Caring in Nursing



Caring in NursingNick KurekFerris State UniversityAbstractWhat is caring? What does it mean? What is the importance and purpose of caring? How does it apply to nursing? How do I apply it in my practice? What difference does it make? These are questions that are essential for every nurse to contemplate. Caring is inherent to nursing. This paper explores what is and what is perceived to be caring in nursing. The integration of caring and nursing theory in practice is inevitable and essential. Today’s healthcare environment calls for caring in quality and safety improvement. The reader is left with some proverbial “food for thought” to ruminate upon.Caring in NursingWhat is caring? The Free Dictionary (2013) states “caring is a feeling and exhibiting concern and empathy for others; showing or having compassion”. What is nursing? The Free Dictionary (2013) states “nursing is the practice or profession of caring for the sick and injured; the work of caring for the sick or injured or infirm; the tasks or care of a nurse”. Caring is inherent to nursing. In fact, Lachman (2012) states “caring and nursing are so intertwined that nursing always appeared on the same page in a Google search for the definition of caring” (p. 112). Some consider it to be the heart of nursing. Theory BaseCaring is an integral part of nursing. Several nursing theorist have caring within the very names of their theories: Jean Watson’s Theory of Human Caring; Marilyn Ray’s Theory of Bureaucratic Caring; Kari Martinsen’s Philosophy of Caring; Katie Erikson’s Theory of Caritative Caring; Dorothy Orem’s Self-Care Theory; Anne Boykin’s and Savina Schoenhofer’s Nursing as Caring; Madeleine Leininger’s Culture Care; Kristen Swanson’s Theory of Caring; and Adeline Falk-Rafael’s Critical Caring. In fact, caring is either directly addressed or implied in every major nursing theorist’s work from the recognized founder of modern nursing, Florence Nightingale to today’s Adeline Falk-Rafael. Why is this? Merrill, Hayes, Clukey, & Curtis (2012) inform us “Florence Nightingale wrote that caring is the foundation of nursing practice” (p. 33). Tomey & Alligood (2006) quote nursing theorist Marilyn Ray:Caring is defined as a complex, transcultural, relational process, grounded in an ethical, spiritual context. As such, caring is the relationship between charity and right action, between love as compassion in response to suffering and need, and justice or fairness in terms of what ought to be done. Caring occurs within a culture or society, including personal culture, hospital organizational culture, or society and global culture (M. Ray, personal communication, March 27, 2002) (p.121).Jean Watson Jean Watson developed the Theory of Human Caring. It is also known as the Theory of Transpersonal Caring and The Caring Model. Caring is the basis of her theory (see Appendix A). Simply put, Watson’s theory is a holistic approach which addresses the wholeness and calls for the nurse to provide care for both patients and their families on multiple levels including body, mind, and soul/spirit. Her theory is based on 10 Carative Factors (see Appendix B). The 10 Carative Factors are known as Caritas. Caritas is the Latin word for charity/love. The Free Dictionary (2013) informs us that in Christian theology caritas is altruistic love (“an unlimited loving-kindness toward all others”) as well as the greatest of the 3 theological virtues (faith, hope, and charity/love). Watson (2005) explains: The changing nature of the Carative Factors indicates their evolution to incorporate a more explicit relationship between Caring and Love, moving toward using the language of “Caritas,” closely related to the original term Carative but conveying a deep form of transpersonal caring and love to come into play as part of a caring-healing perspective guiding Caring Science (p.3). Watson’s theory is evolving and is deeply intellectual. There are nurses who are uncomfortable with her views and concepts. Her perspective on caring, as well as her theory for that matter, is complex and can be a little confusing. Tomey & Alligood (2006, p. 94) break it down and explain:Caring is a moral ideal rather than a task-oriented behavior and includes such characteristics as the actual caring moment, phenomena that occur when an authentic caring relationship exists between the nurse and the patient (p. 94).Madeleine Leininger Madeleine Leininger is considered the founder of transcultural nursing. Leininger developed the Theory of Culture Care Diversity and Universality. Caring is the basis of her theory. Vance (2003) states “Madeleine Leininger subscribed to the central tenet that “care is the essence of nursing and the central, dominant, and unifying focus of nursing” (Leinginger, 1991)” (para. 6). Leininger’s Culture Care is rather complex (see Appendix C). Tomey & Alligood (2006) quote Leininger:The purpose of the theory was to discover human care diversities and universalities in relation to world view, social structure, and other dimensions cited, and then to discover ways to provide culturally congruent care to people of different or similar cultures in order to maintain or regain their well-being, health, or face death in a culturally appropriate way (p.476).The goal of the theory is to improve and to provide culturally congruent care to people that is beneficial, will fit with, and will be useful to the client, family, or culture group in healthy life ways.Caring is the basis of both Leininger’s and Watson’s theories. It is not surprising to find that Leininger and Watson were co-editors of a book in 1990 titled The Caring Imperative in Education. Theories and concepts continuously evolve. Nurses work with and expand upon existing theories.Adeline Falk-Rafael Adeline Falk-Rafael developed the Critical Caring Theory. Her theory for public health nursing was the natural evolution of other theories. Falk-Rafael (2005) states:Critical caring transforms the carative processes of Watson’s theory into 7 carative health-promoting processes that form the “core” of public health nursing practice and reflect the legacy and reality of public health nursing practice (p. 38).Falk-Rafael’s theory is simple, yet complex. It is illustrated in a tree diagram (see Appendix D). Falk-Rafael (2005) explains:Theory provides roots to ground practitioners of a discipline. Although the tree above the roots may bend with winds of changing trends, although it may be grafted with branches from other trees and evolve in a new variety, theory that is nourished by practice is a living and growing entity that provides support for practice while dynamically defining the characteristics and parameters of practice (p.39).Abraham MaslowAbraham Maslow was a psychologist who developed a theory of human development. His theory is illustrated in a familiar 5 level pyramid diagram known as Maslow’s Hierarchy of Needs (see Appendix E). The premise is that each of the five levels represents a need that must be obtained before an individual can move up to meet the next. The five levels starting from the basic (bottom up) are physiological, safety, love/belonging, esteem, and self-actualization. Maslow’s theory is taught to all nursing students. It is a way of assessing patients’ needs. Lachman (2012) states “Care is crucial for human development, and is first and foremost aimed at physical needs” (p.114). Caring is essential to reach self-actualization and beyond. Watson (2005) states:The notion of a living, sacred cosmos, within Reason’s view, can inform our notions of inquiry so we can develop a new kind of sacred science. Thus, such a science that restores the metaphysical integrates “a critical, self-reflexive consciousness with a deep experience of the sacred, and would thus make a major contribution to what Maslow (1971) referred to as the ‘further reaches’ of human nature (Reason, 1993)” (p.25).Assessment of the Healthcare EnvironmentHealthcare is a business. Right, wrong, or indifferent healthcare costs money. Our ever increasing understanding of the human body, diseases, and science coupled with corresponding advances in technologies, enable providers with the right resources to provide a higher quality and quantity of life than in years past. This reality brings many questions of quantity verses quality. The evolving field of medical ethics and the increasing cost of care will inevitably dictate the care that is ultimately provided. Money matters. Health care facilities need money to provide care. People are much more informed and involved with their care than in years past. Patients and families are aware of the treatment options and choices that are available. The government and insurance companies, who provide reimbursement and as such essentially and arguably dictate healthcare, are also aware of this. As a direct result of this evolution, both quality of care and patient satisfaction have become markers for reimbursement. Jeffs et al. (2013) state:A renewed focus has been placed on the importance of patient care and family members’ experiences as a key part of quality patient care. Fundamental to nursing practice is establishing therapeutic partnerships with patients and family members to ensure quality care and optimal patient experiences (p.83).Nursing is becoming increasingly more complex. Nurses must be cognitive of patient satisfaction while providing care for the whole of a person as well as their families/loved ones. The nursing paradigm is shifting. It must be understood that hospitals are very intimidating and scary places for those that are not in the medical field. The continuous advancement of science, medicine, and technology is readily evident in all the monitors and equipment. Frequently the nurses are very focused on the patient’s physical condition. Moreover with all the technological advances come increased accountabilities and responsibilities for the nurses. Watson (2005) states “society is in a critical situation today in sustaining human caring ideals and a caring ideology in practice” (p. 19).Unfortunately, many people in today’s fast paced society never take the time to contemplate their own mortality until they or a loved one become seriously ill and end up in the healthcare arena. This includes some healthcare providers. Nurses must be aware of this.Inference/Implications/ConsequencesNurses need to set the example. Over the years, many parents have advised their children to get to know themselves before they start in a relationship with the logic being that you have to have yourself before you can share yourself with anyone else. We need to have an understanding of who we are, where we’ve been, lessons learned along the way, and the practical application of them. This is true of nursing. Nurses need to set the example. The implications and ramifications of self-care are explained by Watson (2005) who states:Our ability to sustain our caring ideal and ideology in practice will affect the human development of civilization and determine the health profession’s contribution to society; as a beginning we have to impose our own will to care and love upon our own behavior and not on others. We have to treat ourselves with gentleness, loving kindness, equanimity, and dignity before we can respect and care for others with gentleness, kindness, equanimity, and dignity (p.19).In their time of need patients and their loved ones look to the nurse. Nursing is continuously evolving. Advances in technology coupled with fiscal reality have resulted in increased demands on nurses. Clukey, Hayes, Merrill, & Curtis (2009) found that “appearing hurried and abrupt was noted as a behavior that was not caring” (p.73). Body language can speak volumes. Today’s nurse must understand this. Merrill, Hayes, Clukey, & Curtis (2012) state, “Caring is the heart and artistry of nursing so understanding what actions, attitudes, and behaviors convey caring is essential to good practice” (p.36). Today’s nurse must be cognitive of what they are doing and how they are doing it. The intent and perception of actions can cause misunderstanding. Nurses must not only be aware of transcultural differences and needs, they need to incorporate it into their practice. Body language which can be interpreted to mean different things in different cultures, often speaks louder than words. Vance (2003) states “the top ten caring behaviors, derived from nursing literature, are: attentive listening, touch, comforting, sensitivity, honesty, respect, patience, responsibility, providing information so the patient can make an informed decision, and calling the patient by name” (para. 4). While these seem like relatively simple things, it is often the simple things that get over looked – even though they arguably matter the most. Clukey, Hayes, Merrill, & Curtis (2009) found that “the dominant behavior identified as being caring was explaining what was going on and interpreting medical jargon” (p.73). Patient satisfaction matters. Nurses must care for the whole patient. This includes providing for spiritual care. Wall, Engelberg, Gries, Glavan, & Curtis (2007) conducted a cross-sectional study to assess what effects family satisfaction with spiritual care provided at end of life in the Intensive Care Unit. The researchers found that families were more satisfied when clergy was involved in the last 24 hours of the patient’s life. They also recommended that care providers “assess spiritual needs sooner than later” and that “further research should be conducted” (p. 1090). Many nurses are uncomfortable with spiritual care. We need to embrace our theorists: Leininger‘s transcultural teachings and Watson’s Transpersonal Caring to provide and care for Maslow’s needs. Weiland (2010) states:Nurses report feeling confused and uncomfortable providing spiritual care. In part, this dilemma stems from lack of education, knowledge, and confidence in assessing the spiritual domain. The outcome is that patients may not receive the spiritual care they need at a time when they are most vulnerable, feeling loss, separation from the world, and powerlessness. Thus, ignoring the spiritual dimension of care may impede drawing upon a powerful inner source of strength and hope – it could also be construed as unethical (p. 283-4).Addressing and providing spiritual care does not have to be scary. Lundberg & Kerdonfag (2010) conducted an explorative qualitative study to explore how Thai critical care nurses provided spiritual care to their patients. The researchers found that “the nurses identified presencing, supporting and encouraging religion, communication, and education as providing spiritual care”. The researchers concluded that “spiritual care is important to meet patients’ needs and nurses should be educated to provide spiritual care” (Lundberg & Kerdonfag, 2010).The take away is seemingly simple: include, acknowledge, explain things to, and communicate with both patients and their loved ones and families. Nurses must remember presencing and active listening are very effective spiritual interventions. Nurses must care for the whole patient and failure to do so can be construed as unethical and potentially neglectful.Recommendations for Quality and Safety ImprovementsQuality and safety are major issues in healthcare. In fact healthcare itself is a major issue. The growing and aging population is placing increased demands on the healthcare system that is already struggling to accommodate increased abilities with stretched resources in the face of both nursing and physician shortages. This is all taking place in the setting of a struggling national and global economy. Healthcare facilities are stressed.Healthcare is an important issue. To better understand some current trends in both healthcare and nursing we must have a working knowledge of a couple major players. It is important that we know about the Robert Wood Johnson Foundation [RWJF] and the Institute of Medicine of the National Academies [IOM].Robert Wood Johnson was one of the founding brothers of the Johnson & Johnson Company. His son Robert Wood Johnson II founded the RWJF. It is the largest the nation's largest philanthropy devoted solely to the public's health (RWJF website, 2013). “The IOM is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public” (IOM, 2012, para. 1).?The American Nurses Association [ANA] is nursing’s main organization. The ANA (2004) informs us that “in 1999 the IOM described the nation’s healthcare system as fractured, prone to errors, and detrimental to safe patient care” and in 2001 “the IOM identified six aims for improvement so that the healthcare system is: safe, effective, patient centered, timely, efficient, and equitable” (p.19). In 2002, the ANA (2004) states:If problems in the work environment are not addressed, nurses will not be able to sufficiently protect patients. The impact of nursing staffing upon patient safety has been clearly demonstrated (Needleman & Buerhaus, 2003). The healthcare industry must address the adverse effects on nurses and patient safety of inadequate staffing, healthcare errors, episodes of failure to rescue, and the looming nursing shortage (p.20).The RWJF responded to the ANA. The RWJF funded the Quality and Safety Education for Nurses [QSEN] Initiative. QSEN (n.d.) states:Using the Institute of Medicine (2003) competencies for nursing, QSEN faculty have defined pre-licensure and graduate quality and safety competencies for nursing and proposed targets for the knowledge, skills, and attitudes to be developed in nursing pre-licensure programs for each competency: Patient-Centered Care, Teamwork & Collaboration, Evidence Based Practice, Quality Improvement, Safety, & Informatics (QSEN Institute website, para. 1).The RWJF also collaborated with the IOM. The IOM (2013, p. 1) informs us:The RWJF Initiative on the Future of Nursing, at the IOM, seeks to transform nursing as part of larger efforts to reform the health care system. The first of the Initiative’s three forums was held on October 19, 2009, and focused on safety, technology, and interdisciplinary collaboration in acute care. The second of the Initiative’s three forums, held on December 3, 2009, examined care in the community, focusing on community health; public health; primary care; and long-term care. The third forum was held on February 22, 2010 in Houston, and examined nursing education.The study was named the Future of Nursing. Donna Shalala (chair of the Committee on the RWJF Initiative on the Future of Nursing, at the IOM) states:This report is really about the future of health care in our country. It points out that nurses are going to have a critical role in that future especially in producing safe, quality care and coverage for all patients in our health care system (Initiative on the Future of Nursing: IOM recommendations, 2011, p. 1).Nursing is changing. Nurses must achieve and maintain new levels of competence on multiple levels. Rhodes, Morris, & Lazenby (2011) stated that “research suggests that nursing curricula can translate the desire to care into motivation for competence” (p.9).? QSEN will help nurses meet become more competent. Clukey, Hayes, Merrill, & Curtis (2009) state: While nursing education is focused on developing skills in providing proficient and safe care, the development and evaluation of appropriate interpersonal skills need attention in undergraduate education programs. An attitude of just getting the job done is observed by family members and does little to promote the image of nursing as a profession based on caring or on the hospital that employs them (p. 81).There is more to nursing than academic competence. Today’s nurse must have emotional intelligence (EI). Tubbs (2009) informs us that some define EI as “a combination of intrapersonal communication (personal competence) and interpersonal communication (social competence)” (p.43). This definition of EI is definitely desirable for nursing. Tubbs (2009) further explains:Whereas the ability to gather, interpret, analyze, and respond to data may be a function of technical competency, the ability to receive, interpret, analyze, and respond to messages, both external and internal, is regulated by one’s EI (p. 43).This definition of EI is also highly desirable in nursing. QSEN addresses knowledge, skills, and attitudes (QSEN Institute website, n.d.). Caring is essential to everything that QSEN addresses. Rhodes, Morris, & Lazenby (2011) concluded that “competence and caring are interrelated” and advocate for the image of nurses to become that of “competent and intelligent caregivers” (p. 10).The ANA writes nursing’s standards to which each nurse is held accountable. Caring is inherent to nursing. In reviewing the ANA’s Standards of Practice, from Standard 1 Assessment through Standard 6 Evaluation, and the ANA’s Standards of Professional Performance, from Standard 7 Quality of Practice through Standard 15 Leadership, it is self-evident that caring is essential in every step of every Standard of Professional Nursing Practice regardless of the setting (see appendices F & G). Nurses must be caring with their patients, others, and selves. Nurses must be caring in their interactions with patients, families, and colleagues. Achieving and maintaining necessary competences is also caring. Nurses must be caring in everything that they do. It is caring that ensures quality and safety.Caring is the attitude that QSEN seeks to address. As such, we can see that caring is fundamental and inherent to both the QSEN initiative and the ANA standards on multiple levels.? In essence we would have neither without caring.?ConclusionThere are many challenges in today’s evolving healthcare arena. Nursing is continuously evolving to meet the expanding needs of the healthcare. The role of nurses is becoming increasingly more responsible, accountable, and liable. This paradigm shift demands that nurses are aware of many things and become better educated than in years past. We must accept and adapt to this reality. Rhodes, Morris, & Lazenby (2011) state:Falk-Rafael proposed that caring in nursing has evolved from a required caring to an assimilated caring, and then further developed to empowered caring within the interprofessional healthcare delivery system, suggesting that empowered caring is informed by knowledge and experience (p. 8).It is essential that we remember our past. “Florence Nightingale wrote that caring is the foundation of nursing practice” (Merrill, Hayes, Clukey, & Curtis, 2012, p. 33). Caring transcends all barriers. Watson (2005) states “Caring and Love are the most universal, the most tremendous and the most mysterious of cosmic forces” (p. 19). Caring is universally recognized. It directly influences people’s thoughts, feelings, and actions. Watson (2005) states:It is when we include caring and love in our science, we discover our caring-healing professions and disciplines are much more than a detached scientific endeavor, but a life-giving and life-receiving endeavor for humanity (p.3).What kind of care do you expect/ hope for you and yours? We are all a moment away from being the patient and/or sitting at the bedside with a family member who is a patient. Do you provide the care you expect to receive? Most folks grew up being taught to “treat others the way you want to be treated”. We must apply the nursing process. We need to continuously reflect and ask ourselves what are we doing and what more should/could we be doing?ReferencesAmerican Nurses Association. (2004). Nursing: Scope & standards of practice (2004 ed.). Silver Spring, Maryland: Author.Chinn, P. (January 9, 2013). ANS: Advances in Nursing Science blog: Critical caring model update. Retrieved from: , L., Hayes, J., Merrill, A., & Curtis, D. (2009). “Helping the understand”: Nurses’ caring behaviors as perceived by family members of trauma patients. Journal of Trauma Nursing 16(2): Pp. 73-81.Falk-Rafael, A. (2005). Advancing nursing theory through theory-guided practice: The emergence of a critical caring perspective. Advances in Nursing Science 28(1): Pp.38-49.Jeffs, L., Beswick, S., Martin, K., Campbell, H., Rose, D. N., & Ferris, E. (2013). Quality nursing care and opportunities for improvement: Insights from patients and family members. Journal of Nursing Care Quality, 28(1): Pp76-84.Initiative on the Future of Nursing: IOM recommendations. (2011). of Medicine of the National Academies. (2012). of Medicine of the National Academies. (2013). , V. D. (2012). Applying the ethics of caring to your nursing practice. MEDSURG Nursing: The Journal of Adult Health 21(2): Pp.112-6.Lundberg, P. C. & Kerdonfag, P. (2010). Spiritual care provided by Thai nurses in intensive care units. Journal of Clinical Nursing 19: Pp.1121-1128. doi: 10.1111/j.1365-2702.2009.03072.xMerrill, A.S., Hayes, J.S., Clukey, L., & Curtis, D. (2012). Do they really care? How trauma patients perceive nurses’ caring behaviors. Journal of Trauma Nursing 19 (1): Pp.33-7.QSEN Institute website. (n.d.). , M.K., Morris, A.H., & Lazenby, R. B. (2011). Nursing at its best: Competent and caring. Online Journal of Issues in Nursing 16(2). Retrieved from: , B.H. (2009). Professional quality of life: compassion satisfaction and fatigue version 5 (ProQOL). Retrieved from: Free Dictionary. (2013). Definition of caring. Retrieved from: Free Dictionary. (2013). Definition of nursing. Retrieved from:, A. M., & Alligood, M. R. (2006). Nursing theorists and their work (6th ed.). St. Louis, Mo: Mosby Elsevier.Tubbs, S. L. (2009). A systems approach to small group interaction (10th ed.). New York, NY: McGraw-Hill.Robert Wood Johnson Foundation website. (2013). , T. (2003). Caring and the professional practice of nursing. Journal of Nursing 195. Retrieved from: Veenema, T. G. (2013). Disaster nursing and emergency preparedness for chemical, biological, and radiological terrorism and other hazards (3rd ed.). New York, NY: Springer Publishing Company.Wall, R. J., Engelberg, R. A., Gries, C. J., Glavan, B., & Curtis, J. R. (2007). Spiritual care of families in the intensive care unit. Critical Care Medicine 35(4): Pp.1084-1090. doi: 101097/M.0000259382.36414.06Watson, J. (2005). Caring science as sacred science. Philidelphia, Pa: F. A. Davis .Weiland, S. A. (2010). Integrating spirituality into critical care: An APN perspective using Roy’s adaptation model. Critical Care Nursing Quarterly 33(3): Pp.282-291.Appendix AImage Retrieved from: BThe Original Ten Carative FactorsThe formation of a humanistic-altruistic system of values;The installation oh faith-hope;The cultivation of sensitivity to one’s self and to others;The development of a helping-trusting relationship;The promotion and acceptance of the expression of positive and negative feelings;The systematic use of the scientific problem-solving method for decision making (later modified to soften the harsh language of linear process, allowing for creativity, openness with caring process, open to all ways of knowing);The promotion of interpersonal teaching-learning (later refined to read as transpersonal teaching-learning);The provision for a supportive, protective, and/or corrective mental, physical, sociocultural, and spiritual environment;Assistance with the gratification of human needs;Allowance for existential-phenomenological dimensions.Watson (2005, p.2)Appendix CImage retrieved from: DChinn, P. (January 9, 2013). Image retrieved from: EImage retrieved from: Retrieved from: 's+hierarchy+of+needs&um=1&ie=UTF-8&hl=en&tbm=isch&source=og&sa=N&tab=wi&ei=Dt3qUcSuEImGrgGg-oHICw&biw=3200&bih=1567&sei=Et3qUYzVJYOVygHJ64DgDQ#facrc=_&imgdii=_&imgrc=c3Ao5gjxwKiSzM%3A%3B0YW4owgzNzRXIM%3Bhttp%253A%252F%252Fthewordin365.files.%252F2011%252F03%252Fmaslows-hierarchy1.jpg%3Bhttp%253A%252F%252Fthewordin365.%252F2011%252F03%252F03%252Fgod-and-maslows-hierarchy-of-needs%252F%3B441%3B386Appendix FANA Standards of Nursing PracticeSTANDARD 1. ASSESSMENTThe registered nurse collects comprehensive data pertinent to the patient’s health or situation.STANDARD 2. DIAGNOSISThe registered nurse analyzes the assessment data to determine the diagnosis or issues.STANDARD 3. OUTCOMES IDENTIFICATIONThe registered nurse identifies expected outcomes for a plan individualized to the patient or the situation.STANDARD 4. PLANNINGThe registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes.STANDARD 5. IMPLEMENTATIONThe registered nurse implements the identified plan.STANDARD 5A: COORDINATION OF CAREThe registered nurse coordinates care delivery.STANDARD 5B: HEALTH TEACHING AND HEALTH PROMOTIONThe registered nurse employs strategies to promote health and a safe environment.STANDARD 5C: CONSULTATIONThe advanced practice registered nurse and the nursing role specialist provide consultation to influence the identified plan, enhance the abilities of others and effect change.STANDARD 5D: PRESCRIPTIVE AUTHORITY AND TREATMENTThe advanced practice registered nurse uses prescriptive authority, procedures, referrals, treatments, and therapies in accordance with state and federal laws and regulations.STANDARD 6. EVALUATIONThe registered nurse evaluates progress towards attainment of outcomes.ANA (2004)Appendix GANA Standards of Professional PerformanceSTANDARD 7. QUALITY OF PRACTICEThe registered nurse systematically enhances the quality and effectiveness of nursing practice.STANDARD 8. PRACTICE EVALUATIONThe registered nurse attains knowledge and competency that reflects current nursing practice.STANDARD 9. EDUCATIONThe registered nurse evaluates one’s own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations.STANDARD 10. COLLEGIALITYThe registered nurse interacts with and contributes to the professional development of peers and colleagues.STANDARD 11. COLLABORATIONThe registered nurse collaborates with patient, family, and others in the conduct of nursing practice.STANDARD 12. ETHICSThe registered nurse integrates ethical provisions in all areas of practice.STANDARD 13. RESEARCHThe registered nurse integrates research findings into practice.STANDARD 14. RESOURCE UTILIZATIONThe registered nurse considers factors related to safety, effectiveness, cost, and impact on practice in the planning and delivery of nursing services.STANDARD 15. LEADERSHIPThe registered nurse provides leadership in the professional practice setting and the profession.ANA (2004) ................
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