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Self-Assessment of Nursing Standards of Practice

Megan M. Childers

Ferris State University

Abstract

The American Association of Critical-Care Nurses (AACN) provides standards of care that establish and create the scope of practice for the specialty of acute and critical care nursing. Each standard of care for acute and critical care nursing practice will be examined pertaining to the practice of this nurse in conjunction to how the standards of professional performance are upheld in a clinical setting. Professional goals will reflect a plan to attain and maintain competency in each standard, including action and evaluation.

Self-Assessment of Nursing Standards of Practice

The American Association of Critical-Care Nurses (AACN) provides standards of care that establish and create the scope of practice for the specialty of acute and critical care nursing. The standards apply to the care that the acute and critical care nurse provides for all patients. The professional practice of the acute and critical care nurse is characterized through the application of relevant theories, evidence-based guidelines, and research to explain human behavior (American Association of Critical Care Nurses [AACN], 2010, p.10). The application of these nursing standards of practice provides a basis for nursing interventions that reflect patient centered care. Each standard of care for acute and critical care nursing practice will be examined pertaining to the practice of this nurse in conjunction to how the standards of professional performance are upheld in a clinical setting. In addition, professional goals will be identified to attain and maintain competency within each standard, including action and evaluation.

AACN Standards of Care

The standards of care for the acute and critical care nurse build upon existing standards of practice established by the American Nurses Association (ANA). The AACN has established six standards of practice that all acute and critical care nurses must provide for all patients. The nursing process serves as the framework for the standards including assessment, diagnosis, outcomes identification, planning, implementation, and evaluation (AACN, 2010, p. 10).

Assessment

The first standard of care, assessment, is the ability of the critical care nurse to collect pertinent and relevant data that provide insight to the patient’s health or present situation (AACN, 2010, p. 10). Assessment is crucial within a critical care setting to develop a holistic picture of the patient’s needs. An accurate and detailed assessment can identify the immediate care needs related to the patient’s deteriorating condition. This critical care nurse obtains pertinent and sufficient data by utilizing appropriate evidence-based assessment techniques and instruments. This nurse relies on her assessment skills and abilities to problem solve and make decisions regarding a particular patients care. Relevant data and patient concerns are then documented and communicated to the multidisciplinary healthcare team.

Diagnosis

According to the AACN (2010), diagnosis for the acutely and critically ill patient analyzes assessment data in order to determine a diagnosis and identify care issues (p. 11). This standard of care is derived from accurate and prompt assessment data. Diagnosis of care issues allow this nurse to prioritize patient needs and develop an effective plan of care. This nurse advocates for patients through interacting and communicating concerns with healthcare providers to apply the assessment data. Dynamic collaboration yields prioritized care issues and facilitates patient care outcomes.

Outcomes Identification

The third standard of care states, “the nurse caring for the acutely and critically ill patient identifies outcomes for the patient or the patient’s situation” (AACN, 2010, p. 11). Patient outcomes are derived from actual diagnoses and identifying care issues. This standard of care allows the healthcare team to form measurable goals and outcomes for the patient to obtain. This nurse formulates attainable outcomes by collaborating with the patient, family, and the multidisciplinary healthcare team. Open communication and collaboration provide a continuity of care in addressing the patient’s healthcare issues. This nurse creates modifiable outcomes that have a target date for attainment that can be altered on the basis of changes in the patient’s condition.

Planning

This standard of care focuses on creating a plan of care that addresses health care issues using evidence-based practices to achieve optimal outcomes. The AACN (2010) denote planning as a developed progression toward prescribed interventions to attain outcomes (p. 12). This nurse implements a plan of care to promote a patient’s well-being and restore their functional status. This nurse also ensures the plan of care is unique to each patient and developed to promote the patient’s contribution toward achieving specified outcomes. The plan should establish priorities for care and strategies to restore health and prevention of further illness (AACN, 2010, p. 12). This nurse continues to incorporate individual patient needs with evidence-based theories to establish the most effective plan of care.

Implementation

Implementation of interventions is crucial to patient care. A nurse caring for the acute or critically ill patient must implement a plan, coordinate care, and employ strategies to promote patient wellness (AACN, 2010, p. 12). This nurse strives to implement interventions that are patient-centered, require patient participation, and minimize complications. Implementation of interventions will impact patient outcomes. This nurse ensures all interventions are evidence-based, patient-centered, collaborative, and promote holistic health for the patient.

Evaluation

Evaluation can be denoted as the progression toward attaining patient-centered outcomes (AACN, 2010, p. 13). The evaluation process is continuous from the patient’s admission to discharge. It is systematic and utilizes evidence-based techniques. This nurse evaluates patient care needs, diagnosis, and outcome attainment. This nurse continually assesses the patient, evaluates responses after interventions are initiated, and revises the plan of care as needed.

AACN Standards of Professional Performance

The Standards of Professional Performance describe acceptable behaviors of an acute and critical care nurse. These behaviors, in the professional nursing role, include quality of practice, professional practice evaluation, education, collegiality, ethics, collaboration, research, resource utilization, and leadership (AACN, 2010, p. 14). The standards of professional performance outline the expectations of an acute and critical care nurse. The AACN (2010) further explains that “membership in professional organizations, certification, continued education, and pursuit of advanced degrees are additional methods of demonstrating professionalism” (p. 14). This nurse will reflect upon which standards of professional performance she has attained and which standards are not fully achieved.

Quality of Practice

Nurses providing patient care need to evaluate and seek improvements in the quality and effectiveness of nursing practice (AACN, 2010, p. 14). Through self-assessment of current practices, this nurse fulfills the quality of practice standard through awareness and implementation of quality improvement initiatives. This nurse also applies critical thinking to initiate changes in current nursing practice. Recently, this nurse helped initiate insulin infusion protocol for diabetic ketoacidosis. Data was collected to monitor the quality of the current protocol and changes were implemented to ensure a revised protocol that would reflect current evidence-based practice. Quality of practice ensures that professional performance standards are met and upheld.

Professional Practice Evaluation

The second standard of professional performance requires the nurse to evaluate his or her own nursing practice in relation to professional practice standards, guidelines, rules, and regulations (AACN, 2010, p. 14). This nurse engages in self-assessment on a daily basis, identifying strengths and minimizing weaknesses. This nurse also inquires how the patient perceived his/her care and requests suggestions for optimal patient/nurse interaction. Reflection on feedback allows this nurse to be aware of her competencies and inspire changes to achieve optimal performance goals. This standard is fulfilled though annual discussion with the Intensive Care Unit manager where a plan is created to progress towards educational and professional nursing goals.

Education

Education is paramount to the nursing profession. The educational standard requires critical care nurses to maintain current knowledge and competency (AACN, 2010, p. 15). This nurse participates in and seeks out ongoing learning activities to refine her knowledge and skills needed to care for the acutely and critically ill patients. This nurse completes all skill competencies, education, and evidence-based readings pertinent to patient care. This nurse also participates in ongoing and lifelong learning to maintain a high level of professionalism.

Collegiality

Civility and collegiality in the nursing profession supports a nurse’s ability to care for an acutely or critically ill patient. According to the AACN (2010), a critical care nurse should interact with and contribute to the professional development of peers (p. 15). Self-assessment of current practice yields that this nurse does not fully meet this standard. This nurse had an incredible opportunity to join the Critical Care Internship directly after graduating nursing school. This nurse was employed to the Intensive Care Unit after a brief orientation to other critical care specialty units. Therefore, this nurse does not have extensive nursing experience to share with peers and colleagues. This nurse does partake in educational discussions, including patient care situations, to promote optimal patient outcomes. This nurse also contributes to a supportive and healthy work environment that encourages mutual respect and appreciation.

Ethics

Ethical decisions are not foreign to critical care patient situations. The AACN (2010) denote ethics as the nurse’s decision and actions carried out in a moral manner in all areas of practice (p.16). This nurse does not fully meet this standard of professional performance. This nurse upholds and maintains patient confidentiality, uses available resources in forming ethical decisions, and demonstrates a commitment to self-advocacy. As a patient advocate, this nurse does attempt to maintain a sensitive nonjudgmental manner that strives to maintain a patient’s dignity. However, this nurse has struggled caring for a patient when the family does not respect or preserve the patient’s autonomy, dignity, and rights. Council with colleagues and the ethics committee have taught this nurse how to acknowledge personal feelings towards an ethical dilemma and remove bias or angst from patient situations.

Collaboration

The ability for a critical care nurse to collaborate with other healthcare professionals is imperative to providing patient care that is a safe, healing, humane, and caring manner (AACN, 2010, p. 16). This nurse fulfills this professional standard by using skilled and effective communication to foster true collaboration. This nurse also engages with other healthcare professionals to generate optimal patient outcomes. Most importantly, this nurse collaborates with the patient and patient’s family to promote continuity of care.

Research

Research findings should be integrated into nursing practice (AACN, 2010, p. 17). After self-assessment, this nurse does not meet this standard. A nurse should strive to continually question and evaluate current practices instead of accepting them as past practice. This nurse needs to begin to question and evaluate her practice against evidence-based suggestions to make effective changes regarding patient care.

Resource Utilization

The AACN (2010) explain resource utilization as the ability for the nurse caring for acutely and critical ill patient to consider factors related to safety, effectiveness, cost, and impact in planning and delivering nursing services (p. 17). This nurse needs to become more cognizant of cost containment issues when it involves developing a plan of care and allocating available resources. This nurse also struggles with delegating certain aspects of patient care. Acknowledging ancillary staff’s abilities, work ethic, addressing the potential for harm, and awareness of a patient’s condition has improved this nurse’s ability to delegate effectively. If delegation is done effectively, this nurse can focus on educating the patient on healthcare options, alternative treatment modalities, risks, and benefits.

Leadership

The final professional performance standard is leadership. The nurse should provide leadership in the professional practice setting as well as the profession (AACN, 2010, p. 18). Although this nurse promotes leadership qualities by being an AACN organization member, this nurse does not fully met this standard. This nurse does encourage peers through mentoring and demonstrates the ability to remain patient-centered in a rapidly changing environment. This nurse can promote her local leadership by associating with committees within her facility.

Professional Development Plan

A professional development plan needs to reflect interventions and goals to attain and maintain competency within each standard of practice for an acute and critical care nurse. This nurse’s development plan will address the collegiality, ethics, research, resource utilization, and leadership professional performance standards. This nurse has illustrated the need for growth in each of these standards. The aspect of collegiality will concentrate on peer involvement and interaction. As a novice nurse, this nurse will become a valuable asset because she able to provide and educate colleagues on current evidence-based practices learned from nursing curriculum. As a successful graduate of the Critical Care Internship, this nurse will also plan to nominate herself as a future mentor for other Critical Care interns. This nurse could provide insight on different critical care specialties and how to acclimate to the Intensive Care Unit. This nurse also plans to recognize colleagues for their contribution and attributes revolving around patient care through a recognition program that rewards behaviors that surpass standards of practice and performance. This nurse plans to be open to constructive criticism from colleagues and apply feedback to her current standards of nursing practice. With regard to heightening the ethical standard, this nurse plans to attend monthly ethics meetings to learn techniques and strategies to manage ethical patient situations. The plan will also include role-playing to assist the nurse in utilizing therapeutic communication to advocate for a patient’s rights and needs. The professional performance standard of research integrates evidence-based practice into patient care. This nurse plans to become inquisitive about current procedures and protocols and apply research techniques to compare them to current evidence-based information. This nurse also strives to fully understand the basis of current protocols. A resource utilization plan will encompass cost effectiveness and increased delegation. This nurse plans to assess and secure resources to meet patient needs. This nurse will also seek opportunities for delegating to ancillary staff to increase patient continuity of care. The professional development plan will include expanded leadership prospects. This nurse plans on joining a committee within her facility to promote the nursing profession. This nurse plans on joining the local chapter of AACN to demonstrate her leadership abilities.

Action Plan

An action plan will be implemented to include actions and timelines that are consistent within the professional goal statements. This nurse will achieve the goal of heightened collegiality by nominating herself as a mentor for the next Critical Care Internship group in May 2014. This nurse will also remain cognizant of her colleagues efforts and exemplary patient care to reward recognition by April 2014. This nurse will meet her goal, regarding ethics, by attending the Ethics Committee meeting monthly, starting in March 2014. Achieving the research goal will include assessing this nurse’s professional practices. This nurse will read the monthly subscription of AACN journal and report the evidence-based findings to colleagues and nurse educator. This nurse will evaluate current protocols as they present in future patient cases. In order to strengthen resource utilization, this nurse plans to incorporate daily evaluation of discharge needs and suggest consults, as needed, into her current nursing practice. This nurse will meet her leadership goals by attending and joining the Unit Action Council, committee for acute and critical care nurses. This nurse will exemplify her leadership abilities by joining the local chapter of AACN by March 2014.

Evaluation Plan

An evaluation plan is imperative to measure the progress toward professional standard goals. This nurse’s progression towards becoming a mentor will include collaborating with the nurse educator to solidify her interest and create an evaluation tool to test her abilities to educate colleagues. This nurse will plan to meet with the new interns and nurse educator to develop a checklist of requirements for the interns to learn, and provide feedback upon her abilities to mentor effectively. To measure progress towards the ethics goal, this nurse will speak with a medical social worker to establish when the Ethics Committee has meetings. This nurse will ensure she is available for those monthly meetings and will openly convey her interest in strengthening her understanding on ethics. Progression toward the research goal will include a quarterly discussion form with colleagues to ensure full comprehension of current evidence-based practices. If changes result to existing protocols, colleagues will be informed electronically. This nurse plans to incorporate resource utilization in her daily nursing practice by providing updates regarding plan of care and discharge needs in morning report with colleagues. To measure progress toward leadership goals, this nurse will discuss interest with current Unit Action Council committee members. This nurse will convey how she contributes to leadership and the development of the standards of professional performance in the nursing profession. This nurse will uphold local nursing leadership by requesting an application form from colleagues that are members of the local AACN chapter.

A self-assessment has revealed how this nurse applies and upholds the standards of practice and standards of professional performance. Insight gained from self-reflection has resulted in higher nursing standards. A professional development plan was initatiated to strengthen this nurse’s professional practice and reflect a plan to attain and maintain competency in each standard. An action plan provided realistic interventions and timelines, wheras an evaluation plan was created to measure progress toward nursing goals. Self-assessment and awareness will strenghten this nurse’s ability to care for acutely and criticall ill patients.

References

American Association of Critical-Care Nurses. (2010). AACN scope and standards for acute and critical care nursing practice. Aliso Viejo, CA: American Association of Critical-Care Nurses.

CHECKLIST FOR SUBMITTING PAPERS

|CHECK | |

|DATE, TIME, & |PROOFREAD FOR: APA ISSUES |

|INITIAL | |

|MC/ss |1. Page Numbers: Did you number your pages using the automatic functions of your Word program? [p. 230 and example on p. |

| |40)] |

|MC/ss |2. 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] |

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| |page? Is it a single paragraph? Is the paragraph flush with the margin without an indentation? Is your abstract a summary|

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| |what to find in your paper. [p. 25 and example on p. 41] |

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| |heading following the title. The first paragraph clearly implies the introduction and no heading is needed. [p. 27 and |

| |example on p. 42] |

|MC/ss |5. Margins: Did you leave 1” on all sides? [p. 229] |

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| |special circumstances. This includes the reference page. [p. 229 and example on p. 40-59] |

|MC/ss |7. Line Length and Alignment: Did you use the flush-left style, and leave the right margin uneven, or ragged? [p. 229] |

|MC/ss |8. Paragraphs and Indentation: Did you indent the first line of every paragraph? See P. 229 for exceptions. |

|MC/ss |9. 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] |

|MC/ss |10. Typeface: Did you use Times Roman 12-point font? [p. 228] |

|MC/ss |11. Abbreviation: Did you explain each abbreviation the first time you used it? [p. 106-111] |

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| |many times…this is what you are supposed to be doing! [p. 170] |

|MC/ss |13. 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). |

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| |of page number, etc. Do all direct quotes look like this? [p. 170-172] |

|MC/ss |14. Quotes Over 40 Words: Did you make block quotes out of any direct quotes that are 40 words or longer? [p. 170-172] |

|MC/ss |15. Paraphrase: A paraphrase citation would look like this: |

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| |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. |

|MC/ss |16. Headings: Did you check your headings for proper levels? [p. 62-63]. |

|MC/ss |17. 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, & STRUCTURE |

|MC/ss |18. Did you follow the assignment rubric? Did you make headings that address each major section? (Required to point out |

| |where you addressed each section.) |

|MC/ss |19. 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? |

|MC/ss |20. Wordiness: check for the words “that”, and “the”. If not necessary, did you omit? |

|MC/ss |21. 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? |

|MC/ss |22. Avoid contractions. i.e. don’t, can’t, won’t, etc. Did you spell these out? |

|MC/ss |23. Did you check to make sure there are no hyphens and broken words in the right margin? |

|MC/ss |24. Do not use “etc.” or "i.e." in formal writing unless in parenthesis. Did you check for improper use of etc. & i.e.? |

|MC/ss |25. 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? |

|MC/ss |26. 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….. |

|MC/ss |27. 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.” |

|MC/ss |28. Did you run a Spellcheck? Did you proofread in addition to running the Spellcheck? |

|MC/ss |29. Did you have other people read your paper? Did they find any areas confusing? |

|MC/ss |30. Did you include a summary or conclusion heading and section to wrap up your paper? |

|MC/ss |31. Does your paper have sentence fragments? Do you have complete sentences? |

|MC/ss |32. 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:

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A peer needs to proofread your paper checking for errors in the listed areas and sign below:

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Revised Spring 2010/slc

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