RN to BSN Portfolio



Self-Assessment of Nursing Standards of PracticeChristina BookheimerFerris State UniversityAbstractAn evaluation of where this nursing student is currently in her professional nursing practice in relationship to standards set by the American Nurses Association (ANA) and the Hospice and Palliative Nurses Association. Each standard of professional performance is evaluated for strengths and weaknesses. A formal plan with goals is developed to address the current and future needs of this nursing student to address identified weaknesses. IntroductionAs I look at the direction my nursing career is taking it becomes quite evident that my heart lies in the hospice and palliative care field. The American Nurses Association (ANA) in collaboration with the Hospice and Palliative Nurses Association (HPNA) has published the ANA Standards of Hospice and Palliative Nursing Practice guidelines (ANA, 2007). These guidelines take into consideration the nursing process of assessment, diagnosis, outcome identification, planning, implementation, and evaluation. To better understand where I am as a nurse in my practice I felt it would be more helpful to take this the next step and evaluate where I am in relationship to the standards of professional performance that is also published by these two entities. There are nine hospice and palliative care standards of professional performance to be considered.Quality of PracticeAccording to the ANA “the hospice and palliative registered nurse systematically enhances the quality and effectiveness of nursing practice” (ANA, 2007). This is demonstrated through quality documentation that supports the nursing process, use of “quality improvement activities to initiate change” (ANA, 2007), developing ways to improve the way that care is delivered, and use of evidenced-based information and studies to improve outcomes (ANA, 2007). Currently I am working with an appropriate documentation system that encompasses all of the regulations and evidenced-based data that is needed to work with my patients. I have been involved in many quality improvement teams and initiatives and find this very rewarding. The area that has become more pronounced for me since starting the BSN program is that of evidenced-based studies. This is an area that I am growing in and could use more practice.EducationThe ANA presents that “the hospice and palliative registered nurse attains knowledge and competency that reflects current hospice and palliative nursing practice” (ANA, 2007). The drive to obtain my BSN is only one step in this process. Nurses are lifelong learners. In order to stay current with this type of nursing practice it will be necessary to continually seek out opportunities. Currently I do hold a certification in hospice and palliative nursing and this is renewed every five years. Certification is one of the many ways that I can meet this performance practice. Attending seminars, work-shops, on-line offerings, and classes offered by universities are other practical opportunities. EvaluationThis professional performance standard deals with “the hospice and palliative registered nurse evaluates one’s own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations” (ANA, 2007). It is important for the nurse to be knowledgeable of all “guidelines, statutes, rules, and regulations” (ANA, 2007) that she is practicing under. This is accomplished by being sensitive to the patients’ culture, age, and ethnic background (ANA, 2007). It is necessary to do self-evaluations “on a regular basis, identifying areas of strength as well as areas in professional development could be beneficial” (ANA, 2007). This should include appraisals from peers, peer reviews, forming action plans, and goal setting. My growth in this area has come a long way through the process of the BSN program. Thinking things through at a higher level and taking more into consideration than just my-self is a milestone in this standard. This paper demonstrates self-evaluation and the need to develop goals and action plans.Collegiality“The hospice and palliative registered nurse interacts with and contributes to the professional development of peers and colleagues” (ANA, 2007) is the standard provided. The measurement criteria includes the sharing of “knowledge and skills with peers and colleagues…provides peers with feedback…interacts with peers and colleagues to enhance one’s own professional nursing practice…maintains compassionate and caring relationships with peers and colleagues, and contributes to an environment that is conducive to the education of healthcare professionals” (ANA, 2007). This is an area that I feel that I excel in. I am often found working on a committee or team which shares ideas and works congruently to help each other. Typically my peers feel very comfortable coming to me with questions related to my areas of expertise which include hospice and palliative care and wound management. Positive reinforcement and praise is a common practice that I incorporate into my daily routine. Evidence of this is our yearly peer reviews. Each employee is asked to give three names of peers that they would like to review them. Every year I get inundated with the peer review request. I feel very honored and humbled that they put so much faith into me. CollaborationThe ANA states “the hospice and palliative registered nurse collaborates with the patient, the family, the interdisciplinary team, and others in the conduct of nursing practice” (ANA, 2007). Collaboration is important in all areas of the health care field. However in hospice and palliative care collaboration takes on a whole new meaning. This type of nursing takes into consideration every aspect of the patient and family. It is essential to work as a team to provide optimal care. Accomplishing a team approach through communication and documentation is important to this performance standard. Currently I am involved with an initiative that is jointly promoted by our local hospital and our home care agency. I have developed a documentation system in our office to track each patient. It was necessary to learn the hospital charting system to effectively communicate with their team as well. Through this and also keeping lines of communication open with each part of the team has been an area of growth for me. I believe I am currently on the right path related to this standard of performance.EthicsThis standard of professional performance states “the hospice and palliative registered nurse integrates ethical provisions in all areas of practice” (ANA, 2007). The measurement criteria for this standard are (ANA, 2007):Uses Code of Ethics for Nurses with Interpretive Statements to guide practiceDelivers care in a manner that preserves and protect patient autonomy, cultural preferences, dignity, and rights, and honors the patient’s wishesMaintains patient confidentiality within the legal and regulatory parametersActively participates in the informed consent processServes as a patient advocate, assisting patients in developing skills for self-advocacyMaintains a therapeutic and professional patient-nurse relationshipDemonstrates a commitment to practicing self-care, managing stress, and connecting with self and othersContributes to resolves ethical issues of patients, colleagues, or systemsReports illegal, incompetent, or impaired practicesWorking with informed consents, patient advocacy, self-advocacy, providing care in the above specified manner are areas that I pride myself in having a good professional ability. This is demonstrated in my day to day duties as well as my involvement with the Care Team initiative. However, after reading through this performance standard it became very clear to me that I have no idea what the Code of Ethics for Nurses with Interpretive Statements is. This is clearly an area for growth and better understanding.ResearchIf you would have asked me two years ago what research meant to nursing I would not have been able to answer. The ANA presents that “the hospice and palliative registered nurse integrates research findings into practice” (ANA, 2007). This is accomplished through a nurse utilizing “the best available evidence, including research findings, to guide practice decisions, actively participates in research activities” (ANA, 2007). Through the BSN program I have found the true worth and meaning of research to nursing. I very often will go to PubMed or one of the other search engines when I encounter an area that I am unfamiliar with or need further information. This has become part of my routine practice. The performance standard does include being part of committees, sharing information that is found with peers, using research to develop policies, procedures and “standards of practice in patient care” (ANA, 2007). Each of these areas has become part of my typical practice. This has been an exciting area of growth.Resource UtilizationAs with other areas of nursing “the hospice and palliative registered nurse considers factors related to safety, effectiveness, cost, and impact on practice in the planning and delivery of nursing services” (ANA, 2007) is a standard of professional performance. This is measured by how the nurse uses evaluation in these stated areas, assisting patients and families in obtaining services, ability to assign and delegate tasks, and helping the patient and family to become knowledgeable health care consumers (ANA, 2007). I relate this performance standard again to my involvement with the Care Team initiative. Some of the goals of this program are to link patients and families with resources, health care options, and promote knowledge of their treatment options. Through hospital and at-home visits I am able to help families navigate what may seem to be an overwhelming system and crisis. This is accomplished by being personally knowledgeable of the many resources that are available to patients, the knowledge of their disease process, family dynamics and the ability to tie this together. This is an area that I feel confident in my ability and level of understanding.LeadershipThe ANA states that “the hospice and palliative registered nurse provides leadership in the professional practice setting and the profession” (ANA, 2007). Key words that are presented are teamwork, healthy work environments, clear vision, mentoring, passion, willingness, valuing, coordination, committees and professional organizations (ANA, 2007). In leadership I believe it is style of leadership that is important. I promote a participative, positive reinforcement and praise tactic. I would not expect anyone to do something I would not personally do. As a professional nurse leadership is an important role. This is an area that I have witnessed my personal growth over the last few years. The ANA states that as a leader the nurse “engages in teamwork as a team player, a team builder, and a team leader” (ANA, 2007) as a measurement criteria. In looking at my current practice I can identify with each of these areas. In being part of countless committees as a member at large, working to develop the care team, and acting as a leader in many of the activities that I am involved with. This is an area that I do excel in.Professional Development PlanThrough the self-evaluation process of each professional performance standard as it applies to hospice and palliative care it became evident to me that there are two areas of concern. Plan for EducationEven though I am currently involved with obtaining my BSN education is an on-going issue as the needs in my field are ever-changing. To address this concern it will be necessary to put actual plans in place to stay current and abreast of these changes. The first step will be to complete my BSN program as currently projected in August of 2013. Renewal for the hospice and palliative care certification is due in April of 2015. Every year a fall seminar is held in Grand Rapids related to palliative care. This will become part of my yearly plan. The Hospice and Palliative Nurses Association routinely offers on-line courses and by doing one each quarter this will help meet my educational goals. Plan for EthicsThe area of ethics is also ever-changing and dependent upon many variables. As this is an area that I have identified as a weakness it is important for me to become more aware and astute in this standard of professional performance. The first step will be to purchase the Code of Ethics for Nurses with Interpretive Standards. This will be accomplished by the end of this current semester. As I am unsure as to the length of this publication, breaking it down into small portions to read will be the next step. My goal will be to read through this over the summer semester as I have only signed up for one course during that time. Another learning experience would be to attend ethics committee meetings. I will seek out permission to do this over the next month. Our ethics committee chairperson works out of our office and this should be a relatively easy task to accomplish. I believe this experience will help me to grow in this area. Evaluation PlanIn looking at appropriate evaluation plans it became clear to me that an old-fashioned check sheet would work best for me (Appendix A). Developing this check sheet first establishes in my mind what my objectives are. As they are clearly written out with dates to accomplish them it will be easy to follow. My plan will be to keep this list as a file on my computer and also on my tack board in my home office. When referencing the list if it becomes evident that I am not meeting the objectives a new plan will need to be thought through and implemented.ConclusionThrough the self-assessment process the hospice and palliative nursing standards of professional performance have been evaluated. Two areas of concern have been identified and a plan including objectives has been developed. The overall expectation of professional growth in my area of desired expertise is the ultimate goal of this project. ReferencesAmerican Nurses Association. (2007). Standards of professional performance. As retrieved from AStandards of Performance Check SheetEducation:BSN completion date August 2012 _____HPCN certification date April 2015_____Grand Rapids Seminar Fall 2012_____Grand Rapids Seminar Fall 2013_____On-Line Course Quarterly 2012_______________On-Line Course Quarter 2013____________________Ethics:Purchase Publication May 2012_____Read Publication Completion Sept. 1, 2012_____Ethics Committee Contact Completion 051512_____Attend First Ethics Committee_____CHECKDATE, TIME, & INITIALPROOFREAD FOR: APA ISSUESsks1. Page Numbers: Did you number your pages using the automatic functions of your Word program? [p. 230 and example on p. 40)]sks2. 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]sks3. 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]sks4. 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]sks5. Margins: Did you leave 1” on all sides? [p. 229]sks6. 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]sks7. Line Length and Alignment: Did you use the flush-left style, and leave the right margin uneven, or ragged? [p. 229]sks8. Paragraphs and Indentation: Did you indent the first line of every paragraph? See P. 229 for exceptions.sks9. 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]sks10. Typeface: Did you use Times Roman 12-point font? [p. 228]sks11. Abbreviation: Did you explain each abbreviation the first time you used it? [p. 106-111]sks12. 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]sks13. 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]sks14. Quotes Over 40 Words: Did you make block quotes out of any direct quotes that are 40 words or longer? [p. 170-172]sks15. 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.sks16. Headings: Did you check your headings for proper levels? [p. 62-63].sks17. 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, & STRUCTUREsks18. Did you follow the assignment rubric? Did you make headings that address each major section? (Required to point out where you addressed each section.)sks19. 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?sks20. Wordiness: check for the words “that”, and “the”. If not necessary, did you omit?sks21. 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?sks22. Avoid contractions. i.e. don’t, can’t, won’t, etc. Did you spell these out?sks23. Did you check to make sure there are no hyphens and broken words in the right margin?sks24. Do not use “etc.” or "i.e." in formal writing unless in parenthesis. Did you check for improper use of etc. & i.e.?sks25. 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? sks26. 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…..sks27. 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.”sks28. Did you run a Spellcheck? Did you proofread in addition to running the Spellcheck?sks29. Did you have other people read your paper? Did they find any areas confusing?sks30. Did you include a summary or conclusion heading and section to wrap up your paper?sks31. Does your paper have sentence fragments? Do you have complete sentences? sks32. 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. Reviewed by Sandra Saylor ................
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