical care to patients and reflection of personal values and morals on an annual basis. Standard 8: EducationEducation is defined by the ANA (2010) as “the registered nurse attains knowledge and competence that reflects current nursing practice” (p. 49). Nursing is a dynamic profession that continues to evolve and change. To be competent in this standard a professional nurse needs to participate in continuing educational opportunities, self-assessment to identify knowledge deficits, active learn from past and new experiences, share knowledge with peers, and maintain profession records that “provide evidence of competence and lifelong learning” (ANA, 2010, p. 49). Nurses need to be lifelong learners in order to stay current with the changing nursing environment and technical changes that are needed. I exhibit competency in this standard by maintaining the continuing education requirements mandated by the State of Michigan Board of Nursing, attending yearly seminars, participating in required yearly organizational learning modules, and subscribing to peer reviewed nursing journals. I maintain records of all educational competencies and certifications that have been obtained. I provide mentorship to peers that are obtained from informal and formal educational experiences. I am currently enrolled in the Bachelor of Science in Nursing (BSN) program to enrich and enhance my professional abilities with a planned graduation date in May of 2015. I plan to maintain this standard by obtaining my BSN degree, applying for a Master’s of Science in Nursing (MSN) program, and continuing to subscribe and evaluate current nursing information from professional journals. Standard 9: Evidence-Based Practice and ResearchThe ANA (2010) states “the registered nurse integrates evidence and research findings into practice” (p. 51). The use of evidence-based practice (EBP) has developed and evolved through research, clinical experience, and clinical evidence to direct patient care. The ANA (2010) states competencies in this standard by utilizing EBP, including EBP in practice, contributing to EBP through research, and sharing knowledge and “research findings with colleagues and peer” (p. 51). I find myself understanding the rationale behind EBP since enrolling in the BSN program and incorporating EBP daily in the care of my patients. I plan to maintain competency in this standards by being a lifelong learner, staying current with EBP by reviewing professional journals, and attending seminars to guide professional nursing practice. Standard 10: Quality of PracticeQuality of practice is the action of contributing “to quality nursing practice” (ANA, 2010, p. 52). Competencies for this standards is obtained by providing quality nursing services in patient care, documentation, demonstrating accountability, and engaging in quality improvement projects (ANA, 2010). I actively participate in quality improvement initiatives and projects at the department and organizational level. I am currently involved in a departmental quality improvement project for medication reconciliation. This project has been implemented to improve patient outcomes for medication compliance and reduce the number of medication errors that occur with home care patients. I plan to maintain this standard by actively participating in quality improvement projects, collect data that is needed, monitor the effectiveness of my practices, and be involved in community activities that reinforce a positive image for the nursing profession. Standard 11: CommunicationCommunication is the act of effective use of communication “in a variety of formats in all areas of practice.” (ANA, 2010, p. 54). The ANA (2010) states this need to present in every aspect of communication with patients and health care team members. It is important for nurses to understand the type of communication that is needed by the receiver and to perform reflective analysis on the type of communication level that the sender projects. Interdisciplinary communication needs to be professional and effective to improve patient care and eliminate ineffective or unsafe care (ANA, 2010). To maintain this standard I perform reflective analysis encounters that occur with patients and colleagues and strive to improve patient outcomes with effective appropriate communication to patients. I acknowledge that this is an ongoing process that can be improved upon with continued informal and formal education. Standard 12: LeadershipThe ANA (2010) defines this standard as the ability of the nurse to “demonstrate leadership in professional practice setting and the profession” (p. 55). I am a member of the State and National ANA organization but recognize the need to actively participate at a local level and have been unable to do so at this time due to time restraints. I exhibit leadership skills by mentoring peers in my department, acting as case manager to home care patients, embracing the organizational and department vision statements, and being a lifelong learning role model for peers. One of my goals is to eventually obtain a management position within my organization and I will need to continue my informal and formal education in leadership to obtain this goal. Standard 13: CollaborationCollaboration is the act of the nurse to collaborate “with healthcare consumer, family, and others in the conduct of nursing practice” (p. 57). Collaboration in home care is essential to obtain the best outcomes for patients. This includes working with an interdisciplinary team, several physicians, patients, family, and caregivers. The entire team needs to work as a collective whole and understand the needs and expectations of the patient. This often includes brain storming team meetings to discuss the best possible options for the patient that results in effective intervention to achieve patient goals and improve outcomes. I plan to maintain competency in this standards by effectively and efficiently communicating with physicians, patients, families, caregivers, and healthcare team members on all aspects of patient care. Standard 14: Professional Practice EvaluationThe ANA (2010) states “the registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations” (p. 59). I demonstrate competencies in this standard by participating in yearly learning modules on cultural diversity, age appropriate care, and ethically appropriate care. I engage in a yearly organizational performance evaluation that reflects on my strengths and weaknesses, encourage constructive criticism of my practice, and provide constructive criticism to my peers. I encourage patients to respond to satisfaction surveys and ensure them this is used as a learning tool for the organization that can improve patient care at all levels. I plan to maintain competency in this standard by continuing in self-assessment of my practice and continuing my education by obtaining a MSN. Standard 15: Resource UtilizationResource utilization is the action of using “appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible” (p. 60). Home care is not excluded from the financial restraints that have been placed on health care. As reimbursement from payers declines and conditions are placed on payment for home care services the agency must address areas that can reduce costs while maintaining quality care that produces exceptional outcomes for patients. I have demonstrated competency in this standard by assessing the needs of the patient that can be provided by free or no cost community agencies. This is also accomplished with the use of licensed practical nurses as team members in home care and the RN performing the role of case manager. I plan to maintain competency in this standard by perfecting my skills as a case manager with continuing informal and formal education. Standard 16: Environmental HealthThe ANA defines this standard as “the registered nurse practices in an environmentally safe and healthy manner” (p. 61). I participate in yearly safety courses at organizational and department levels to evaluate safety and environmental issues that can cause personal harm and be hazardous to the community. Competences in the knowledge and use of personal protective equipment, isolation protocols, emerging infection control issues, and maintaining standard precautions is essential in home care to protect myself, patients, other staff members, and the community from harm. Upon reflection of this standard I am aware that I need to become more actively involved in community management programs that foster health promotion. Professional Development Plan GoalsUpon reflection of the ANA’s Standards of Professional Nursing Practice I realize that I am competent in the basic standards but acknowledge there is always areas that can be enhanced and improved upon with continued formal and informal education. I have developed five goals that will enhance my progression as a professional nurse within the standards of assessment, ethics, education, leadership, and community. The first goal is to become an expert in assessment data collection for home care patients. The second goal is to inquire and become knowledgeable on ethical committee proceedings. The third goal is to complete by BSN degree and apply for a MSN degree program. The fourth goal is to obtain a management mentor within my department to provide guidance for transition to a management position. The fifth goal is to volunteer for community projects that improve and educate on health promotion.Action PlanI plan on applying and scheduling to test to become certified as a clinical specialist in the collection of the Medicare mandated outcome and assessment information set that is used for all home care patients in May of 2014. I will be able to share this knowledge with my colleagues to ensure that my agency is providing exceptional assessment and data collection on every patient in home care. I plan on requesting permission by January 2014 to observe the first available ethical committee meeting. This will assist in a clearer understanding of the process and procedures that are needed to make ethical decisions for care of a patient at an organizational level. I plan to complete the BSN program in May of 2015. I plan to apply to a MSN program by August of 2015. Continuing education provides me with opportunities for growth as a professional nurse and in my future as a nurse manager. In January of 2014 I plan to inquire and request if a current manager in home care will be able to partner with me in a mentorship program to assist me in obtaining the skill sets that I will be need in a nurse manager position. In July and August of 2014 I plan on volunteering for community health promotion projects that are sponsored by my organization at county fairs and senior centers. This will provide me with a better sense of community needs and build on a relationship between professional nurses and the community. Evaluation PlanI plan on performing an evaluation on my goals and timelines for completion of the goals every six months in June and December. Frequent evaluation provides me with the opportunity to reflect on the progress toward my goals and make revision to the goals as warranted. Evaluation will include examination of the barriers that may have been present that prevented the accomplishment of a planned goal. Yearly evaluation of competencies will be performed on all sixteen Standards of Professional Nursing Practice to ensure that I am performing as a competent professional nurse and new goals will be established for improvement of my professional practice as they are discovered. ConclusionEvery nurse needs to periodically review the standards of professional practice by the ANA or their individual specialty organization. These are the standards that all nurses are held accountable to for providing care to patients and communities. Upon review, reflection, and critical analysis, personal deficits can be identified in standards of care that need to be improved upon and corrected to be a competent professional nurse. An action plan with identifiable and measurable goals can then be developed with periodic evaluation to determine if the goals have been met or need to be modified. This type of professional analysis allows a nurse to provide exceptional evidence based care for patients and improve the nursing profession. Organizations, communities, and patient expect that nurses are competent in all of the professional standards and it is the responsibility of each nurse to continually develop their skills to maintain and exceed these standards. The nursing profession continuously evolves and individual nurses need to evolve with the profession. It is the responsibility of every nurse to evolve with the professional by evaluating competency, develop a plan to correct deficits, improve upon strengths, and continue to improve the nursing profession. This self-assessment of the sixteen standards provided by the ANA has allowed me to evolve in the nursing profession. ReferencesAmerican Nurses Association. (2010). Nursing: Scope and standards of Practice (2nd ed.). Silver Springs, Maryland: CHECKLIST FOR SUBMITTING PAPERSCHECKDATE, TIME, & INITIALPROOFREAD FOR: APA ISSUESAE/RJ1. Page Numbers: Did you number your pages using the automatic functions of your Word program? [p. 230 and example on p. 40)]AE/RJ2. Running head: Does the Running head: have a small “h”? Is it on every page? Is it less than 50 spaces total? Is the title of the Running head in all caps? Is it 1/2” from the top of your title page? (Should be a few words from the title of your paper). [p. 229 and example on p. 40]AE/RJ3. Abstract: Make sure your abstract begins on a new page. Is there a label of Abstract and it is centered at the top of the page? Is it a single paragraph? Is the paragraph flush with the margin without an indentation? Is your abstract a summary of your entire paper? Remember it is not an introduction to your paper. Someone should be able to read the abstract and know what to find in your paper. [p. 25 and example on p. 41]AE/RJ4. Introduction: Did you repeat the title of your paper on your first page of content? Do not use ‘Introduction’ as a heading following the title. The first paragraph clearly implies the introduction and no heading is needed. [p. 27 and example on p. 42]AE/RJ5. Margins: Did you leave 1” on all sides? [p. 229]AE/RJ6. Double-spacing: Did you double-space throughout? No triple or extra spaces between sections or paragraphs except in special circumstances. This includes the reference page. [p. 229 and example on p. 40-59]AE/RJ7. Line Length and Alignment: Did you use the flush-left style, and leave the right margin uneven, or ragged? [p. 229]AE/RJ8. Paragraphs and Indentation: Did you indent the first line of every paragraph? See P. 229 for exceptions.AE/RJ9. Spacing After Punctuation Marks: Did you space once at the end of separate parts of a reference and initials in a person’s name? Do not space after periods in abbreviations. Space twice after punctuation marks at the end of a sentence. [p. 87-88]AE/RJ10. Typeface: Did you use Times Roman 12-point font? [p. 228]AE/RJ11. Abbreviation: Did you explain each abbreviation the first time you used it? [p. 106-111]AE/RJ12. Plagiarism: Cite all sources! If you say something that is not your original idea, it must be cited. You may be citing many times…this is what you are supposed to be doing! [p. 170]AE/RJ13. Direct Quote: A direct quote is exact words taken from another. An example with citation would look like this:“The variables that impact the etiology and the human response to various disease states will be explored” (Bell-Scriber, 2007, p. 1).Please note where the quotation marks are placed, where the final period is placed, no first name of author, and inclusion of page number, etc. Do all direct quotes look like this? [p. 170-172]AE/RJ14. Quotes Over 40 Words: Did you make block quotes out of any direct quotes that are 40 words or longer? [p. 170-172]AE/RJ15. Paraphrase: A paraphrase citation would look like this:Patients respond to illnesses in various ways depending on a number of factors that will be explored (Bell-Scriber, 2007). It may also look like this: Bell-Scriber (2007) found that…… [p. 171 and multiple examples in text on p. 40-59]For multiple references within the same paragraph see page 174.AE/RJ16. Headings: Did you check your headings for proper levels? [p. 62-63].AE/RJ17. General Guidelines for References: A. Did you start the References on a new page? [p. 37]B. Did you cut and paste references on your reference page? If so, check to make sure they are in correct APA format. Often they are not and must be adapted. Make sure all fonts are the same.C. Is your reference list double spaced with hanging indents? [p. 37]PROOFREAD FOR GRAMMAR, SPELLING, PUNCTUATION, & STRUCTUREAE/RJ18. Did you follow the assignment rubric? Did you make headings that address each major section? (Required to point out where you addressed each section.)AE/RJ19. Watch for run-on or long, cumbersome sentences. Read it out loud without pausing unless punctuation is present. If you become breathless or it doesn’t make sense, you need to rephrase or break the sentence into 2 or more smaller sentences. Did you do this?AE/RJ20. Wordiness: check for the words “that”, and “the”. If not necessary, did you omit?AE/RJ21. Conversational tone: Don’t write as if you are talking to someone in a casual way. For example, “Well so I couldn’t believe nurses did such things!” or “I was in total shock over that.” Did you stay in a formal/professional tone?AE/RJ22. Avoid contractions. i.e. don’t, can’t, won’t, etc. Did you spell these out?AE/RJ23. Did you check to make sure there are no hyphens and broken words in the right margin?AE/RJ24. Do not use “etc.” or "i.e." in formal writing unless in parenthesis. Did you check for improper use of etc. & i.e.?AE/RJ25. Stay in subject agreement. When referring to 1 nurse, don’t refer to the nurse as “they” or “them”. Also, in referring to a human, don’t refer to the person as “that”, but rather “who”. For example: The nurse that gave the injection….” Should be “The nurse who gave the injection…” Did you check for subject agreement? AE/RJ26. Don’t refer to “us”, “we”, “our”, within the paper…this is not about you and me. Be clear in identifying. For example don’t say “Our profession uses empirical data to support ….” . Instead say “The nursing profession uses empirical data…..AE/RJ27. Did you check your sentences to make sure you did not end them with a preposition? For example, “I witnessed activities that I was not happy with.” Instead, “I witnessed activities with which I was not happy.”AE/RJ28. Did you run a Spellcheck? Did you proofread in addition to running the Spellcheck?AE/RJ29. Did you have other people read your paper? Did they find any areas confusing?AE/RJ30. Did you include a summary or conclusion heading and section to wrap up your paper?AE/RJ31. Does your paper have sentence fragments? Do you have complete sentences? AE/RJ32. Did you check apostrophes for correct possessive use. Don’t use apostrophes unless it is showing possession and then be sure it is in the correct location. The exception is with the word it. It’s = it is. Its is possessive. Signing below indicates you have proofread your paper for the errors in the checklist:_____Rhonda Jones__________________________________DATE:___November 28, 2013__________A peer needs to proofread your paper checking for errors in the listed areas and sign below_____Angela Ekema________________________________DATE:___11/27/13_________________Revised Spring 2010/slc ................
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