NUR 112 Professionalism/Scope of Practice/Competent Care/Community Ethics
Competent Care: Role of the Nurse in Community-Based Care
- Provide continuity of care when patient moves from one level of care to another or from one setting to another. - Provide interventions to promote health. - Manage acute or chronic illness. - Promote self-care.
Factors to Consider Prior to Delegating Patient Care
- Qualifications and capabilities of the UAP - Stability of the patient condition - Complexity of the activity to be delegated - The potential for harm - The predictability of the outcome - The overall context of other patient needs
- Appreciate the power of connectedness and presence. - Stop frequently to stretch and take deep diaphragmatic breaths.
- Reflect frequently on what brings you joy, makes you smile. - Keep a positive, hopeful outlook. Hope allows us to envision a positive future and work to bring this into being.
- Gives nurses the knowledge base necessary for appropriate actions - Helps resolve current nursing issues - Prepares nurses to question assumptions and values
- Serves research, education, and practice - The Most Important Concept of Nursing Theory-The Person
Concept Mastery Alert
- Standards of Practice address the key steps involved in caring for patients. - Standards of Professional Performance address the key concepts that the nurse integrates into his or her role as a professional nurse.
ANA Principles for Delegating Care
- The nursing profession determines the scope of nursing practice. - The nursing profession defines and supervises UAPs involved in providing direct nursing care.
- The RN is responsible and accountable for nursing practice. - The RN supervises any assistant providing direct patient care.
- The purpose of UAP is to work in supportive role to the RN.
- May consist of specific nursing interventions or may use guidelines established for the care of patients with certain illnesses, treatments, or surgical procedures
- The use of EBP mandates the analysis and systematic review of research findings
Standard 12. Education
The registered nurse seeks knowledge and competence that reflects current nursing practice and promotes futuristic thinking.
Standard 16. Resource Utilization
The registered nurse utilizes appropriate resources to plan, provide, and sustain evidence-based nursing services that are safe, effective, and fiscally responsible.
Framework of Nursing Theory
Theory: group of concepts that describe a pattern of reality Can be tested, changed, or used to guide research
Standard 5a. Coordination of Care
The registered nurse coordinates care delivery.
Standard 4. Planning
The registered nurse develops a plan that prescribes strategies and alternatives to attain expected, measurable outcomes.
Standard 5b. Coordination of Care
The registered nurse employs strategies to promote health and a safe environment.
Standard 15. Professional Practice Evaluation
The registered nurse evaluates one's own and others' nursing practice.
Standard 6. Evaluation
The registered nurse evaluates progress toward attainment of goals and outcomes
Standard 3. Outcomes Identification
The registered nurse identifies expected outcomes for a plan individualized to the health care consumer or the situation.
Standard 5. Implementation
The registered nurse implements the identified plan.
Standard 13. Evidence-Based Practice and Research
The registered nurse integrates evidence and research findings into practice.
Standard 11. Leadership
The registered nurse leads within the professional practice setting and the profession.
Standards of Professional Performance Standard 7. Ethics
The registered nurse practices ethically.
Standard 8. Culturally Congruent Practice
The registered nurse practices in a manner that is congruent with cultural diversity and inclusion principles.
Standard 17. Environmental Health
The registered nurse practices in an environmentally safe and healthy manner.
Nursing Social Policy Statement of Issues Nurses Address
- Promotion of health and wellness - Promotion of safety and quality of care - Care, self-care processes, and care coordination
Developing Resilience
- Begin and end the day with gratitude. - Practice mindfulness: What is the most important thing right now? - Appreciate that all humans are limited; some things can't be "fixed."
Community Ethics
- Beginning of Life - pregnancy, prenatal care, abortion, circumcision, - Lifespan - - End of Life
Steps in Implementing EBP
- Cultivate a spirit of inquiry. - Ask the burning clinical question in PICOT format. - Search for and collect the most relevant best practice.
Nurse Practice Acts
- Define legal scope of nursing practice - Create a state board of nursing to make and enforce rules and regulations - Define important terms and activities in nursing, including legal requirements and titles for RNs and LPNs - Establish criteria for the education and licensure of nurses
Benefits of Nursing Theory
- Directs nurses toward common goal - Leads to improved patient care - Provides rational and knowledgeable reasons for nursing actions
- Health literacy - Decision making and the ability to make choices - Relationships, role performance, and change processes within relationships - Social policies and their effects on health
- Health care systems and their relationships to access, cost, and quality of health care - The environment and the prevention of disease and injury
Goals of Nursing Research
- Improve care of people in clinical setting. - Study people and the nursing process. Education Policy development Ethics Nursing history
Qualities of the Community-Based Nurse
- Knowledgeable and skilled - Independent in making decisions - Accountable
- Physical, emotional, and spiritual comfort, discomfort, and pain - Adaptation to physiologic and pathophysiologic processes - Emotions related to the experience of birth, growth and development, health, illness, disease, and death
- Meanings ascribed to health, illness, and other concepts - Nursing Social Policy Statement of Issues Nurses Address #2 - Linguistic and cultural sensitivity
Roles of the Community-Based Nurse
- Patient advocate - Coordinator of services - Patient and family educator
Considerations When Delegating Nursing Care
- Patient's condition - Complexity of the activity - Potential for harm - Degree of problem solving and innovation necessary - Level of interaction required with the patient - Capabilities of the UAP - Availability of professional staff to accomplish workload
Evidence-Based Practice
- Problem-solving approach to making clinical decisions using the best evidence available - Blends both the science and the art of nursing so that the best patient outcomes are achieved
Five right of delegation
1. Right task 2. Right circumstances 3. Right person 4. Right direction/communication 5. Right supervision
National Nursing Organizations in U.S.
ANA - American nurses' association NLN - National League for Nursing AACN - American Association of colleges of Nurses NSNA - National Student Nurses' Association OADN - Organization for Associate Degree Nursing Specialty Practice/Special Interest/Ethnical
Sources of Knowledge Traditional
Knowledge passed down through generations of nurses form the basis of traditional understanding. Traditional practices can be conveyed through observed practice, role modelling, written documents, books, journal articles, and often from 'experienced' practitioners.
Legal and Ethical Issues in Maternal and Child Health Care #1
Abortion: legal, social, and political issue; nurses struggling with personal beliefs and professional duty
Nursing Organizations
American Nursing Association National League for Nursing International Council of Nursing National Student Nurses Association International Honor Society: Sigma Theta Tau
Nursing Process
Assessment Diagnosis Planning Implementation Evaluation
Authoritative
Authoritative Knowledge. Knowledge that comes from an expert and is accepted as truth based on the person's perceived expertise. Ex: Senior staff nurse teaches a new graduate nurse a more effecient method of doing a technical process. Scientific Knowledge.
Nurse Practice Acts and Licensure
Chapter 610-x-6 Standards of Nursing Practice, read section .01, .04, .05, .07, and .11.
Continuing education
Classes required for license renewal
- Critically appraise the evidence (i.e., rapid critical appraisal, evaluation, and synthesis). - Integrate the best evidence with one's clinical expertise and patient preferences and values in making a practice decision or change.
Evaluate the outcomes of the practice decision or change based on evidence. - Disseminate the outcomes of the EBP decision or change
Confidentiality
HIPAA Exceptions: mandatory reporting for abuse, injuries due to weapons or criminal acts, infectious diseases, a threat to an identifiable person
Professional Nursing Organizations
ICN - International Council of Nurses
Substance abuse: fetal injury if woman is pregnant; possible charges of negligence and child endangerment
Intrauterine therapy: medical technology versus nature; better quality of life via surgical intervention
Maternal-fetal conflict: beneficence and autonomy
Legal and Ethical Issues in Maternal and Child Health Care #2
Developing Leadership Responsibilities
Mentorship - Nurse mentorship is a synergetic relationship between a beginning nurse (the mentee) and a nurse with multiple years of experience (the mentor). Nurse mentorship programs are meant to encourage mutual professional growth between both the mentor and the mentee through a dynamic and supportive relationship.
Standard 2. Diagnosis - not medical diagnosis
The registered nurse analyzes the assessment data to determine the actual or potential diagnoses, problems, and issues.
Standard 10. Collaboration
The registered nurse collaborates with health care consumer and other key stakeholders in the conduct of nursing practice.
Scientific
Scientific knowledge is developed through enquiry and can use the scientific method research approaches discussed throughout - evidence based practice (EBP)
Standard 1. Assessment
The registered nurse collects pertinent data and information relative to the health care consumer's health or the situation.
Standard 9. Communication
The registered nurse communicates effectively in all areas of practice.
Guidelines for Nursing Practice
Standards of Nursing Practice - p18/ box 1-4
Acronym for delegation (no delegation)
Teach Assess Planning Evaluation
Standard 14. Quality of Practice
The registered nurse contributes to quality nursing practice.