SELF ASSESSMENT OF NURSING STANDARDS 4
Self-Assessment of Nursing Standards
Marianne Lannen
Ferris State University
SELF ASSESSMENT OF NURSING STANDARDS 4
Abstract
Nurses must individually evaluate their competencies in nursing practice. The American Nurses Association has established professional standards and scope of practice to guide the nursing profession. Through these standards the author identifies her personal strengths and opportunities for growth. Outlined is the author’s personal plan for development in her nursing practice.
SELF ASSESSMENT OF NURSING STANDARDS 4
Self- Assessment of Nursing Standards
According to the American Nurses Association (ANA) (2010), “registered nurses must continually reassess their competencies and identify needs for additional knowledge, skills, personal growth and integrative learning experiences (p.13). The following paper is a personal evaluation by the author of her competencies in nursing skills as defined by the ANA and the Hospice and Palliative Nurses Association (HPNA).
Analysis of Nursing Skills
Standards: Assessment , Diagnosis, Outcome Identification
“The registered nurse collects comprehensive data pertinent to the healthcare consumer’s health and/or the situation” (ANA, 2010, p. 32). “The registered nurse analyzes the assessment data to determine the diagnoses or the issue” (ANA, 2010, p. 34). “The registered nurse identifies expected outcomes for a plan individualized to the healthcare consumer or the situation” (ANA, 2010, p. 35).
As a hospice nurse, I frequently admit patients into our program. Assessment skills are utilized daily. Researching current medical conditions, creating a clinical summary assuring the patient meets the qualifications for admission to hospice, identification of goals, and assessment of the needs of patients utilizing a holistic approach including spiritual, medical, psycho-social and family dynamics are integrated into with each patient visit. My assessment skills continue to improve. I continuously work on expanding my nursing clinical skills in order to ensure I am thoroughly identifying possible complications and needs.
Diagnosis is an area that I have grown the most during my fairly new nursing career. My position requires me to be on call one night a week and every 4th weekend. I triage patients over the phone, make clinical decisions regarding the assessments made and implement interventions. Each admission of a new patient requires an initial plan of care to be developed in which the identification of objectives, goals and interventions are created specific to the patient. Each patient visit requires utilization of a plan of care that outlines goals and interventions that need to be assessed, modified or added to each plan of care
Standard: Planning, Implementation and Evaluation
“The registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes” (ANA, 2010, p.36). “The registered nurse implements the identified plan” (ANA, 2010, p.36). “The registered nurse evaluates progress toward attainment of outcomes’ (ANA, 2010, p.45). Again this is a core component of my position as a hospice nurse. Creating a plan for the patient related to “values, beliefs, spiritual and health practices, preferences, choices, developmental level, coping style, culture and environment” is performed with every admission and at each visit (ANA, 2010, p.36). As an organization that focuses on a holistic approach, it is vital that identification of patient and family characteristics and capabilities are assessed. As outlined in the ANA’s Scope of Nursing Practice (2010), “alleviating suffering, implementing pathways and utilizing a plan to direct other members of the team” are priorities in my practice (p. 36).
Implementation of a plan of care in collaboration with other team members and with patient/family members is essential. The role we play as hospice nurses is also supportive in that we create plans and educate the patient, caregiver or facility staff regarding medications, interventions and care. I have been able to utilize evidence based practice that I have researched through my classes and implement interventions regarding pain and dyspnea based on current data. My knowledge base has advanced considerably from a year ago and now I feel competent with implementation of plans of care and interventions. During my performance review, I was told that my clinical judgment and critical thinking are strengths of mine and I have excelled in this area. However, this aspect of nursing is an area we are always challenged to improve because it directly relates to individualized clinical aspects of nursing.
Standard: Coordination of Care
“The registered nurse coordinates care delivery” (ANA, 2010, p.39). I am responsible for coordinating the care of patients in a variety of settings. Often patients are being discharged from the hospital or reside in a facility and require coordination of their care, medications, equipment, and physician orders. I am effective in this area and able to take a leadership role in coordinating the safe transfer, admissions and care of patients. The opportunity for growth in this area involves actively participating in changing policies and procedures that currently represent a potential risk to patients when hospital discharges are not safely implemented.
Standard: Ethics
“The registered nurse practices ethically” (ANA, 2010, p.46). I incorporate honesty and integrity into both my personal and professional life. This aspect is a difficult one for me as a new nurse who has been given quite a bit of responsibility and autonomy. I am very rigid about my license and following my scope of practice. There are times when emergency situations call for difficult decisions and the comfort of the patient becomes the priority in care. However, ensuring one adheres to the guidelines is as important and yet can be challenging. Even excellent nurses have been observed to bend the rules for the sake of the patient or the organization. I am very uncomfortable when faced with these types of situations and have had to explain that I am not comfortable with participating in certain practices. This is an area I am constantly performing checks and balances within my practice.
Standard: Education
“The registered nurse attains knowledge and competence that reflects current nursing practice” (ANA, 2010, p.49). This past year has represented significant growth and development in my critical thinking and abilities. Completing my degree as well as learning many new clinical aspects for hospice care has been challenging. There are still many aspects of my nursing practice that I need to focus on related to clinical tasks and basic knowledge. I need to get better at blood draws, wound care, pain medication conversions along with numerous other skills. I am proud of my practice and skills as a nurse but know that it will require hard work and personal discipline to continue to expand my knowledge in order to become the best nurse I can be.
Standard: Evidence Based Practice and Research
“The registered nurse integrates evidence and research findings into practice” (ANA, 2010, p.51). My coursework has really strengthened my skills regarding this area. In fact, I find myself advocating for more consistent use and dissemination of evidence based practice within our organization. This is always developing and I am continuously working on researching questions for my own knowledge base.
The HPNA states that “individual hospice and palliative nurses apply evidenced-based, nurse-led translational research, clinical practice guidelines, clinical/critical pathways and nationally accepted standards of practice to the care provided to seriously ill patients and their families”(HPNA, 2010, p.2). Several of the research papers I have written or participated with are directly related to hospice care. I am already incorporating my findings into my practice through education to patients and will continue to do so throughout my career.
Standard: Communication
“The registered nurse communicates effectively in a variety of formats in all areas of practice” (ANA, 2010, p.54). Communication is essential to every aspect of my position. Effective communication determines the success of my practice and ensures the safety and positive outcomes for patients. On a daily basis, I have to present information to patients either during an admission or a nursing visit. Other facilities require charting in their systems at each visit. I have to delegate, collaborate and strategize with patients, families, co-workers, physicians, pharmacy, vendors, management, discharge planners, other nurses and administrators regarding patients. I electronically chart, write orders, leave voice mails, email and fill out admission paperwork daily. I support other case managers and thus have to effectively update regarding their patients and notify them of any changes to condition or plan of care. This is a definite strength of mine and I feel fortunate to have had a sales background that established these skills prior to becoming a nurse. Regardless, I still strive to improve and self-evaluate when I am effective in this area and when breakdown has occurred.
The HPNA states that ”patient advocacy remains a core nursing function and vital role supporting improved and more efficient systems of care that have a direct relationship to quality patient care” (HPNA, 2011, p.2). Communication is essential to being able to advocate for one’s patients. It is not enough to identify patient needs but to ensure that the needs of the patient are met is critical to providing quality of care. While I believe I am an effective patient advocate, I recognize that I still need to develop more organization skills to ensure that important information is not missed or overlooked.
Standard: Environmental Health
“The registered nurse practices in an environmentally safe and healthy manner” (ANA, 2010, p.). This is a definite hole in my education and practice. My organization has not provided great detail regarding environmental safety and procedures. I have often gone into a home without knowledge of MRSA conditions or proper cleaning supplies to wipe down my equipment. There are regulations regarding clean and dirty areas in my vehicle and I have never seen an official guideline for practice. Sometimes in the field, one can only do the best they can with the environment that they are in. I use hand sanitizer when I am unable to wash my hands in the home environment. I plan on improving my knowledge in this area.
Standard: Pain Management
The following guidelines regarding pain management are supported by the HPNA:
Pain assessment and management should incorporate principles of cultural sensitivity as well as patients’ values and beliefs. All healthcare providers have the obligation to believe the patient’s report of pain. All healthcare professionals caring for the patients with progressive, life-threatening illness need to acquire and utilize current knowledge and skills to implement appropriate pain management. Pain assessments and management should be aligned with evidence-based practice. Pain management should be part of education for all healthcare providers who are caring for patients with advanced, life-limiting illness (HPNA, 2011, p.2).
My knowledge regarding pain management has increased considerably. I am comfortable with utilizing standing orders to prescribe and implement medication interventions for patients. I still need to expand my knowledge base and full understanding of pain management options. Recently, I was able to gain clinical experience with converting medication equivalents and starting a patient on a pain pump. I utilize the more seasoned nurses and management to consult whenever needed. I have researched and read many evidence based research articles to incorporate into practice. I have barely touched the surface of the knowledge I still need to acquire. Most importantly, I incorporate a philosophy into my care that the patient’s pain is whatever they say it is and that an agreed upon level of pain relief that is congruent with patient goals is a right to care and should be honored for every patient.
Professional Development Plan
“The registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines relevant statutes, rules, and regulations (ANA, 2010, p.59). In order to further develop nursing skills and knowledge base, the author will engage in the following activities suggested by the ANA (2010): engage in self-evaluation of practice on a regular basis, obtain informal feedback regarding practice from patients, peers and professional colleagues, interact with peers and colleagues to enhance professional nursing practice or role performance and provide the evidence for practice decisions and actions as part of the informal and formal evaluation processes (p.59). The following in a personal professional development plan the author has identified for herself:
Goals
1. The author will find opportunities to gain additional experience in a clinical setting that will allow for the exposure to all aspects of clinical nursing skills and further expand her knowledge base related to performing of clinical tasks.
2. The author will complete a BSN degree at Ferris State University by 2012.
3. The author will become a Certified Hospice and Palliative Nurse (CHPN) by December of 2012.
4. The author will continue to incorporate evidence based practice into her nursing practice.
5. The author will expand her knowledge regarding safe environmental policies in order to ensure adherence to regulations and safe nursing practices in the field/home environment.
6. The author will advance her knowledge of pain management practices, evidence based practices and interventions by April of 2012.
Action Plan
1. The author will apply for a contingent nursing position within a hospital setting or inpatient hospice by the fall of 2012 in order to further develop clinical skills. A checklist of skill deficits will be developed and marked off when the author feels she has gained the competence in that skill.
2. The author will take the last three nursing classes required to obtain her degree during the spring of 2012 semester. Approval from her advisor is still pending and will need to be received by Dec. 31, 2011. If approval is not received, the author will finish in the summer of 2012 semester.
3. The author will develop a study plan that will prepare her for the test to become a CHPN by fall of 2012. She will apply to take the test by December of 2012.
4. The author is going to research one clinical question related to hospice and palliative care per month and distribute this data to other peers within her organization.
5. By April 1, the author will gather all published policy regarding environmental practices related to such topics including but not limited to MRSA precautions, vehicle regulations, transporting of blood products and create an informal personal plan that will outline the integration of these guidelines into practice.
6. The author will develop a checklist of materials to read or re-read regarding pain management. Included in this will be the Hospice manual regarding pain management, pain pump manual, journal articles regarding pain management, and development of a personal spreadsheet as a resource about available medications via the standing orders.