Scope and Standards of Nursing Web viewPage Numbers: Did you number your pages using the automatic functions of your Word program? [p. ... It may also look like this: Bell-Scriber

Running head: SCOPE AND STANDARDS OF NURSING 1

Scope and Standards of Nursing

Patricia Burgess

Ferris State University

Leadership in Nursing

NURS 440

SCOPE AND STANDARDS OF NURSING 2

Abstract

The purpose of this paper is to describe the importance of following the Standards of

Professional Practice put forth by the American Nurses Association (ANA). Taking a

look at how well I live up to those standards in my every day practice to determine if I

have met my goals and what goals are yet to be achieved. Describing how I will

accomplish, alter change and evaluate my goals. Entering the profession of nursing, one

must accept the responsibilities and trust that the nurses that have gone before built the

respect that society has for nurses today. The obligation is to adhere to the professions'

code for ethics. The Code of Ethics for Nurses is the standard by which ethical conduct

is both guided and evaluated by the profession of nursing. It concentrates on the rights,

responsibilities, and obligations of health care professionals, the institutions of care, and

its’ clients. Enter the profession of nursing, and accept the responsibility. The obligation

is only to follow the standards and codes set by the profession to improve the overall

quality.


Standards of Practice

Standards of Practice and performance define the Who, What, Where, When,

Why, and How of nursing practice. It outlines key aspects of nursing’s professional role

and practice for any level, setting, population focus, or specialty. The clients or patients

can and do include the individual, family, group, or community that the nurse may be

caring for. My strength is in health promotion along with holistic therapies and how to

maintain that health. My specialty is progressive patients and is growing in the burn

population. The work of establishing professional improvement with continued

education to heighten my knowledge in my specialties. Most nursing skills would need

in the domains are that of analytic assessment skills, communication skills, financial

planning and management skills.

Quality of Practice

As a nurse, we systematically evaluate the quality and effectiveness of our

nursing practice. In attending staff or team meetings, our manager keeps us up to date on

the quality dashboard to help us visualize where we are in quality and safety. While we

feel that we give quality care all the time, the statistics can show differently. I participate

in committees that brainstorm on how we can improve those numbers, or on our quality

of care. Collecting data and formulating recommendations to improve patient outcomes.

Personally, I feel I meet this standard, and participate on an educational committee to

help develop and initiate changes. I work on my competencies; it is expected and is a

measurable level for my skills, abilities, and judgment based on expectations for my unit

and the organization.


Ethics

The Code of Ethics for Nurses was developed as a guide for carrying out nursing

responsibilities in a manner consistent with quality in nursing care and the ethical

obligations of the profession (Code of Ethics with Interpretive Statements). The ANA

believes the Code for Nurses is nonnegotiable and that each nurse has an obligation to

uphold and adhere to the code of ethics. (American Nurses Association Scopes and

Standards of Nursing). According to the ANA (2004), ethics is defined as, “The

registered nurse integrates ethical provisions in all areas of practice” (p. 39). I believe I

take ethics very seriously in all areas of my practice, from considering a patient's right to

confidentiality to becoming an advocate in difficult situations. Representation of my

patient is probably what I am best at regarding this standard. Collaborating with

physicians to come back and listen to the family's concerns about any situation that the

family had shared with me. The mutual respect of the patients’ wishes and accepting the

commonality of goals for the patient has to be communicated. It is a right for the patient

to get their needs and goals.

Situations can be tough to handle due to values and beliefs of different cultures.

Over the years of my nursing career, I still believe there is a sense of entitlement that

comes with patients and is what I still have a hard time dealing with. I do not believe that

anything in life is free. You do not deserve to blame anyone if you have constantly

practiced non-compliance. I believe that a nurse can run out of compassion for the

patient that continually comes back to the hospital for the same non-compliance. I know

in my heart that there is an underlying cause, and so many times, I have reached out,


thinking I may have helped in some small way. Only to realize I was the only one

hearing what I was saying.

Education

Nursing education includes efforts to recruit and retain nurses as well as support

competence and quality care (American Nurses Association Scopes and Standards of

Nursing). In the area of education, we have the opportunity to improve upon our

knowledge. I have received my Progressive Care Certified Nurse (PCCN). I must obtain

one hundred continuing education units every three years to keep this active. I also

subscribe to the AACN, (American Association of Critical Care Nurses) and read their

articles that have adjoining quizzes. Given the opportunity, I have recently attended

conferences in burns, cystic fibrosis, and the National Teaching Institute (NTI). We all

have opportunity for growth in our own fields of nursing. My current opportunity is to

continue in school, to receive my Bachelors of Science in Nursing (BSN). I should be

done with my BSN in May 2015. I have also received my Progressive Care Certified

Nurse (PCCN). Both of these opportunities were encouraged and recommended by my

organization, for my leadership role. Other opportunities are tuition reimbursement, free

continuing education units CEUs’, conferences, in services, and being part of

committees’ that encourage, plan, and teach new opportunities. My floor had the

privilege of welcoming the Regional Burn Unit, everyone working in Progressive Care

was offered the opportunity to become critical care nurses and take the burn classes and

pediatric care to become certified in taking care of this population.

Evidence Based Practice and Research


A measurement criteria for Research by the AACN (2008) is, “The nurse

continually questions and evaluates practice and uses the best available evidence,

including research findings, to guide practice decisions.” I was on a research committee

two years ago and realized how much I did not know about what actually goes in to

research. I have learned to respect the process of research, for what the researcher gives

back to profession in maintaining evidence-based policies to use as resources. I use the

policies and guide my practice. Policies are evidence based with references that maintain

quality in our practice, proven to increase a more safe practice. My profession uses

evidence based practice and displays an understanding of human beings in their most

vulnerable states. Nursing is a profession that allows me to provide the highest quality

care possible to achieve excellence in patient results, while providing a respectful healing

environment. I feel that it is worth the journey of researching if it improves the quality of

care we give our patients. My personal evaluation for research with evidence based

practice is that our research project Nurses and Emotional Intelligence has been approved

for publishing. A higher goal than I had imagined going into research.

Standards of Professional Performance

Entering the profession of nursing, we should realized that we are accepting the

responsibilities and trust what the nurses that have gone before us have built over the

years. The obligation is to adhere to the professions' code for ethics. The Code of Ethics

for Nurses is the standard by which ethical conduct is guided and evaluated by the

profession. It provides a framework within which I can make ethical decisions by

advocating for my patients and their wishes, being honest with my patients, their families

and co-workers. What we do. One of the criteria for the ANA (2004) standard Quality of


Practice is that the nurse “systematically enhances the quality and effectiveness of

nursing practice” (p.33). My employer offers many quality improvement opportunities,

from medication administration to monthly pressure ulcer audits. I have been on multiple

committees to improve quality of care. The most recent committee is Staff Teaching and

Resource Symposium (STARS). This committee surveys staff on my unit to find out

what we need to improve on. For example, if we are aware of our quality dashboard that

we are having an increase of falls then we need to come up with an action plan to

decrease the number of falls. Once we have a plan we implement this through in

services, posters, e-mails and at team meetings. The way that I currently participate in

quality of practice is by filling out surveys that track different objectives throughout the

facility. These surveys are tools to influence policy and procedures by obtaining nurse

feedback on the issues. The most current survey I have completed was the practice of our

pain scale use and reassessment of pain. Looking at the effectiveness of this practice

from the patients’ perspective. It is one of our quality initiatives that required

improvement.

Assessment & Diagnosi

Assessment is the health data that the nurse collects that involves the patient

family and other healthcare providers as appropriate (American Nurses Association

Scopes and Standards of Nursing). The assessment and data collection is an important

skill for nurses keeping the concern or need of the patient and the priority that is to be

addressed. This process is ongoing, systematic and probably the most important thing we

as nurses do all day. If one cannot notice subtle changes in the patients’ condition then

there was a problem missed. There have been nurses’ that I have worked with who have


no sense of what is going on with their patients. The assessments have to be of the

complete person. Interaction with the patient and their families plays an important role in

collecting data and being able to analyze it.

The nurse analyzes the assessment data in determining the diagnosis. This is a

strong point for me. It provides the basis for determining if the plan needs to be changed

or will assist in achieving planned outcomes. Knowing when to call the doctor, make

changes in the care of the patient, knowing when to hold a medication that could cause

more harm. Setting priorities according to the assessment of the patient, paying attention

to the patients’ response to their health condition or needs. This is a met standard

measured by evaluation by my peers and patients.

Outcome Planning & Implementation

The nurse identifies expected outcomes individualized to the patient; this would

be where the plan of care (POC) comes alive. This is a very important step in the day of

a patient. Although this is part of my day, it tends to be the most important to the patient

and least important on the priority list. When goals are made and accomplished by the

patient, it is an expected feat for the nurse that the patient gets there. This was my goal to

be more complete this last year so it is now a met goal for me as I have been at100% in

identifying and individualizing goals and plans of care for my patients. This is done by

chart reviews by my manager.

The nurse develops a plan of care that prescribes interventions to attain expected

outcomes (American Nurses Association Scopes and Standards of Nursing). Planning for

a day on the floor is much different from planning the day for a patient. The Plan of Care

(POC), in my floor routine has become one of my strongest standards of my nursing. The


patient has to be at the center of this part of the day. The ability to have a POC written

down for interdisciplinary use is so important and it has proved helpful on more than one

occasion. Proving that a plan not written down is not of much use for anyone.

The nurse implements the interventions identified in the plan of care.

Implementation is a working relationship between patient and nurse (American Nurses

Association Scopes and Standards of Nursing). Setting goals, developing trust, and

providing a caring environment together. A caring environment is one that offers the

development of a patients full potential while allowing the person to choose the best

action for him or herself in time. This is a strong point for me, searching ways to help the

patient set up their goals and then work to meet them. Orem’s theory is my philosophy

both my patients’ and I work very well with this theory. This theory can develop a

relationship and build trust with the patient. The other theory that works closely with my

practice is Imogene King’s theory of Goal Attainment. To involve a patient with their

goal along with my goal would help them attain the faster recovery level. I believe being

a patient advocate, practicing clear communication, critical thinking skills and utilizing

education that will facilitate a better outcome

Evaluation

The nurse evaluates the patient’s progress toward the attainment of outcomes; this

is the favorite part of most nurses’ days. To see the patient improve and move towards

getting back to their baseline. A plan of care(POC) that is done appropriately can make

for the warm fuzzies we all dream of receiving. I often parallel the (POC) with my peer

evaluation asking myself if I have done enough to meet my outcomes and goals. The

charting at Spectrum Health does not really focus on this in the charting portion of our


computer charting, but this does not mean I have not personally improved on my

charting. Work still can be done in this area and it is a continuous work in progress.

Nursing is a moral art…it involves the design and fostering of a healing atmosphere that

rests upon the creation of a therapeutic relationship and the application of scientific

knowledge and skill” Koloroutis, M. (2004). Being a charge nurse has taught me how

important constructive feedback is to maintaining and improving skills. Throughout the

past twenty years I think that I have done a great job at “looking at my practice and

evaluating myself on the constructive feedback regarding my own competencies from the

teams of patients, family and other healthcare providers” (AACN, 2004). Evaluations are

done by our unit manager but also by peers chosen by our manager to evaluate us. I am a

very consistent employee, setting and expecting very high expectations of myself. I put a

lot of effort into “taking action to achieve performance goals” (AACN, 2004) set by my

superiors. In conclusion, there are times when I believe I am too critical of myself and

question myself. I come up with the same answer every year. I love what I do, I care too

much and I hope that never changes. Scopes, standards, and ethics are part of me, I work

within them for my profession. I am a high functioning nurse with a lot to offer, but it is

at the bedside for my patients. What I feel is that, I measure up but where can I improve?

I can in some areas and improving what I do is part of what I attempt to do everyday I go

to work.


References

American Nurses Association (ANA). (2007). Public Health Nursing: Scope and

Standards of Practice. Silver Spring, MD.

American Association of Critical Care Nurses. (2008). AACN Scope and

Standards for Acute and Critical Care Nursing Practice. Retrieved from

http://www. AACN.org/wd/practice

/docs/130300_standards_for_acute_and_critical_care.pdf

Harkness, G. A. & DeMarco, R. F. (2012). Community and Public Health Nursing

Practice: Evidence for Practice. Wolters Kluwer/Lippincott, Williams & Wilkins:

Philadelphia. ISBN: 987-0-7817-5851-2.

Koloroutis, M. (2004). Relationship-Based Care: A Model for Transforming Practice.

Creative Health Care Management. Miinneapolis, MN.


CHECKLIST FOR SUBMITTING PAPERS

CHECKDATE, TIME, & INITIAL

PROOFREAD FOR: APA ISSUES

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

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]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]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]

5. Margins: Did you leave 1” on all sides? [p. 229]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]7. Line Length and Alignment: Did you use the flush-left style, and leave the right margin uneven, or ragged? [p. 229]8. Paragraphs and Indentation: Did you indent the first line of every paragraph? See P. 229 for exceptions.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]10. Typeface: Did you use Times Roman 12-point font? [p. 228]11. Abbreviation: Did you explain each abbreviation the first time you used it? [p. 106-111]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]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]

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

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

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

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

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.)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?20. Wordiness: check for the words “that”, and “the”. If not necessary, did you omit?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?22. Avoid contractions. i.e. don’t, can’t, won’t, etc. Did you spell these out?23. Did you check to make sure there are no hyphens and broken


words in the right margin?24. Do not use “etc.” or "i.e." in formal writing unless in parenthesis. Did you check for improper use of etc. & i.e.?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?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…..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.”28. Did you run a Spellcheck? Did you proofread in addition to running the Spellcheck?29. Did you have other people read your paper? Did they find any areas confusing?30. Did you include a summary or conclusion heading and section to wrap up your paper?31. Does your paper have sentence fragments? Do you have complete sentences?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.

Documents

Scope and Standards of Nursing Web viewPage Numbers: Did you number your pages using the automatic functions of your Word program? [p. ... It may also look like this: Bell-Scriber