SELF-ASSESSMENT OF NURSING STANDARDS OF PRACTICE 23
Self-Assessment of Nursing Standards of Practice
Whitney Ayers
Ferris State University
SELF-ASSESSMENT OF NURSING STANDARDS OF PRACTICE 23
Abstract
This paper will define each of the nursing standards of practice and code of ethics as described by the American Nurses Association (ANA). The standards of practice “describe a competent level of nursing care as demonstrated by the nursing process” and the code of ethics is “explicit goals, values, and obligations of the nursing profession and expresses its values, duties, and commitments to society” (American Nurses Association [ANA], 2010, p. 64 & 67). The paper will then state if I have met the standard or ethic and describe how it has been met. If the standard or ethic has not been met then there will be a plan on how I will achieve the task. I have met most of the standards and ethics so far as a student nurse.
SELF-ASSESSMENT OF NURSING STANDARDS OF PRACTICE 23
Self-Assessment of Nursing Standards of Practice
The history of nursing has not always been what it is today. It was not a highly sought after profession that one would be proud they had. As nursing changed and developed over the years, it has grown to become a highly skilled profession. The nursing standards of practice and code of ethics has help nursing become a profession, and nurses today are held to these high standards. The nursing profession has a responsibility not only to its members, but also to the community in which it is serving. The American Nurses Association (ANA) has developed the scope and standards of practice that apply to the practice of all professional nurses (American Nurses Association [ANA], 2010, p. 1-2). The scopes of practice describe all of the important details of the nursing practice. All the skills used in nursing are combined to create a dynamic and complex practice, and having these standards is going to help the profession to continue to grow in the future. The ANA has identified sixteen standards of practice that all professional nurses are expected to preform competently. The first six standards fall under the category of standards of practice, and the last ten standards fall under the category of professional performance (ANA, 2010, p. 9-10). The standards of practice describe a level of nursing care known as the nursing process. The nursing process includes assessment, diagnosis, outcome identification, planning, implementation, and evaluation. This process is significant to nursing and forms the foundation of the nurse’s decision making process. The standards of professional performance describe levels of behavior in the professional role. These include activities related to ethics, education, evidence-based practice and research, quality of practice, communication, leadership, collaboration, professional practice evaluation, resource evaluation, and environmental health. These standards hold nurses accountable for their actions to not only themselves, but also their healthcare consumers, peers, and community. In this paper I will discuss how I have met or plan to meet the ANA Standards of Practice and the Code of Ethics for nurses.
Nursing Scope and Standards of Practice
Standards of Practice
Assessment
“The registered nurse (RN) collects comprehensive data pertinent to the healthcare consumer’s health and the situation” (ANA, 2010, p.32). I have met this outcome in the clinical setting by gathering data from each of my patients and getting involved in their care. With each patient assigned to me at clinical, I first researched their chart on the computer to find out their health history, diagnosis, labs, diagnostic testing, diet, and any precautions they might have. I would then get report from the nurse on my patient for more information that I did not get from the electronic chart. I then go into the room and do a complete head-to-toe assessment on each patient, but focus more on what condition or conditions they are being treated for. Each patient is different and I tried to determine how each patient communicated best. One specific example of a cultural assessment was in my first semester in Fremont Hospital. I had a patient that was from the Amish community that was very sick from gallstones. When I went in the room to do my head-to-toe assessment the patient’s husband answered all of the questions I was asking about the patient’s pain level and health history. At first this was very strange to me and I thought he was being controlling, so I talked to my clinical instructor and she explained that it was part of their culture, and that he was not trying to control the situation. The Amish culture is focused around community and they collaborate together to help anyone in their community that may need it, and men are looked to for guidance. After she explained this to me it made the care of the patient easier. At first, I thought of assessment as “what is wrong with the patient, and how do we fix it” but after caring for this patient I realized it is more than that. Although it is important to know what is happening to patients physically, it is also important to know what their emotional and cultural needs may be as well. This will help to build a strong patient-nurse relationship which is important for not only the patient, but the nurse as well. It is important to treat each patient as an individual, and find out the best way to care for each of them in their own unique way. This will ensure that each patient feels that they received high quality care.
Diagnosis
“The RN analyzes the assessment data to determine the diagnoses or the issue” (ANA, 2010, p. 34). I have met this outcome in my clinical experience by recognizing a dangerous situation a patient was in. I had a patient that was admitted for aspiration pneumonia that was on a soft food, and nectar thickened liquid diet. I went into the room to complete my head-to-toe assessment and noticed that someone had left his breakfast tray next to the patient’s bed. There were waffles on the plate that were cut into small pieces, but the patient was not able to feed themself. I feed him a small bite of waffle and watched as the patient chewed it for approximately three minutes. I asked him if he could swallow it, and he shook his head “no”. I tried to give him a drink of thickened milk hoping that he could swallow it, but he could not. I looked up his medication list and there were two medications that could not be crushed on his list. I went and talked to my clinical instructor and we went to give him his medications. She assessed him swallowing and called the pharmacy to get the two medications changed to liquid. I left a note for the doctor about what I had seen and he ended up changing his diet to only nectar thick liquids. I was happy I recognized the potential risk for aspiration or chewing hazard for this patient. If he could have feed himself and someone just left the tray in his room, the patient could have aspirated or choked on the food and had no one there to see it. We have learned a lot about advocating for our patients, and that day I believe I helped to keep a patient safe.
Outcome Identification
“The RN identifies expected outcomes for a plan individualized to the healthcare consumer or the situation” (ANA, 2010. p. 35). I have met this outcome with a patient I cared for this semester at Butterworth Hospital. This patient was a young man who was admitted with acute pancreatitis and newly diagnosed type 1 diabetes. He was a college student and was worried about all the school work he was missing. He was in the hospital for almost a month so I cared for him on more than one occasion. He was in a great deal of pain, which gave him very little motivation to get up and move. He was planning on going home in a few days under the condition that he stops taking intravenous (IV) pain medication, and that he start ambulating more frequently. I sat down with him and his mother and developed a plan for that day. I explained to him what needed to happen if he wanted to be discharged home. We came up with a plan for that day to ambulate one lap in the hall, three times that day, and try to do it with no IV pain medications. This was for the ultimate outcome of being discharged in the following week, and getting back to school by the end of March. Although it was not easy for him, he got up and ambulated in the hallway three times with the help of his mother and myself. He did use some IV pain medication, but it was dramatically less than days prior.
Planning
“The RN develops a plan that prescribes strategies and alternatives to attain expected outcomes” (ANA, 2010, p.36). I have met this requirement in the home health clinical setting. The patient was sent home from the hospital on high flow oxygen because he could not keep his oxygen saturation up after being diagnosed with pneumonia. His nursing diagnosis was decreased tissue perfusion as evidence by low oxygen saturation related to pneumonia. Before the diagnosis of pneumonia this patient was not on home oxygen. My plan was to start to wean him slowly off the high dose oxygen until he no longer needed it to keep his saturation at a normal level. The patient was fairly young and wanted to begin being active again. The timeline was set to be off all home oxygen within two weeks.
Implementation
“The RN implements the identified plan” (ANA, 2010, p.38). I have met this standard in the clinical setting by beginning the plan for a patient, educating him about the use of home oxygen, and coordinating his care with the help from the home care nurse and the patient’s family. The plan was to get the patient off home oxygen within two weeks. The patient was on four liters of oxygen in order to keep his saturation above 94%. On the four liters he was at 98% saturation. We turned the oxygen down to three liters and waited three minutes. Then rechecked his oxygen level and it was at 98%. We then turned it down to two liters and waited three minutes, and checked his saturation again. He was at 97%, so we had him take it off and waited three minutes. After three minutes we checked his saturation and it was at 96%, so we had him leave it off and walk to the kitchen and back, which was about twenty-five feet. After exercise his oxygen saturation dropped to 89%, so he put the oxygen back on but left it at two liters. Within a few minutes his saturation was back up to 98%. After learning this it was decided that he would try to keep his oxygen at two liters per minute and had his wife keep a log of his saturations and activity until the next day. I educated him on the importance of using the incentive spirometer that he was given at the hospital, and the importance of using his prescribed inhalers. The patient’s wife usually gave him his medications throughout the day, so she was educated on the importance of each medication and what time they needed to be given. It is a challenge in home care because you are not in charge of your patient’s actions. Education is one of the most important things a nurse can do, because the patient is in control of their own care and if they do not know the importance of a medication, side effects, or procedures they may not do it. At the end of the week the patient was down to one liter of oxygen.
Evaluation
“The RN evaluates progress toward attainment of outcomes” (ANA, 2010, p. 45). I have met this standard in the clinical setting this semester in the burn unit at Butterworth Hospital. I had a patient that I cared for on numerous occasions that was admitted to the burn unit for third degree burns covering 60% of her body. She had already been on the unit for five months before we started our clinical rotation. The outcome she was working towards was to be discharged and moved to a rehab facility where she was to start extensive physical therapy and rehabilitation. My evaluation of this patient the first time I had her was that she was not motivated to heal and move on to rehab. She seemed to me that she felt bad for herself and just wanted to lie in bed and be depressed. I understood what she had already been through and could not blame her for feeling this way, but in order to get better she needed to try. Everyone involved in her care collaborated together to motivate her and get her well enough to be moved to rehab. The patient’s sister was very involved in her care and did not leave the hospital once the entire five months. Every week that I went back to clinical, even if I was not assigned to this patient, I went in to see how she was doing. Every week she started to get better and better until the seventh week of our clinical rotation, I went to see her and she was not there. She was strong enough that she was discharged and sent to the rehab facility to continue her healing process. It was rewarding to see her room empty, compared to the first time I cared for her when she had just basically given up.
Standards of Professional Performance
Ethics
“The RN practices ethically” (ANA, 2010, p.47). I have met this standard this semester in my clinical rotation at Butterworth Hospital. I had a patient that was diagnosed with dementia and was admitted with pneumonia. The patient did not have any visitors and he was very confused. He did not know where he was, or even his own name. This patient had been admitted for two days and after looking through his chart I did not see where anyone had given him a bath. I am not sure if he did not get one or if it was just not charted, but I decided to get him cleaned up. The patient was not oriented, and the night nurse said he did not sleep much the night before. I tried to communicate with him that I was going to get him cleaned up, but I could tell that he did not understand. The aid came in and I told her I was going to get him cleaned up and she handed me a pack of cold wipes, and left the room. I have never been a patient in a hospital, but if I was I would not want to have a bath with cold wipes. I got some hot, soapy water and wash cloths, and talked to him and explained everything I was doing, even though I did not think he understood me. I started at his face, and from his reaction I could tell he was enjoying it. I uncovered one extremity at a time, washed it, dried it, and covered him back up. After the bath I got him a clean gowned, and a warm blanket. He was asleep before I had a chance to leave the room. I put myself in the patient’s position and advocated for him because he could not advocate for himself. I treated the patient with dignity and respect. The response I got from the patient was not verbalized, but I could tell he was comfortable.