Upgrade to remove ads
Only $2.99/month

310 Final: Professional Standards of Nursing

Terms in this set (72)

Objectives
- Compare and contrast Nursing Social Policy Statement, Scope and Standards of Practice and the Nursing Code of Ethics and how the nurse uses these in practice
- Apply the nursing process to selected patient care scenarios
- Identify professional issues in the field of nursing to include policy advocacy, how nurses influence health care
- Describe the framework that supports nursing practice to include the nursing process and nursing roles and obligations
- Distinguish nursing organizations and role of membership in organization as it relates to nursing practice
What guides our practice as nurses?
1. Nursing Social Policy Act - describes profession, framework, & obligations

2. Nursing Scope & Standards of Practice - authoritative statements defined & promoted by the profession

3. Code of Ethics for Nurses - professions public expression of values, duties, & committments.
What is the nurse's social policy statement?
describes the profession, framework, & obligations and guides nurses practice

tells people what . nursing is
What are the elements of the nurse's social policy statement?
- Definition
- Knowledge Base: science & art
- Scope of Nursing Practice
- Social Context
- Standards: competent caring
- Regulation of Professional Nursing
- Application to your Nursing Practice
What is the ANA's social policy statement?
"Nursing, like other professions, is an essential part of the society out of which it grew and within which it continues to evolve. Nursing is responsible to society in the sense that nursing's professional interest must be perceived as serving the interests of society. It is a mutually beneficial relationship between society and the nursing profession."
When was the first edition of the scope and standards of practice for nursing?
2004
When was the second edition of the scope and standards of practice for nursing?
2009
What were the changes to the 2nd edition of the scope and standards of practice for nursing?
- New scope of practice statement
- New standards of professional nursing practice
- Based on the nursing process
- Standards of professional performance -> Address ethics, education, evidence-based practice and research, resource utilization, and environmental health.
What are the 16 Nat'l Standards of Practice & Performance?
1. Assessment
2. Diagnosis
3. Outcome identification
4. Planning
5. Implementation
6. Evaluation
7. Ethics
8. Education
9. EBP & Research
10. Quality of Practice
11. Communication
12. Leadership
13. Collaboration
14. Professional Practice Evaluation
15. Resource Utilization
16. Environmental Health
What are the 4 subcategories of standard 5 (implementation)?
5a. Coordination of Care
5b. Health Teaching & Health Promoting
5c. Consultation (Graduate Prepared Specialty or Advanced Practice Nurse)
5d. Prescriptive Authority and Treatment (Advanced Practice Nurse)
How can we summarize the first six standards of practice?
ADPIE
What is the Nurse Practice Act (NPA)?
- statute enacted by each state legislature
- contains scope of practice for: RNs, LPN, & UAP
- protects public safety (b/c people practice w/in their scope)
- guidelines to help nurses assign & delegate care to & supervise other members of healthcare team
Why is the NPA important?
Scope of practice establishes boundaries between roles, functions, activities, and procedures performed by each member of the health care team
Other elements of the NPA
- authority, power, & composition of a board of nursing
- education program standards
- types of titles & licenses
- requirements for licensure
- grounds for disciplinary action, other violations & possible remedies
What is the role of state boards of nursing?
- implement the NPA
- licensure of new graduates
- delineates guidelines for assignment, delegation, supervision
- monitor nurse edu programs
- deal w/ administrative regulation
- review problems w/ licensure, administer discipline (publish decision)
What is important to remember about licensure?
Licensure is a privilege, not a right
What is the Nat'l Council of State Boards of Nursing?
- non-profit org
- represents all (US) boards of nursing: 50 states, DC, 4 US territories
- states work together on issues
- develops & administers NCLEX
- disseminates data
- conducts research
- info exchange
What does eNLC stand for?
enhanced Nurse Licensure Compact
What does the eNLC do?
states who are members of the eNLC issue multistate licenses which allow you to practice physically, electronically, and/or over the telephone across a state border (26 states are members)
What is a ULR?
Uniform Licensure Requirement
What if you need to practice in a state that is not a member of the eNLC?
You must have a single state license issued from that state regardless of whether you hold a multistate license
What does MBON stand for?
Maryland Board of Nursing
What is the Code of Maryland Regulations (COMAR)?
the official compilation of all administrative regulations issued by agencies of the state of Maryland
Delegation
act involves giving another staff member the responsibility and authority to complete a task, nurse is accountable for outcome
Supervision
when a nurse is monitoring care and the work that is done, nurse manager, team leader
Assignment
process that moves an activity from one person to another including responsibility and accountability, a nurse manager assigns a nurse to lead a team
Delegation Principles outlined by the ANA and NCSBN
- Take responsibility and accountability for the provision of nursing practice
- Directs care and determines utilization of asst
- Cannot delegate the nursing process itself but can designate components of care
- Decision based on RN judgment
- Delegates the right task
- Creates individualized communication, verifies communication & comprehension, encourages questions
- Uses critical thinking and professional judgment
- Accountable for assessment and evaluation
- Active process of guidance, direction, oversight, evaluation, follow-up
5 Rights for effective Delegation
Right Task

Right Circumstances

Right Person

Right Direction/Communications

Right Supervision/Evaluation
Good Samaritan Law
State laws: CA the 1st, all states have it now

Federal law: Good Samaritan Law
What is the Duty to Rescue?
VT, WI, MN, RI have this legislation which requires healthcare providers to render assistance in an emergency; legally accountable if they fail to do so
What are ethics?
- Reasons for decisions about how one should act
- Based upon shared values and beliefs of the group
- A way to guide our thinking
- The most fundamental universal principle is respect for people
Guides for Nurses in ethical dilemmas
guide called the Code of Ethics for Nurses with Interpretive Statements

patient rights:
- self-determination
- privacy & confidentiality
- client bill of rights

ANA code of ethics
International Council of Nurses' Code of Ethics for Nurses
1st adopted in 1953

A universal global document for ethical practice in nursing

Involves standards related to nurses and people, practice, the profession and coworkers
Social Policy Statement
ANA, 2010 - "The authority for the practice of professional nursing is based on a social contract that acknowledges professional rights and responsibilities as well as mechanisms for accountability"
Define ethical dilemma
- Having to choose between two or more undesirable alternatives.
- Can arise when one's personal values are in conflict with professional situations
- 'what should be done' in an individual, patient-care situation is at the heart of many practice dilemmas nurses face on a regular basis."
Types of ethical issues
Moral indifference
Moral uncertainty or conflict
Moral distress
Moral outrage
Ethical dilemmas
Moral indifference
an individual questions why morality in practice is even necessary
Moral uncertainty or conflict
an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is
Moral distress
occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action
Moral outrage
occurs when an individual witnesses the immoral act of another but feels powerless to stop it
Ethical dilemmas
described as being forced to choose between two or more undesirable alternatives
C. Everett Koop
- Surgeon General & Pediatric Surgeon
- 1976 - The Right to Live, The Right to Die (concerns about abortion, infanticide, euthanasia)
- Baby Doe Amendment
- Rights of Handicapped Children
- AIDS policy & education
- advocate against tobacco
Nancy Beth Cruzan
- Spurred a movement towards living wills
- national attention
- family wanted to allow her to pass, national outrage
Karen Anne Quinlin
- ODed, had an NG tube
- Catholic parents, did not want to go to extraordinary means to support her; went to court
- spurred the development of formal ethics committees in hospitals, nursing homes, hospices
Terry Schiavo
- husband thought she would not want to live; parents did not want to stop artificial nutrition and hydration
Ethics vs. Morals vs. Values
Ethics: refers to a standardized code or guide to behaviors

Morals: refers to an individuals code of acceptable behavior, they shape one's values according to cultural influences

Values: abstract standards that establish a code of conduct for living
Morals
refers to an individuals code of acceptable behavior, they shape one's values according to cultural influences
Values
abstract standards that establish a code of conduct for living
Ethical Principles
Definition: used in nursing and healthcare delivery these principle guide nurses when confronted with ethical issues

Principles:
- Autonomy
- Beneficence
- Justice
- Veracity
- Fidelity
Autonomy
focus on the patients right to make decision about matters that affect the patient, patients require complete information or informed consent
Beneficence
aware of patients situation and needs, doing good for the patient, doing no harm, involves action to help someone
Justice
treating patients fairly
Veracity
truth and trust in caring for your patient
Non-maleficence
the duty not to inflict harm, intentionally refraining from actions that cause harm
Fidelity
the obligation to be faithful to the agreements , commitments, and responsibilities that one has made to oneself and to others
Most Common ethical issues in nursing practice
Protecting patients' rights (63.9%)

Informed consent to treatment procedures (61.3%).

Advanced care planning (41%)

Staffing patterns (37.3%)

Surrogate decision-making (32.5%)

End-of life (26.2%) issues
Bioethical Dilemmas
Life: genetic screening, abortion, stem cell, cloning

Death: vegetative state, cerebral vs. biological death, 'peaceful death', 'dying with dignity', assisted suicide

Research: humans, animals, protecting rights, 'do no harm'

Internal Review Board (IRB)
Ethical Framework
1. ID the problem
2. ID the potential issues involved
3. Review relevant ethical guidelines
4. Know relevant laws and regulations
5. Obtain consultation, request ethics committee review
6. Consider possible & probably courses of action
7. List the consequences of the probable courses of action; remember patient rights to self-determination
8. Decide on best course of action
policy
a course of action that affects a large number of people and is stimulated by a specific need to achieve certain outcomes
health policy
policy that focuses on health and health-related issues.
policy planning
development of a plan to change the value system or laws and regulation
What aspects of nursing does policy impact?
- roles and standards
- federal laws & rules/regulations
- how nursing care is provided
- health
- staffing levels
- policies & procedures
- nursing education
What are some examples of critical healthcare policy issues?
- nursing shortage & staffing
- costs of health care
- healthcare quality & safety
- Disparities in health care
- Consumers
- Commercialization of health care
- Reimbursement for nursing care
- Immigration and the nursing workforce
Federal Legislation to know
Social Security Act of 1935

Public Health Act of 1944

Maternity & Infancy Act of 1921

Veterans Act of 1924

Medicare and medicaid Acts of 1965

COBRA 1984

ADA 1990

CHIP 1997

ACA
Policy-making process
1. Recognize that an issue might require a policy
2. Learn more about the issue
3. Identify solution options and select best option
4. Implement the policy
5. Monitor and evaluate the policy
How can nurses impact politics?
- lobbying
- committees
- political action committee (PAC)
- grassroots advocacy
- nurses in government
Shirley Nathan-Pulliam
elected to MD House of Delegates in 1994

RN w/ years of experience
What is the purpose of professional organizations & associations?
- To judge competency
- To perform social functions
- To provide a vehicle to keep up with changes, challenges
- To work toward needed changes
Maryland Nursing Association (MNA)
- founded 1903
- promotes excellence in nursing
- advocates for policy supporting the highest quality healthcare
American Nurses Association (ANA)
- uses nurses' insights to set policy, influence legislation
- setting policy wherever nurses are engaged
- closely watch federal/regulatory issues
- promote nursing
- improve healthcare system
- protects nurses
Organizations working for nursing
AACCN, AWHONN, NAPNAP, AANP, NSNA, ENA, Nursing's Agenda for the Future, Sigma Theta Tau
Specialty Nursing Organizations
Academy of Medical-Surgical Nurses
American Association of Critical Care Nurses
American Association of Neuroscience Nurses
American Psychiatric Nurses
Association of PeriOperative Registered Nurses
Association of Women's Health, Obstetric and Neonatal Nurses
Emergency Nurses Association
Oncology Nursing Society
Society of Pediatric Nursing
THIS SET IS OFTEN IN FOLDERS WITH...