Running head: SELF-ASSESSMENT OF NURSING STANDARDS OF PRACTICE 1

Self-Assessment of Nursing Standards of Practice

Christina Bookheimer

Ferris State University

SELF-ASSESSMENT OF NURSING STANDARDS OF PRACTICE 2

Abstract

An 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.

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Introduction

As 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 Practice

According 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.

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Education

The 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.

Evaluation

This 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

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“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.

Collaboration

The 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

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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.

Ethics

This 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

practice

Delivers care in a manner that preserves and protect patient autonomy,

cultural preferences, dignity, and rights, and honors the patient’s wishes

Maintains patient confidentiality within the legal and regulatory

parameters

Actively participates in the informed consent process

Serves as a patient advocate, assisting patients in developing skills for

self-advocacy

Maintains a therapeutic and professional patient-nurse relationship

Demonstrates a commitment to practicing self-care, managing stress, and

connecting with self and others

Contributes to resolves ethical issues of patients, colleagues, or systems

Reports illegal, incompetent, or impaired practices

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Working 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.

Research

If 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 Utilization

As 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

SELF-ASSESSMENT OF NURSING STANDARDS OF PRACTICE 8

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.

Leadership

The 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 Plan

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Through 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 Education

Even 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 Ethics

The 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 Plan

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In 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.

Conclusion

Through 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.

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References

American Nurses Association. (2007). Standards of professional performance. As retrieved from

http://www.nursesbooks.org/ebooks/download.cfm?orderid=152042&pdkey=1QBGTZI

KSO

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Appendix A

Standards of Performance Check Sheet

Education:

1. BSN completion date August 2012 _____

2. HPCN certification date April 2015 _____

3. Grand Rapids Seminar Fall 2012 _____

4. Grand Rapids Seminar Fall 2013 _____

5. On-Line Course Quarterly 2012 _____ _____ _____

6. On-Line Course Quarter 2013 _____ _____ _____ _____

Ethics:

1. Purchase Publication May 2012 _____

2. Read Publication Completion Sept. 1, 2012 _____

3. Ethics Committee Contact Completion 051512 _____

4. Attend First Ethics Committee _____

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CHECK

DATE, TIME, & INITIAL

PROOFREAD FOR: APA ISSUES

sks 1. Page Numbers: Did you number your pages using the automatic functions of your Word program? [p. 230 and example on p. 40)]

sks 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]

sks 3. 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]

sks 4. 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]

sks 5. Margins: Did you leave 1” on all sides? [p. 229]

sks 6. 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]

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

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

sks 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]

sks 10. Typeface: Did you use Times Roman 12-point font? [p. 228]

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

sks 12. 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]

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sks 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).

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]

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

sks 15. 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.

sks 16. Headings: Did you check your headings for proper levels? [p. 62-63].

sks 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

sks 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.)

sks 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?

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

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sks 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?

sks 22. Avoid contractions. i.e. don’t, can’t, won’t, etc. Did you spell these out?

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

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

sks 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?

sks 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…..

sks 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.”

sks 28. Did you run a Spellcheck? Did you proofread in addition to running the Spellcheck?

sks 29. Did you have other people read your paper? Did they find any areas confusing?

sks 30. Did you include a summary or conclusion heading and section to wrap up your paper?

sks 31. Does your paper have sentence fragments? Do you have complete sentences?

sks 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.

Reviewed by Sandra Saylor