Upload
others
View
0
Download
0
Embed Size (px)
Citation preview
Nursing’s Social PolicyStatementthe Essence of the Profession
2010 Edition
American Nurses AssociationSilver Spring, Maryland2010
Nursing’sSocial PolicyStatementthe Essence of the Profession
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
2010 Edition
http://www.nursesbooks.org
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
Library of Congress Cataloging-in-Publication data
American Nurses Association. Nursing’s social policy statement : the essence of the profession / American NursesAssociation. — 3rd ed. p. ; cm.Includes bibliographical references and index. ISBN-13: 978-1-55810-286-6 (e-publication, single user) ISBN-10: 1-55810-286-8 (e-publication, single user) ISBN-13: 978-1-55810-294-1 (e-publication, multiple users) ISBN-10: 1-55810-294-9 (e-publication, multiple users) 1. Nursing. 2. Nursing—Philosophy. 3. Nursing—Practice. 4. Nursing—Social aspects. I. Title. [DNLM: 1. Philosophy, Nursing—Guideline. 2. Nurse’s Role—Guideline. 3. Nursing—standards—Guide-line. 4. Social Responsibility—Guideline. WY 86 A512n 2010] RT82.A59 2010 610.73—dc22 2010019423
The American Nurses Association (ANA) is a national professional association. This ANA publication—Nursing’s Social Policy Statement: The Essence of the Profession—reflects the thinking of the nursing profession on various issues and should be reviewed in conjunction with state board of nursing policies and practices. State law, rules, and regulations govern the practice of nursing, while Nursing’s Social Policy Statement: The Essence of the Profession guides nurses in the application of their professional skills and responsibilities.
Published by Nursesbooks.orgThe Publishing Program of ANAwww.Nursesbooks.org
American Nurses Association8515 Georgia Avenue, Suite 400Silver Spring, MD 20910-34921-800-274-4ANAwww.NursingWorld.org
design and typesetting: David Fox, AURAS Design, Silver Spring, MDprinting: McArdle Printing, Upper Marlboro, MDeditorial services: Grammarians, Inc, Washington, DC: Francis Taylor (copyediting); Kelly Saxton (proofreading); Gina Wiatrowski (indexing)
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
ISBN-13: 978-1-55810-286-6
First eBook publication August 2010. (First paper publication July 2010.)
http://www.nursesbooks.orghttp://www.nursingworld.org
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
iii
Contents
Contributors v
Nursing’s Social Policy Statement: An Overview 1
Social Context of Nursing 3TheSocialConcernsinHealthCareandNursing 4TheAuthorityforPracticeforNurses 5TheElementsofNursing’sSocialContract 6ProfessionalCollaborationinHealthCare 7
Definition of Nursing 9HumanResponses 10TheoryApplication 10NursingActions 11Outcomes 11
Knowledge Base for Nursing Practice 13
Scope of Nursing Practice 15SpecializationinNursingPractice 17AdvancedNursingPractice 18
AdvancedPracticeRegisteredNurses(APRNs) 18AdditionalSpecializedAdvancedNursingRoles 19
Copy
right
Definition of Nursing
Copy
right
Definition of NursingHuman
Copy
right
Human R
Copy
right
Responses
Copy
right
esponses
Theory
Copy
right
Theory A
Copy
right
Application
Copy
right
pplicationApplicationA
Copy
right
ApplicationA
Nursing
Copy
right
Nursing A
Copy
right
Actions
Copy
right
ctionsActionsA
Copy
right
ActionsA
Outcomes
Copy
right
Outcomes
Knowledge Base for Nursing PracticeCopy
right
Knowledge Base for Nursing Practice
Ameri
can
ealth
Ameri
can
ealth C
Ameri
can
Care
Ameri
can
areractice
Ameri
can
ractice f
Ameri
can
for
Ameri
can
orforf
Ameri
can
forfursing’s
Ameri
can
ursing’sNursing’sN
Ameri
can
Nursing’sNollaboration
Ameri
can
ollaboration
Definition of NursingAmeri
can
Definition of Nursing
Nurse
s
Nursing’s Social Policy Statement: An OverviewNurse
s
Nursing’s Social Policy Statement: An Overview
Asso
ciatio
n
iv Nursing’s Social Policy Statement
Contributors
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
iv
Standards of Professional Nursing Practice 21DefinitionandFunctionofStandards 21DevelopmentofStandards 22StandardsofProfessionalNursingPractice 23
StandardsofPractice 23StandardsofProfessionalPerformance 23
ApplicationofScopeandStandards 24CodeofEthicsforNurses 24AutonomyandCompetentPractice 25
Regulation of Professional Nursing 27ProfessionalRegulation 28LegalRegulation 29InstitutionalPoliciesandProcedures 29Self-Regulation 29
Application of Nursing’s Social Policy Statement 33
Conclusion 35
References 37
Glossary 39
Appendix A. 43ConsensusModelforAPRNRegulation:Licensure,Accreditation,Certification,andEducation(2008)
Appendix B. 87Nursing’sSocialPolicyStatement,2ndEdition(2003)
Appendix C. 105Nursing’sSocialPolicyStatement(1995)
Appendix D. 133Nursing:ASocialPolicyStatement(1980)
Appendix E. 169TheDevelopmentofFoundationalNursingDocumentsandProfessionalNursing:ATimeline
Index 173
Copy
right
Nursing’s
Copy
right
Nursing’s S
Copy
right
Social
Copy
right
ocialSocialS
Copy
right
SocialS P
Copy
right
Policy
Copy
right
olicyPolicyP
Copy
right
PolicyP
Appendix C.
Copy
right
Appendix C.
Nursing’s
Copy
right
Nursing’s S
Copy
right
S
Copy
right
ocial
Copy
right
ocialSocialS
Copy
right
SocialS
Appendix D.
Copy
right
Appendix D.Nursing:Co
pyrig
ht
Nursing:
Ameri
can
A
Ameri
can
APRN
Ameri
can
PRNAPRNA
Ameri
can
APRNA R
Ameri
can
RE
Ameri
can
Education
Ameri
can
ducationEducationE
Ameri
can
EducationE
Nurse
s Application of Nursing’s Social Policy Statement
Nurse
s Application of Nursing’s Social Policy Statement Asso
ciatio
n24
Asso
ciatio
n2425
Asso
ciatio
n25
Contributors
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
v
Revision of the Social Policy Statement Workgroup, 2009–2010Catherine E. Neuman, MSN, RN, NEA-BC – Co-ChairJohn F. Dixon, MSN, RN, NE-BC – Co-Chair
Bette K. Idemoto, PhD, RN, CCRN, ACNS-BCPamela A. Kulbok, DNSc, RN, PHCNS-BCJackie R. Pfeifer, MSN, RN, APRN, CCNSCheryl-Ann Resha, EdD, MSN, RNSue Sendelbach, PhD, RN, CCNS, FAANAnn O’Sullivan, MSN, RN, NE-BC, CNEKathleen M. White, PhD, RN, CNAA-BC
ANA Staff, 2009–2010Carol J. Bickford, PhD, RN-BC – Content editorKatherine C. Brewer, MSN, RN – Content editorMaureen E. Cones, Esq. – Legal counselYvonne Humes, MSA – Project coordinatorEric Wurzbacher – Project editor
Contributors
Copy
right
esha,
Copy
right
esha,endelbach,
Copy
right
endelbach, P
Copy
right
PhD,
Copy
right
hD,’Sullivan,
Copy
right
’Sullivan, M
Copy
right
MSN,
Copy
right
SN,
Kathleen
Copy
right
Kathleen M
Copy
right
M.
Copy
right
. W
Copy
right
White,
Copy
right
hite,White,W
Copy
right
White,W
Copy
right
ANA Staff, 2009–2010Copy
right
ANA Staff, 2009–2010CarolCo
pyrig
ht
Carol
Ameri
can N,
Ameri
can N, N
Ameri
can NEA-BC
Ameri
can EA-BCE-BC
Ameri
can E-BC –
Ameri
can – C
Ameri
can Co-Chair
Ameri
can o-Chair
N,
Ameri
can
N, C
Ameri
can
CCRN,
Ameri
can
CRN,NSc,
Ameri
can
NSc, R
Ameri
can
RN,
Ameri
can
N,RN,R
Ameri
can
RN,RM
Ameri
can
MSN,
Ameri
can
SN, R
Ameri
can
RN,
Ameri
can
N,RN,R
Ameri
can
RN,Resha, Am
erica
n
esha, EAmeri
can
EdD,Ameri
can
dD,hD,Am
erica
n
hD,
Nurse
s Revision of the Social Policy Statement
Nurse
s Revision of the Social Policy Statement
EA-BCNurse
s
EA-BC
Asso
ciatio
n
vi Nursing’s Social Policy Statement
Contributors
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
Congress on Nursing Practice and Economics, 2008–2010
Chair
Kathleen M. White, PhD, RN, CNAA-BC
ViCE-Chair
Ann M. O’Sullivan, MSN, RN, NE-BC, CNE
Susan A. Albrecht, PhD, RN, FAAN
Mary L. Behrens, MSN, RN, FNP-C
Carolyn Baird, MBA, MEd, RN-BC, CARN-AP, CCDP-D-DiplomateInternational Nurses Society on Addictions (INSA)
Carola M. Bruflat, RNC, MSN, WHNP-BC/FNP-BCAssociation of Women’s Health, Obstetrics and Neonatal Nurses (AWHONN)
Garry Brydges, MSN, ACNP-BS, CRNA
Stephanie Davis Burnett, MSN, RN, ACNSpBC, CRRNAssociation of Rehabilitation Nurses (ARN)
Mary Eileen Callan, MS, RN, FNP-BC
Myra C. Carmon, EdD, RN, CPNP
Robin Chard, PhD, RN, CNORAssociation of periOperative Registered Nurses (AORN)
Thomas Coe, PhD, RN, NEA-BC, FACHE
John F. Dixon, MSN, RN, NE-BCAmerican Association of Critical-Care Nurses (AACN)
William R. Donovan, MA, RN
Merilyn Douglass, ARNP, MSN
Bette M. Ferree, MSN, RN, FNP-BC
Susan Foster, MSN, RN, FNP-BC
Copy
right
P
Copy
right
PhD,
Copy
right
hD, R
Copy
right
RN,
Copy
right
N,RN,R
Copy
right
RN,Rssociation
Copy
right
ssociation o
Copy
right
of
Copy
right
f p
Copy
right
periOperative
Copy
right
eriOperative
homas
Copy
right
homas C
Copy
right
Coe,
Copy
right
oe, P
Copy
right
PhD,
Copy
right
hD,
ohn
Copy
right
ohn F
Copy
right
F.
Copy
right
. D
Copy
right
Dixon,
Copy
right
ixon,ACo
pyrig
ht
AmericanCopy
right
mericanAmericanACopy
right
AmericanA
illiamCo
pyrig
ht
illiam
Ameri
can
RNA
Ameri
can
RNA
R
Ameri
can RN,
Ameri
can N,RN,R
Ameri
can RN,R A
Ameri
can ACNSpBC,
Ameri
can CNSpBC,ACNSpBC,A
Ameri
can ACNSpBC,A
N
Ameri
can
Nurses
Ameri
can
ursesNursesN
Ameri
can
NursesN (
Ameri
can
(
S,
Ameri
can
S, R
Ameri
can
RN,
Ameri
can
N,RN,R
Ameri
can
RN,R F
Ameri
can
FNP-BC
Ameri
can
NP-BC
dD,Ameri
can
dD, RAmeri
can
RN,Ameri
can
N,RN,RAmeri
can
RN,R
N,Am
erica
n
N,
Nurse
s INSA)
Nurse
s INSA)HNP-BC/FNP-BC
Nurse
s HNP-BC/FNP-BC
a
Nurse
s and
Nurse
s ndanda
Nurse
s anda N
Nurse
s Neonatal
Nurse
s eonatalNeonatalN
Nurse
s NeonatalN
Asso
ciatio
n
CDP-D-DiplomateAsso
ciatio
n
CDP-D-Diplomate
Contributors
Nursing’s Social Policy Statement vii
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
Lisa A. Gorski, MS, HHCNS-BC, CRNI, FAANInfusion Nurses Society (INS)
Janet Y. Harris, MSN, RN, CNAA-BC
Kimberly A. Hickey, MSN, APRN-BC
Debra Hobbins, MSN, APRN
Patricia L. Holloman, RN, BSN, CNOR
Patricia K. Howard, PhD, RN, CENEmergency Nurses Association (ENA)
Sally Burrows-Hudson, MS, RN, CNNAmerican Nephrology Nurses Association (ANNA)
Bette K. Idemoto, PhD, RN, CCRN, ACNS-BC
Sandra Gracia Jones, PhD, ARNP, CS-C, ACRN, FAAN
Beverly Jorgenson, RNC, MSN, NNP
David M. Keepnews, PhD, JD, RN, FAAN
Patricia L. Keller, MSN, RN, NE-BC
Patrick E. Kenny, EdD, RN-BC, ACRN, APRN-PMH, NE-CAssociation of Nurses in AIDS Care (ANAC)
Linda Riazi-Kermani, RN, BSN, CEN
Robin R. Potter-Kimball, MS, RN, CNS-BC
Jane Kirschling, DNS, RNAmerican Association of Colleges of Nursing (AACN)
Pamela A. Kulbok, DNSc, RN, PHCNS-BC
Kathleen G. Lawrence, MSN, RN, CWOCNWound Ostomy and Continence Nurses Society (WOCN)
Carla A. B. Lee, PhD, ARNP-BC, CNAA, FAAN
Lori Lioce, MSN, FNP-BC
Jennifer H. Matthews, PhD, ACNS-BC
Copy
right
iazi-Kermani,
Copy
right
iazi-Kermani,P
Copy
right
Potter-Kimball,
Copy
right
otter-Kimball,
K
Copy
right
Kirschling,
Copy
right
irschling,Kirschling,K
Copy
right
Kirschling,K
merican
Copy
right
merican A
Copy
right
Association
Copy
right
ssociation
Copy
right
P
Copy
right
Pamela
Copy
right
amela A
Copy
right
A
KCopy
right
KathleenCopy
right
athleenKathleenKCopy
right
KathleenK
Ameri
can N,
Ameri
can N, F
Ameri
can FAAN
Ameri
can AANFAANF
Ameri
can FAANFN
Ameri
can NE-BC
Ameri
can E-BC
R
Ameri
can
RN-BC,
Ameri
can
N-BC,RN-BC,R
Ameri
can
RN-BC,R A
Ameri
can
Aurses
Ameri
can
urses i
Ameri
can
in
Ameri
can
n A
Ameri
can
AIDS
Ameri
can
IDS
iazi-Kermani,Ameri
can
iazi-Kermani, RAmeri
can
R
Nurse
s CRN,
Nurse
s CRN, F
Nurse
s FAAN
Nurse
s AANFAANF
Nurse
s FAANF
AANNurse
s
AAN
Asso
ciatio
n
viii Nursing’s Social Policy Statement
Contributors
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
Sara A. McCumber, RN, CNP, CNS
Peter T. Mitchell, MSN, RN, CNP, APRN-BC
Karen Leone-Natale, RN, BSN
Pamela Sue Neal, MSN-NA, RN, FNP, APRN-BC
Catherine E. Neuman, MSN, RN, NEA-BC
Linda L. Olson, PhD, RN, NEA-BC
Jackie R. Pfeifer, MSN, APRN, RN, CCNS
Theresa A. Posani, MS, RN, CNS, APRN-BC, CCRN, CNE
Elizabeth Poster, PhD, RN, FAAN
Susan E. Reinarz, MSN, RN, NNP-BCNational Association of Neonatal Nurses (NANN)
Cheryl-Ann Resha, EdD, MSN, RNNational Association of School Nurses (NASN)
Patricia Schlosser, RN, BSN
Cheryl K. Schmidt, PhD, RN, CNE, ANEF
Sue Sendelbach, PhD, RN, CCNSNational Association of Clinical Nurse Specialists (NACNS)
Nancy Shirley, PhD, RN
Joanna Sikkema, MSN, ARNP, FAHAPreventive Cardiovascular Nurses Association (PCNA)
Elaine L. Smith, MSN, MBA, RN, CNAANational Nursing Staff Development Organization (NNSDO)
Karen J. Stanley, MSN, RN, AOCN, FAANOncology Nursing Society (ONS)
Thomas E. Stenvig, PhD, RN, MPH, CNAA
Mary Mason Wyckoff, PhD, MSN, ACNP-BC, FNP-BC, NNP, CCNS, CCRN
Copy
right
P
Copy
right
PhD,
Copy
right
hD,ikkema,
Copy
right
ikkema, M
Copy
right
MSN,
Copy
right
SN,
reventive
Copy
right
reventive C
Copy
right
Cardiovascular
Copy
right
ardiovascular
laine
Copy
right
laine L
Copy
right
L.
Copy
right
. S
Copy
right
Smith,
Copy
right
mith,N
Copy
right
National
Copy
right
ational N
Copy
right
N
KCopy
right
KCopy
right
arenCopy
right
arenKarenKCopy
right
KarenK
Ameri
can
N,
Ameri
can
N, C
Ameri
can
CNE,
Ameri
can
NE, A
Ameri
can
AANEFA
Ameri
can
ANEFA
N,
Ameri
can
N, C
Ameri
can
CCNS
Ameri
can
CNSo
Ameri
can
of
Ameri
can
f C
Ameri
can
Clinical
Ameri
can
linical
RAmeri
can
RNAmeri
can
NRNRAmeri
can
RNR
Nurse
s NANN)
Nurse
s NANN)NASN)Nu
rses
NASN)
Asso
ciatio
n
Contributors
Nursing’s Social Policy Statement ix
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
About the Workgroup
John F. Dixon, MSN, RN, NE-BCDirector, The Center for Nursing Education and Research, Baylor UniversityMedical Center, Dallas TX
Mr. Dixon has over 25 years of nursing experience in critical care, education,management, administration, quality, innovation, and research in hospitalpractice, academic, and industry settings. Recent activities include nurs-ing research and the development professional nursing practice models andtheir integration into clinical practice and operations. He has served on theAmerican Association of Critical-Care Nurses’ national board, and been theAACCN organizational liaison representative to ANA.
Bette K. Idemoto, PhD, RN, CCRN, ACNS-BCCardiovascular Clinical Nurse Specialist, University Hospitals Case MedicalCenter, Cleveland, OH
An experienced CNS, Dr. Idemoto has almost 40 years of nursing in acute andcritical care, and has been educator, mentor, and presenter on a wide rangeof clinical topics. Her area of study includes delirium in the critically ill. Shehas encouraged participation among staff nurses in research scholarship, pro-moting nursing research through the coordination of evidence-based practiceconferences, project development, and a nursing research internship program.Dr. Idemoto has served at the local, state and national levels of the ANA andother nursing organizations.
Pamela A. Kulbok, DNSc, RN, PHCNS-BCAssociate Professor of Nursing and Public Health Sciences; Coordinatorof Community/Public Health Leadership, University of Virginia, School ofNursing, Charlottesville, VA
Dr. Kulbok’s nursing career has included the U.S. Navy, a visiting nurse service,directing a hospital-based home health agency, and teaching undergraduateand graduate courses in public health nursing, health promotion research, andnursing knowledge development. She is the Principle Investigator of an inter-professional, cross-institution, community-based research project in substanceuse prevention. An active ANA member, she has held leadership roles in twopublic health nursing organizations.
Copy
right
o
Copy
right
organizations.
Copy
right
rganizations.amela A. Kulbok, DNSc, RN, PHCNS-BC
Copy
right
amela A. Kulbok, DNSc, RN, PHCNS-BC
Associate
Copy
right
Associate Pr
Copy
right
Professor
Copy
right
ofessor
o
Copy
right
of
Copy
right
f C
Copy
right
Community/Public
Copy
right
ommunity/PublicN
Copy
right
N
Copy
right
ursing,
Copy
right
ursing,Nursing,N
Copy
right
Nursing,N
Dr.Copy
right
Dr.
Ameri
can ducator,
Ameri
can ducator, m
Ameri
can mtudy
Ameri
can tudy i
Ameri
can includes
Ameri
can ncludes
articipation
Ameri
can
articipation a
Ameri
can
among
Ameri
can
mong
Ameri
can
t
Ameri
can
through
Ameri
can
hroughthrought
Ameri
can
throughtd
Ameri
can
development,
Ameri
can
evelopment,s Am
erica
n
servedAmeri
can
erved aAmeri
can
atAmeri
can
tataAmeri
can
atarganizations.Am
erica
n
rganizations.
Nurse
s ette K. Idemoto, PhD, RN, CCRN, ACNS-BC
Nurse
s ette K. Idemoto, PhD, RN, CCRN, ACNS-BCniversity
Nurse
s niversity H
Nurse
s Ha Nu
rses
almostNurse
s lmostalmosta Nu
rses
almosta 4Nurse
s 4
entor,Nurse
s
entor,
Asso
ciatio
nospital
Asso
ciatio
nospitalnclude
Asso
ciatio
nnclude n
Asso
ciatio
nnurs-
Asso
ciatio
nurs-m
Asso
ciatio
nmodels
Asso
ciatio
nodels a
Asso
ciatio
na
as
Asso
ciatio
nas s
Asso
ciatio
nserved
Asso
ciatio
nerved
oard,
Asso
ciatio
noard, a
Asso
ciatio
nand
Asso
ciatio
nnd
x Nursing’s Social Policy Statement
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
Contributors
Catherine E. Neuman, MSN, RN, NEA-BCNurse Consultant, Marion, IL
With over 30 years of practice as a chief nursing executive, Ms. Neuman hasbeen director of nursing education, an infection control nurse, and a staffnurse in acute care hospitals. She has been a leader in and an active memberof ANA and the Illinois Nurses Association; her state-level work includesnurse representative to the hospital licensing board. She is involved in boththe ANCC Magnet Nursing Recognition Program as an appraiser and mentor,and in ANCC’s Pathway to Excellence Program as a reviewer. She is presentlya nurse consultant and an active parish nurse and staff nurse at a free clinic.
Jackie R. Pfeifer, MSN, RN, CCNS, APRNAdvance Practice Registered Nurse, Interventional Radiology, MarshfieldClinic, Marshfield, WI
As a clinical nurse specialist, Mrs. Pfeifer has over 10 years of experience inpatient care, which has included specialty practice in medical–cardiology,surgical intensive care, and ambulatory care. She is an active member ofthe Wisconsin Nurses Association and American Association of Critical CareNurses. She currently sits on the board as a Director-at-Large for the Centerfor American Nurses. Mrs. Pfeifer has a passion for the promoting accessand the improvement in the quality of care provided at all levels of care.
Cheryl-Ann Resha, EdD, MSN, RNDirector, School Health and Nutrition Programs, Connecticut Department ofEducation; Adjunct Professor, University of Hartford; College of Education,Nursing and Health Professions
A nurse administrator and nurse educator working in the field of public policyand pediatric health and wellness, Dr. Resha has over 30 years experience ofclinical practice, administration, and education aimed at improving the healthand well-being of children and their families. Her more recent work in the stategovernment involves advocating for school health programs, safe and healthyschool environments, and such school nursing practice issues as competencyand the roles of school nurses in public health and community nursing. Inthis role, she works with many state and national professional organizations.
Copy
right
H
Copy
right
Health
Copy
right
ealthA
Copy
right
Adjunct
Copy
right
djunctAdjunctA
Copy
right
AdjunctA P
Copy
right
Professor,
Copy
right
rofessor,
a
Copy
right
and
Copy
right
nd H
Copy
right
Health
Copy
right
ealth
urse
Copy
right
urse a
Copy
right
administrator
Copy
right
dministratornd
Copy
right
nd p
Copy
right
pediatric
Copy
right
ediatricc Co
pyrig
ht
clinicalCopy
right
linicalclinicalc Copy
right
clinicalc Copy
right
pCopy
right
pndCo
pyrig
ht
nd wCopy
right
w
Ameri
can nd
Ameri
can nd A
Ameri
can Ab
Ameri
can board
Ameri
can oard a
Ameri
can a
P
Ameri
can
Pfeifer
Ameri
can
feifer h
Ameri
can
hhe
Ameri
can
he q
Ameri
can
quality
Ameri
can
ualityqualityq
Ameri
can
qualityq
Cheryl-Ann Resha, EdD, MSN, RNAmeri
can
Cheryl-Ann Resha, EdD, MSN, RNealthAm
erica
n
ealth aAmeri
can
a
Nurse
s o
Nurse
s over
Nurse
s ver 1
Nurse
s 10
Nurse
s 0
pecialty
Nurse
s pecialty p
Nurse
s practice
Nurse
s ractice
mbulatory Nurse
s mbulatory cNu
rses
care.Nurse
s are.
mericanNurse
s
merican
Asso
ciatio
noth
Asso
ciatio
nothm
Asso
ciatio
nmentor,
Asso
ciatio
nentor,p
Asso
ciatio
npresently
Asso
ciatio
nresently
a
Asso
ciatio
na f
Asso
ciatio
nfree
Asso
ciatio
nreefreef
Asso
ciatio
nfreef c
Asso
ciatio
nclinic.
Asso
ciatio
nlinic.clinic.c
Asso
ciatio
nclinic.c
R Asso
ciatio
n
Radiology,Asso
ciatio
n
adiology,
Nursing’s Social Policy Statement xi
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
Contributors
Sue Sendelbach, PhD, RN, CCNS, FAHADirector of Nursing Research and Clinical Nurse Specialist at AbbottNorthwestern Hospital, Minneapolis, MN
Dr. Sendelbach is a nurse researcher and a clinical nurse specialist in criticalcare with 34 years of nursing experience. She has worked in the area of cogni-tion of cardiovascular patients and delirium of hospitalized patients, and is anadvocate for evidence-based practice in patient care. She is past president ofthe National Association of Clinical Nurse Specialists and the book editor forClinical Nurse Specialist: The Journal for Advanced Nursing Practice.
Ann O’Sullivan, MSN, RN, NE-BC, CNEAssistant Dean, Associate Professor, Blessing-Rieman College of Nursing,Quincy, IL
With over 35 years experience as a nurse educator and nurse administra-tor, with current certification as Nurse Educator and Nurse Executive, Ms.O’Sullivan has long been active in nursing and health care at the national andstate level. Her national-level work includes Sigma Theta Tau and numerouscontributions to developing and advocating for ANA’s standards and guidelines.In addition to roles in such Illinois Nurses Association efforts as workforceadvocacy and health policy, she has served on state-level groups on nursingresources and safety, and is now the nurse representative on its board of health.
Kathleen M. White, PhD, RN, NEA-BC, FAANAssociate Professor, Johns Hopkins School of Nursing, Department of HealthSystems and Outcomes; Director, Doctor of Nursing (DNP) Program
Dr. White has been involved at many levels with graduate nursing educationthe Johns Hopkins University School of Nursing. As a clinical nurse specialistat the Johns Hopkins Hospital, she is a member of the collaborative SON/JHHteam that has developed nursing evidence-based practice model and guide-lines. She also maintains a faculty practice appointment at Howard CountyGeneral Hospital as nurse research liaison focusing on EBP initiatives. Herpractice leadership roles include such Maryland state-level issues as hospitalperformance evaluation and patient safety, and nationally, including leadershipand other roles in ANA’s standards and guidelines work.
Copy
right
rofessor,
Copy
right
rofessor,nd
Copy
right
nd O
Copy
right
Outcomes;
Copy
right
utcomes;
W
Copy
right
White
Copy
right
hiteWhiteW
Copy
right
WhiteW h
Copy
right
has
Copy
right
as b
Copy
right
b
he
Copy
right
he J
Copy
right
Johns
Copy
right
ohns H
Copy
right
Hopkins
Copy
right
opkinsa
Copy
right
at
Copy
right
tata
Copy
right
ata t
Copy
right
t
Copy
right
he
Copy
right
hethet
Copy
right
thet J
Copy
right
Johns
Copy
right
ohnstCo
pyrig
ht
teamCopy
right
eam tCopy
right
thatCopy
right
hatlines.Co
pyrig
ht
lines.
Ameri
can dvocating
Ameri
can dvocatingllinois
Ameri
can llinois N
Ameri
can Nurses
Ameri
can ursesNursesN
Ameri
can NursesN
olicy,
Ameri
can
olicy, s
Ameri
can
she
Ameri
can
he h
Ameri
can
has
Ameri
can
asi
Ameri
can
is
Ameri
can
s n
Ameri
can
now
Ameri
can
ow t
Ameri
can
the
Ameri
can
hethet
Ameri
can
thet
athleen M. White, PhD, RN, NEA-BC, FAANAmeri
can
athleen M. White, PhD, RN, NEA-BC, FAANrofessor, Am
erica
n
rofessor, JAmeri
can
JohnsAmeri
can
ohns
Nurse
s ducator
Nurse
s ducator a
Nurse
s aducator
Nurse
s ducator a
Nurse
s and
Nurse
s nd
ursing
Nurse
s ursing a
Nurse
s and
Nurse
s nd h
Nurse
s health
Nurse
s ealth
ncludesNurse
s ncludes SNu
rses
SdvocatingNu
rses
dvocating fNurse
s
f
Asso
ciatio
nresident
Asso
ciatio
nresident o
Asso
ciatio
noditor
Asso
ciatio
nditor f
Asso
ciatio
nfor
Asso
ciatio
norforf
Asso
ciatio
nforfractice
Asso
ciatio
nractice.
Asso
ciatio
n.
lessing-Rieman
Asso
ciatio
n
lessing-Rieman C
Asso
ciatio
n
College
Asso
ciatio
n
ollege
ndAsso
ciatio
n
nd
xii Nursing’s Social Policy Statement
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
Contributors
About the American Nurses AssociationThe American Nurses Association (ANA) is the only full-service professionalorganization representing the interests of the nation’s 3.1 million registerednurses through its constituent member nurses associations, its organizationalaffiliates, and the Center for American Nurses. The ANA advances the nurs-ing profession by fostering high standards of nursing practice, promoting therights of nurses in the workplace, projecting a positive and realistic view ofnursing, and by lobbying the Congress and regulatory agencies on health careissues affecting nurses and the public.
About Nursesbooks.org, The Publishing Program of ANANursesbooks.org publishes books on ANA core issues and programs, includingethics, leadership, quality, specialty practice, advanced practice, and the pro-fession’s enduring legacy. Best known for the foundational documents of theprofession on nursing ethics, scope and standards of practice, and social policy,Nursesbooks.org is the publisher for the professional, career-oriented nurse,reaching and serving nurse educators, administrators, managers, and research-ers as well as staff nurses in the course of their professional development.
Copy
right
Ameri
can ducators,
Ameri
can ducators, a
Ameri
can administrators,
Ameri
can dministrators,c
Ameri
can course
Ameri
can ourse o
Ameri
can of
Ameri
can f N
urse
s a
Nurse
s a
dvanced
Nurse
s dvanced p
Nurse
s pf
Nurse
s foundational
Nurse
s oundationalfoundationalf
Nurse
s foundationalf
tandards
Nurse
s tandards o
Nurse
s of
Nurse
s f
he Nurse
s he pNu
rses
professional,Nurse
s rofessional,
dministrators,Nurse
s
dministrators,
Asso
ciatio
no
Asso
ciatio
nof
Asso
ciatio
nf
c
Asso
ciatio
ncare
Asso
ciatio
nare
nd Asso
ciatio
n
nd pAsso
ciatio
n
programs,Asso
ciatio
n
rograms,ractice,A
ssocia
tion
ractice,
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
1
“Nursing is the pivotal health care profession, highly valued for its specialized knowledge, skill, and caring in improving the health status of the public and ensuring safe, effective, quality care.”
(ANA, 2003)
This revision of Nursing’s Social Policy Statement is the culmination of anextensive review process that also included a long public comment period. Itbuilds on previous editions, especially the original 1980 document. The workdescribes the essence of the profession by discussing nursing as a professionthat is both valued within a society and uniquely accountable to that society.The definition of nursing follows and describes contemporary nursing prac-tice. A more detailed discussion of practice is presented in the sections aboutthe scope and standards of practice and professional performance. A briefcommentary about regulation provides an overview of professional, legal, andself-regulation expectations. This foundational ANA publication remains a keyresource for nurses both to conceptualize the framework of nursing practiceand to provide direction to nursing educators, administrators, and research-ers. This publication also can inform other health professionals, legislatorsand other regulators, those who work in funding bodies, and members of thegeneral public.
Nursing’s Social Policy Statement: An Overview
Copy
right
e
Copy
right
essence
Copy
right
ssenceoth
Copy
right
oth v
Copy
right
valued
Copy
right
alued w
Copy
right
w
efinition
Copy
right
efinition o
Copy
right
of
Copy
right
f
A
Copy
right
A m
Copy
right
more
Copy
right
ore d
Copy
right
detailed
Copy
right
etailed
he
Copy
right
he s
Copy
right
scope
Copy
right
cope a
Copy
right
ac
Copy
right
commentary
Copy
right
ommentarysCo
pyrig
ht
self-regulationCopy
right
elf-regulation
Ameri
can ensuring safe, effective, quality care.”
Ameri
can ensuring safe, effective, quality care.”
ursing’s
Ameri
can
ursing’s S
Ameri
can
Social
Ameri
can
ocialSocialS
Ameri
can
SocialSrocess
Ameri
can
rocess t
Ameri
can
that
Ameri
can
hatthatt
Ameri
can
thattrevious Am
erica
n
revious e Ameri
can
editions,Ameri
can
ditions,ssenceAm
erica
n
ssence oAmeri
can
o
Nurse
s pivotal health care profession, highly valued for its specialized
Nurse
s pivotal health care profession, highly valued for its specialized
knowledge, skill, and caring in improving the health status of the public and Nurse
s knowledge, skill, and caring in improving the health status of the public and
Asso
ciatio
n
Copy
right
Ameri
can N
urse
s Asso
ciatio
n
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
3
Social Context of Nursing
“Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.”
(ANA, 2002)
Nursing, like other professions, is an essential part of the society out of which itgrew and within which it continues to evolve. Nursing is responsible to societyin the sense that nursing’s professional interest must be perceived as servingthe interests of society. The mutually beneficial relationship between societyand the nursing profession has been expressed as follows:
Professions acquire recognition and relevance primarily in terms ofneeds, conditions, and traditions of particular societies and their mem-bers. It is societies (and often vested interests within them) that deter-mine, in accord with their different technological and economic levels ofdevelopment and their socioeconomic, political, and cultural conditionsand values, what professional skills and knowledge they most need anddesire. By various financial means, institutions will then emerge to train[educate] interested individuals to supply those needs.
Logically, then, the professions open to individuals of any particularsociety are the property not of the individual, but of the society. What
Copy
right
hat
Copy
right
hato
Copy
right
o
Copy
right
f
Copy
right
f s
Copy
right
society.
Copy
right
ociety.n
Copy
right
nursing
Copy
right
ursing p
Copy
right
profession
Copy
right
rofession
Professions
Copy
right
Professionsn
Copy
right
needs,
Copy
right
eeds, c
Copy
right
conditions,
Copy
right
onditions,bers.
Copy
right
bers.mine,Copy
right
mine,
Ameri
can
the diagnosis and treatment of human response, and advocacy in the care of
Ameri
can
the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.”
Ameri
can individuals, families, communities, and populations.”
rofessions,
Ameri
can
rofessions,hich
Ameri
can
hich i
Ameri
can
it
Ameri
can
t c
Ameri
can
continues
Ameri
can
ontinuesn Am
erica
n
nursing’sAmeri
can
ursing’society.
Ameri
can
ociety.
Nurse
s “Nursing is the protection, promotion, and optimization of health and
Nurse
s “Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through
Nurse
s abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of Nu
rses
the diagnosis and treatment of human response, and advocacy in the care of
Asso
ciatio
n
4 Nursing’s Social Policy Statement
soCial ContExt of nursing
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
individuals acquire through training [education] is professional knowl-edge and skill, not a profession or even part ownership of one. (Page,1975, p. 7)
The Social Concerns in Health Care and NursingHealth care continues to be a major focus of attention in the United States andworldwide. Many other societal concerns garner extensive attention and sub-sequent action by the nursing profession and its nurse constituency. Nursinghas an active and enduring leadership role in public and political determina-tions about the following six key areas of health care:
u Organization, delivery, and financing of quality health careQuality health care is a human right for all (ANA, 2008b). To improvethe quality of care, healthcare professionals must address these complexissues: increasing costs of care; health disparities; and the lack of safe,accessible, and available healthcare services and resources.
u Provision for the public’s healthIncreasing responsibility for basic self-help measures by the individual,family, group, community, or population complements the use of healthpromotion, disease prevention, and environmental measures.
u Expansion of nursing and healthcare knowledge and appropriate application of technologyIncorporation of research and evidence into practice helps inform theselection, implementation, and evaluation processes associated with thegeneration and application of knowledge and technology to healthcareoutcomes.
u Expansion of healthcare resources and health policyExpanded facilities and workforce capacity for personal care and com-munity health services are needed to support and enhance the capacityfor self-help and self-care of individuals, families, groups, communities,and populations.
u Definitive planning for health policy and regulationCollaborative planning is responsive to consumer needs and provides forbest resource use in the provision of health care for all.
Copy
right
Incorporation
Copy
right
Incorporation o
Copy
right
oelection,
Copy
right
election, i
Copy
right
i
Copy
right
mplementation,
Copy
right
mplementation,
eneration
Copy
right
eneration a
Copy
right
and
Copy
right
nd
o
Copy
right
outcomes.
Copy
right
utcomes.
u
Copy
right
u E
Copy
right
Expansion of healthcare resources and health policy
Copy
right
xpansion of healthcare resources and health policyExpandedCopy
right
Expanded
Ameri
can
rovision for the public’s health
Ameri
can
rovision for the public’s healthb
Ameri
can basic
Ameri
can asic s
Ameri
can s
Ameri
can elf-help
Ameri
can elf-helpommunity,
Ameri
can ommunity, o
Ameri
can or
Ameri
can r p
Ameri
can population
Ameri
can opulation
revention,
Ameri
can
revention,
xpansion of nursing and healthcare knowledge and appropriate
Ameri
can
xpansion of nursing and healthcare knowledge and appropriate application of technologyAm
erica
n
application of technologyf Am
erica
n
f rAmeri
can
researchAmeri
can
esearch
Nurse
s ANA,
Nurse
s ANA,
m
Nurse
s must
Nurse
s ust a
Nurse
s address
Nurse
s ddressisparities;
Nurse
s isparities;
ervices
Nurse
s ervices a
Nurse
s and
Nurse
s nd
Asso
ciatio
na
Asso
ciatio
nand
Asso
ciatio
nndanda
Asso
ciatio
nandand
Asso
ciatio
nnd s
Asso
ciatio
nsub-
Asso
ciatio
nub-onstituency.
Asso
ciatio
nonstituency. N
Asso
ciatio
nNursing
Asso
ciatio
nursingNursingN
Asso
ciatio
nNursingN
olitical
Asso
ciatio
nolitical d
Asso
ciatio
ndetermina-
Asso
ciatio
netermina-
rganization, delivery, and financing of quality health care
Asso
ciatio
n
rganization, delivery, and financing of quality health careANA, As
socia
tion
ANA, 2Asso
ciatio
n
2008b).Asso
ciatio
n
008b).ddressA
ssocia
tion
ddress
soCial ContExt of nursing
Nursing’s Social Policy Statement 5
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
u Duties under extreme conditionsHealth professionals will weigh their duty to provide care with obligationsto their own health and that of their families during disasters, pandem-ics, and other extreme emergencies.
Of increasing importance, healthcare regulatory bodies set institutional stan-dards for mandated quality of care, and other healthcare entities provide guide-lines and protocols to attain quality care and better outcomes. The goals toprovide quality while addressing the costs and quantity of available healthcareservices will continue to be social and political priorities for nursing action.
The Authority for Nursing Practice for Nurses The authority for nursing, as for other professions, is based on social respon-sibility, which in turn derives from a complex social base and a social contract.
There is a social contract between society and the profession. Under itsterms, society grants the professions authority over functions vital toitself and permits them considerable autonomy in the conduct of theirown affairs. In return, the professions are expected to act responsibly,always mindful of the public trust. Self-regulation to assure quality andperformance is at the heart of this relationship. It is the authentic hall-mark of the mature profession. (Donabedian, 1976)
Nursing’s social contract reflects the profession’s long-standing core valuesand ethics, which provide grounding for health care in society. It is easy tooverlook this social contract underlying the nursing profession when faced withcertain facets of contemporary society, including depersonalization, apathy,disconnectedness, and growing globalization. But upon closer examination,we see that society validates the existence of the profession through licensure,public affirmation, and legal and legislative parameters. Nursing’s response isto provide care to all who are in need, regardless of their cultural, social, oreconomic standing.
The nursing profession fulfills society’s need for qualified and appropriatelyprepared individuals who embrace, and act according to, a strong code ofethics, especially when entrusted with the health care of individuals, families,groups, communities, and populations. The public ranks nurses among thetop-few most trusted professionals. In turn, the nursing profession’s trustedposition in society imposes a responsibility to provide the very best health
Copy
right
hich
Copy
right
hich p
Copy
right
phis
Copy
right
his s
Copy
right
social
Copy
right
ocial c
Copy
right
contract
Copy
right
ontract
f
Copy
right
facets
Copy
right
acetsfacetsf
Copy
right
facetsf o
Copy
right
of
Copy
right
f c
Copy
right
c
Copy
right
isconnectedness,
Copy
right
isconnectedness,
w
Copy
right
we
Copy
right
e s
Copy
right
see
Copy
right
ee t
Copy
right
that
Copy
right
hatthatt
Copy
right
thattp
Copy
right
public
Copy
right
ublic a
Copy
right
affirmation,
Copy
right
ffirmation,tCo
pyrig
ht
toCopy
right
o pCopy
right
provideCopy
right
rovideconomicCo
pyrig
ht
conomic
Ameri
can
onsiderable
Ameri
can
onsiderablerofessions
Ameri
can rofessionsublic
Ameri
can ublic t
Ameri
can trust.
Ameri
can rust.
h
Ameri
can
heart
Ameri
can
eart o
Ameri
can
of
Ameri
can
f t
Ameri
can
this
Ameri
can
hisp
Ameri
can
profession.
Ameri
can
rofession.
ocial Ameri
can
ocial cAmeri
can
contractAmeri
can
ontractp Am
erica
n
provideAmeri
can
rovide
Nurse
s rofessions,
Nurse
s rofessions,
ocial
Nurse
s ocial b
Nurse
s base
Nurse
s aseociety
Nurse
s ociety a
Nurse
s and
Nurse
s nd t
Nurse
s the
Nurse
s hethet
Nurse
s thet
rofessions
Nurse
s rofessions a
Nurse
s authority
Nurse
s uthority
onsiderable Nurse
s
onsiderable aNurse
s
autonomyNurse
s
utonomyautonomyaNurse
s
autonomya
Asso
ciatio
nuide-
Asso
ciatio
nuide-
g
Asso
ciatio
ngoals
Asso
ciatio
noals t
Asso
ciatio
nto
Asso
ciatio
noh
Asso
ciatio
nhealthcare
Asso
ciatio
nealthcare
ursing
Asso
ciatio
nursing a
Asso
ciatio
naction.
Asso
ciatio
nction.
The Authority for Nursing Practice for Nurses
Asso
ciatio
n
The Authority for Nursing Practice for Nurses s As
socia
tion
s bAsso
ciatio
n
basedAsso
ciatio
n
ased
6 Nursing’s Social Policy Statement
soCial ContExt of nursing
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
care. The provision of such health care relies on well-educated and clinicallyastute nurses and a professional association, comprising these same nurses,that establishes a code of ethics, standards of care and practice, educationaland practice requirements, and policies that govern the profession.
The American Nurses Association (ANA) is the professional organizationthat performs an essential function in articulating, maintaining, and strength-ening the social contract that exists between nursing and society, upon whichthe authority to practice nursing is based. That social contract is evident inANA’s most enduring and influential work, which is derived from the collec-tive expertise of its constituent member associations, individual members, andaffiliate member organizations. Such work includes:
u Developing and maintaining nursing’s code of ethics;
u Developing and maintaining the scope andstandards of nursing practice;
u Supporting the development of nursing theory and researchto explain observations and guide nursing practice;
u Establishing the educational requirements of professional practice;
u Defining professional role competence; and
u Developing programs and resources to establish andarticulate nursing’s accountability to society, includingpractice policy work and governmental advocacy.
The Elements of Nursing’s Social Contract The following statements undergird professional nursing’s social contractwith society:
u Humans manifest an essential unity of mind, body, and spirit.
u Human experience is contextually and culturally defined.
u Health and illness are human experiences. The presence of illnessdoes not preclude health, nor does optimal health preclude illness.
u The relationship between the nurse and patient occurs withinthe context of the values and beliefs of the patient and nurse.
Copy
right
The Elements of Nursing’s Social Contract
Copy
right
The Elements of Nursing’s Social Contract
ollowing
Copy
right
ollowing s
Copy
right
statements
Copy
right
tatements
ith
Copy
right
ith s
Copy
right
society:
Copy
right
ociety:
uCopy
right
u HCopy
right
HumansCopy
right
umans
uCo
pyrig
ht
u
Ameri
can equirements
Ameri
can equirementsc
Ameri
can competence;
Ameri
can ompetence;
rograms
Ameri
can
rograms a
Ameri
can
and
Ameri
can
nd r
Ameri
can
resources
Ameri
can
esourcesursing’s
Ameri
can
ursing’s a
Ameri
can
accountability
Ameri
can
ccountabilityolicy Am
erica
n
olicy w Ameri
can
workAmeri
can
ork aAmeri
can
andAmeri
can
nd
Nurse
s ursing
Nurse
s ursing t
Nurse
s theory
Nurse
s heorytheoryt
Nurse
s theoryt
ursing
Nurse
s ursing p
Nurse
s practice;
Nurse
s ractice;
equirementsNurse
s
equirements
Asso
ciatio
nhich
Asso
ciatio
nhich
vident
Asso
ciatio
nvident i
Asso
ciatio
nin
Asso
ciatio
nnhe
Asso
ciatio
nhe c
Asso
ciatio
ncollec-
Asso
ciatio
nollec-
embers,
Asso
ciatio
nembers, a
Asso
ciatio
na
thics;
Asso
ciatio
n
thics;
soCial ContExt of nursing
Nursing’s Social Policy Statement 7
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
u Public policy and the healthcare delivery system influence thehealth and well-being of society and professional nursing.
u Individual responsibility and interprofessionalinvolvement are essential.
These values and assumptions apply whether the recipient of professionalnursing care is an individual, family, group, community, or population.
Professional Collaboration in Health CareThe nursing profession is particularly focused on establishing effective work-ing relationships and collaborative efforts essential to accomplish its health-oriented mission. Multiple factors combine to intensify the importance ofdirect human interactions, communication, and professional collaboration: thecomplexity, size, and culture of the healthcare system and its transitional anddynamic state; increasing public involvement in health policy; and a nationalfocus on health.
Collaboration means true partnership, valuing expertise, power, and respecton all sides and recognizing and accepting separate and combined spheres ofactivity and responsibility. Collaboration includes mutual safeguarding of thelegitimate interests of each party and a commonality of goals that is recognizedby all parties. The parties base their relationship upon trust and the recogni-tion that each one’s contribution is richer and more truly real because of thestrength and uniqueness of the others.
Successful collaboration requires that nursing and its members respond todiversity by recognizing, assessing, and adapting the nature of working rela-tionships with individuals, populations, and other health professionals andhealth workers. These efforts also extend to relationships within nursing andbetween nursing and representatives of the public in all environments wherenursing practice may occur.Co
pyrig
ht niqueness
Copy
right
niquenessuccessful
Copy
right
uccessful c
Copy
right
collaboration
Copy
right
ollaborationb
Copy
right
by
Copy
right
y r
Copy
right
recognizing,
Copy
right
ecognizing,
tionships
Copy
right
tionships w
Copy
right
with
Copy
right
ithwithw
Copy
right
withw i
Copy
right
individuals,
Copy
right
ndividuals,
ealth
Copy
right
ealth w
Copy
right
workers.
Copy
right
orkers.b
Copy
right
between
Copy
right
etween n
Copy
right
nnCo
pyrig
ht
nursingCopy
right
ursing
Ameri
can
artnership,
Ameri
can
artnership,a
Ameri
can accepting
Ameri
can cceptingollaboration
Ameri
can ollaboration
ach
Ameri
can
ach p
Ameri
can
party
Ameri
can
arty a
Ameri
can
and
Ameri
can
ndanda
Ameri
can
andaarties
Ameri
can
arties
Ameri
can
b
Ameri
can
base
Ameri
can
asec
Ameri
can
contribution
Ameri
can
ontributionniquenessAm
erica
n
niquenessollaboration
Ameri
can
ollaboration
Nurse
s rofessional
Nurse
s rofessionals
Nurse
s system
Nurse
s ystemnvolvement
Nurse
s nvolvement i
Nurse
s in
Nurse
s n h
Nurse
s health
Nurse
s ealth
artnership,Nurse
s
artnership, vNurse
s
valuingNurse
s
aluingvaluingvNurse
s
valuingv
Asso
ciatio
nProfessional Collaboration in Health Care
Asso
ciatio
nProfessional Collaboration in Health Care
stablishing
Asso
ciatio
nstablishing e
Asso
ciatio
neffective
Asso
ciatio
nffective
a
Asso
ciatio
n
accomplish
Asso
ciatio
n
ccomplishintensifAs
socia
tion
intensifyAsso
ciatio
n
yintensifyintensifAsso
ciatio
n
intensifyintensif theAsso
ciatio
n
therofessionalAs
socia
tion
rofessional
Copy
right
Ameri
can N
urse
s Asso
ciatio
n
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
9
Definition of Nursing
Definitions of nursing have evolved to reflect the essential features of profes-sional nursing:
u Provision of a caring relationship that facilitates health and healing
u Attention to the range of human experiences and responses tohealth and illness within the physical and social environments
u Integration of assessment data with knowledge gainedfrom an appreciation of the patient or the group
u Application of scientific knowledge to the processes of diagnosisand treatment through the use of judgment and critical thinking
u Advancement of professional nursing knowledge throughscholarly inquiry
u Influence on social and public policy to promote social justice
u Assurance of safe, quality, and evidence-based practice
In her Notes on Nursing: What It Is and What It Is Not, published in 1859,Florence Nightingale defined nursing as having “charge of the personal healthof somebody . . . , and what nursing has to do . . . is to put the patient in thebest condition for nature to act upon him.”
Copy
right
ppreciation
Copy
right
ppreciationpplication
Copy
right
pplication o
Copy
right
of
Copy
right
f s
Copy
right
s
nd
Copy
right
nd t
Copy
right
treatment
Copy
right
reatment
u
Copy
right
u A
Copy
right
Advancement
Copy
right
dvancementAdvancementA
Copy
right
AdvancementAs
Copy
right
scholarly
Copy
right
cholarly
uCopy
right
u
Ameri
can elationship
Ameri
can elationship t
Ameri
can t
ange
Ameri
can
ange o
Ameri
can
of
Ameri
can
f h
Ameri
can
human
Ameri
can
umanw
Ameri
can
within
Ameri
can
ithinwithinw
Ameri
can
withinw t
Ameri
can
the
Ameri
can
hethet
Ameri
can
thet
a
Ameri
can
assessment
Ameri
can
ssessment
Ameri
can
ppreciationAmeri
can
ppreciation
Nurse
s eflect
Nurse
s eflect t
Nurse
s the
Nurse
s hethet
Nurse
s thet
Asso
ciatio
n
10 Nursing’s Social Policy Statement
dEfinition of nursing
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
A century later, Virginia Henderson (1961) defined the purpose of nursingas “to assist the individual, sick or well, in the performance of those activitiescontributing to health or its recovery (or to a peaceful death) that he wouldperform unaided if he had the necessary strength, will or knowledge. And todo this in such a way as to help him gain independence as rapidly as possible.”
In the original Nursing: A Social Policy Statement (ANA, 1980), nursingwas defined as “the diagnosis and treatment of human responses to actual orpotential health problems.”
In 2001, ANA’s Code of Ethics With Interpretive Statements stated that“nursing encompassed the prevention of illness, the alleviation of suffering, andthe protection, promotion and restoration of health in the care of individuals,families, groups, and communities.”
The definition for nursing remains unchanged from the 2003 edition ofNursing’s Social Policy Statement:
Nursing is the protection, promotion, and optimization of health andabilities, prevention of illness and injury, alleviation of suffering throughthe diagnosis and treatment of human response, and advocacy in thecare of individuals, families, communities, and populations.
This definition encompasses four essential characteristics of nursing: humanresponses or phenomena, theory application, nursing actions or interventions,and outcomes.
Human ResponsesThese are the responses of individuals to actual or potential health problems,and which are the phenomena of concern to nurses. Human responses includeany observable need, concern, condition, event, or fact of interest to nursesthat may be the target of evidence-based nursing practice.
Theory ApplicationIn nursing, theory is a set of interrelated concepts, definitions, or propositionsused to systematically describe, explain, predict, or control human responsesor phenomena of interest to nurses. Understanding theories of nursing andother disciplines precedes, and serves as a basis for, theory application throughevidence-based nursing actions.
Copy
right
Human Responses
Copy
right
Human Responseshe
Copy
right
he r
Copy
right
responses
Copy
right
esponses
hich
Copy
right
hich a
Copy
right
are
Copy
right
rearea
Copy
right
area t
Copy
right
the
Copy
right
hethet
Copy
right
thet p
Copy
right
phenomena
Copy
right
henomena
bservable
Copy
right
bservable n
Copy
right
n
hat
Copy
right
hat m
Copy
right
may
Copy
right
ay b
Copy
right
be
Copy
right
e t
Copy
right
the
Copy
right
hethet
Copy
right
thet
Theory ApplicationCop
yrigh
t
Theory Application
Ameri
can
ommunities,
Ameri
can
ommunities,
our
Ameri
can our e
Ameri
can essential
Ameri
can ssential
heory
Ameri
can
heory a
Ameri
can
a
Ameri
can
pplication,
Ameri
can
pplication,application,a
Ameri
can
application,a
Human ResponsesAmeri
can
Human Responses
Nurse
s ptimization
Nurse
s ptimizationlleviation
Nurse
s lleviation
uman
Nurse
s uman r
Nurse
s response,
Nurse
s esponse,
ommunities,Nurse
s
ommunities,
Asso
ciatio
nr
Asso
ciatio
nr
tated
Asso
ciatio
ntated t
Asso
ciatio
nthat
Asso
ciatio
nhat
uffering,
Asso
ciatio
nuffering, a
Asso
ciatio
nand
Asso
ciatio
nnd
o
Asso
ciatio
nof
Asso
ciatio
nf i
Asso
ciatio
nindividuals,
Asso
ciatio
nndividuals,
t
Asso
ciatio
n
the
Asso
ciatio
n
hethet
Asso
ciatio
n
thet 2
Asso
ciatio
n
2003
Asso
ciatio
n
003
dEfinition of nursing
Nursing’s Social Policy Statement 11
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
Nursing Actions The aims of nursing actions (also nursing interventions) are to protect, pro-mote, and optimize health; to prevent illness and injury; to alleviate suffer-ing; and to advocate for individuals, families, communities, and populations.Nursing actions are theoretically derived, evidence-based, and require well-developed intellectual competencies.
Outcomes The purpose of nursing actions is to produce beneficial outcomes in relationto identified human responses. Evaluation of outcomes of nursing actionsdetermines whether the actions have been effective. Findings from nursingresearch provide rigorous scientific evidence of beneficial outcomes of specificnursing actions.
Figure 1 depicts the intertwined relationships of human responses, theoryapplication, nursing actions, and outcomes.
Figure 1. Defining CharaCteristiCs of nursing PraCtiCe
*EBP - Evidence-Based Practice
HumanResponses
(Phenomena)
TheoryApplication
(Science)
NursingActions(EBP)*
Outcomes(Eects)
Copy
right
Copy
right
Ameri
can hara
Ameri
can haraC
Ameri
can CharaChara
Ameri
can haraChara teristi
Ameri
can teristi
Ameri
can
Ameri
can
Ameri
can
Ameri
can
Theory
Ameri
can
TheoryApplication
Ameri
can
Application(Science)Am
erica
n
(Science)Ameri
can N
urse
s elationships
Nurse
s elationships o
Nurse
s of
Nurse
s f h
Nurse
s human
Nurse
s uman
teristiNurse
s
teristi
Asso
ciatio
nutcomes
Asso
ciatio
nutcomes i
Asso
ciatio
nin
Asso
ciatio
nn r
Asso
ciatio
nrelation
Asso
ciatio
nelation
nursing
Asso
ciatio
nnursing
indings
Asso
ciatio
n
indings f
Asso
ciatio
n
from
Asso
ciatio
n
romfromf
Asso
ciatio
n
fromfeneficial
Asso
ciatio
n
eneficial o
Asso
ciatio
n
outcomes
Asso
ciatio
n
utcomes
Copy
right
Ameri
can N
urse
s Asso
ciatio
n
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
13
Knowledge Base for Nursing Practice
Nursing is a profession and is both a science and an art. The knowledge basefor professional nursing practice includes nursing science, philosophy, and eth-ics; biology and psychology; and the social, physical, economic, organizational,and technological sciences. To refine and expand nursing’s knowledge base,nurses use theories that fit with professional nursing’s values of health andhealth care and that are relevant to professional nursing practice. Nurses applyresearch findings and implement the best evidence into their practice basedon applicability to the individual, family, group, community, population, orsystem of care. These efforts generate knowledge and advance nursing science.
Nurses are concerned with human experiences and responses across the lifespan. Nurses partner with individuals, families, communities, and populationsto address issues such as the following:
u Promotion of health and wellness
u Promotion of safety and quality of care
u Care, self-care processes, and care coordination
u Physical, emotional, and spiritual comfort, discomfort, and pain
u Adaptation to physiological and pathophysiological processes
u Emotions related to the experience of birth, growth anddevelopment, health, illness, disease, and death
Copy
right
are.
Copy
right
are. T
Copy
right
These
Copy
right
hesea
Copy
right
are
Copy
right
rearea
Copy
right
area c
Copy
right
concerned
Copy
right
oncerned
N
Copy
right
Nurses
Copy
right
ursesNursesN
Copy
right
NursesN p
Copy
right
partner
Copy
right
artner
ddress
Copy
right
ddress i
Copy
right
issues
Copy
right
ssues
u
Copy
right
u P
Copy
right
Promotion
Copy
right
romotion
uCopy
right
u
Ameri
can he
Ameri
can he s
Ameri
can social,
Ameri
can ocial,r
Ameri
can refine
Ameri
can efine a
Ameri
can and
Ameri
can nd
w
Ameri
can
with
Ameri
can
ithwithw
Ameri
can
withw p
Ameri
can
professional
Ameri
can
rofessionalr
Ameri
can
relevant
Ameri
can
elevant t
Ameri
can
tnd
Ameri
can
nd i
Ameri
can
implement
Ameri
can
mplemento Am
erica
n
o t Ameri
can
theAmeri
can
hethet Ameri
can
thet iAmeri
can
individual,Ameri
can
ndividual,heseAm
erica
n
hese eAmeri
can
effortsAmeri
can
fforts
Nurse
s cience
Nurse
s cience a
Nurse
s and
Nurse
s nd
ncludesNurse
s ncludes nNu
rses
nursingNurse
s ursing
ocial,Nurse
s
ocial,
Asso
ciatio
n
14 Nursing’s Social Policy Statement
KnowlEdgE basE for nursing PraCtiCE
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
u Meanings ascribed to health, illness, and other concepts
u Linguistic and cultural sensitivity
u Health literacy
u Decision making and the ability to make choices
u Relationships, role performance, and change processeswithin relationships
u Social policies and their effects on health
u Healthcare systems and their relationships to access, cost, andquality of health care
u The environment and the prevention of disease and injury
Nurses use their theoretical and evidence-based knowledge of these humanexperiences and responses to collaborate with patients and others to assess,diagnose, plan, implement, evaluate care, and identify outcomes. Nursinginterventions aim to produce beneficial effects, contribute to quality outcomes,and—above all—do no harm. Nurses use the process that is evidence-basedpractice as a foundation of quality patient care to evaluate the effectiveness ofcare in relationship to identified outcomes.
Copy
right
Ameri
can
eneficial
Ameri
can
eneficialurses
Ameri
can urses u
Ameri
can use
Ameri
can seuality
Ameri
can uality p
Ameri
can patient
Ameri
can atient
dentified
Ameri
can
dentified o
Ameri
can
outcomes.
Ameri
can
utcomes.
Nurse
s vidence-based
Nurse
s vidence-based k
Nurse
s knowledge
Nurse
s nowledgeith
Nurse
s ith p
Nurse
s patients
Nurse
s atients
are,
Nurse
s are, a
Nurse
s and
Nurse
s nd
Nurse
s i
Nurse
s identify
Nurse
s dentify
ffects,Nurse
s
ffects,
Asso
ciatio
nost,
Asso
ciatio
nost, a
Asso
ciatio
nand
Asso
ciatio
nnd
a Asso
ciatio
n
andAsso
ciatio
n
nd iAsso
ciatio
n
injuryAsso
ciatio
n
njury
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
15
Scope of Nursing Practice
Professional nursing has a single scope of practice that encompasses the rangeof activities from those of the beginning registered nurse through those ofthe most advanced level of nursing practice. The scope of practice statement(ANA, 2010) describes the who, what, where, when, why, and how of nursingpractice. Although a single scope of professional nursing practice exists, thedepth and breadth to which individual nurses engage in the total scope ofprofessional nursing practice are dependent on their educational preparationand self-development, their experience, their role, the setting, and the natureof the populations they serve.
Further, all nurses are responsible for practicing in accordance with rec-ognized standards of professional nursing practice and the recognized profes-sional code of ethics. Note that the lower level and foundation of the pyramidin Figure 2 (see next page) includes the scope of professional practice, standardsof practice, and the code of ethics.
Each nurse remains accountable for the quality of care within his or herscope of nursing practice. The level of application of standards varies withthe education, experience, and skills of the individual nurse, who must relyon self-determination and self-regulation as the final level of professionalaccountability.
Professional nursing’s scope of practice is dynamic and continually evolv-ing, characterized by a flexible boundary responsive to the changing needsof society and the expanding knowledge base of applicable theoretical and
Copy
right
opulations
Copy
right
opulationsFurther,
Copy
right
Further, a
Copy
right
all
Copy
right
llalla
Copy
right
alla n
Copy
right
nurses
Copy
right
urses
ognized
Copy
right
ognized s
Copy
right
standards
Copy
right
tandards
sional
Copy
right
sional c
Copy
right
code
Copy
right
ode o
Copy
right
of
Copy
right
f
n
Copy
right
n F
Copy
right
Figure
Copy
right
igure 2
Copy
right
2 (
Copy
right
(o
Copy
right
of
Copy
right
f p
Copy
right
practice,
Copy
right
ractice,EachCopy
right
Each
Ameri
can ursing
Ameri
can ursing p
Ameri
can practice.
Ameri
can ractice.ho,
Ameri
can ho, w
Ameri
can what,
Ameri
can hat,
s
Ameri
can
scope
Ameri
can
cope o
Ameri
can
of
Ameri
can
fw
Ameri
can
which
Ameri
can
hichwhichw
Ameri
can
whichw i
Ameri
can
individual
Ameri
can
ndividualp
Ameri
can
practice
Ameri
can
racticeelf-development,Am
erica
n
elf-development, tAmeri
can
theirAmeri
can
heirtheirtAmeri
can
theirtt Am
erica
n
theyAmeri
can
heytheyt Ameri
can
theyt
Nurse
s f
Nurse
s f p
Nurse
s practice
Nurse
s ractice
eginningNurse
s eginning rNu
rses
registeredNurse
s egistered
ractice.Nurse
s
ractice.
Asso
ciatio
n
16 Nursing’s Social Policy Statement
sCoPE of nursing PraCtiCE
© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
scientific domains. This scope of practice thus overlaps those of other profes-sions involved in health care, whose boundaries are also constantly evolving.Members of any profession collaborate in various ways, such as:
u Sharing knowledge, techniques, and ideas about how todeliver and evaluate quality and outcomes in health care
u Sharing some functions and a common focus on the sameoverall mission
u Recognizing the expertise of others within and outside theprofession, referring patients to other providers when appropriate
Quality
Evidence
Institutional Policies and Procedures
Nurse Practice Act and Rules and Regulation
Nursing Professional Scope of Practice, Standards of Practice, Code of Ethics,
and Specialty Certification
Self Determination
Safety
Figure 2. MoDel of Professional nursing PraCtiCe
Copy
right
scientific
Copy
right
scientific d
Copy
right
domains.
Copy
right
omains.
sions
Copy
right
sions i
Copy
right
involved
Copy
right
nvolved i
Copy
right
iM
Copy
right
Members
Copy
right
embers o
Copy
right
of
Copy
right
f
uCopy
right
u SCopy
right
SharingCopy
right
haring
Ameri
can
Ameri
can
Ameri
can
Ameri
can Evidence
Ameri
can Evidence
Ameri
can
Ameri
can N
urse
s
Nurse
s
Nurse
s
Nurse
s Nursing Professional Scope of Practice,
Nurse
s Nursing Professional Scope of Practice, Standards of Practice, Code of Ethics,
Nurse
s Standards of Practice, Code of Ethics,
and Specialty CertificationNurse
s and Specialty Certification
Asso
ciatio
n
Asso
ciatio
n
Asso
ciatio
n
Asso
ciatio
n
Asso
ciatio
n
Asso
ciatio
n
Asso
ciatio
n
Asso
ciatio
n
Asso
ciatio
n
sCoPE of nursing PraCtiCE
Nursing’s Social Policy Statement 17
© 2010 American Nurses Associ