Running head: NURSING STANDARDS OF PRACTICE 1 Self-Assessment of Nursing Standards of Practice Holly K. Ehrke Ferris State University
NURSING STANDARDS OF PRACTICE 2 Self-Assessment of Nursing Standards of Practice Standards of care are quality guidelines that direct a profession. Mosby (2009) defines standards of nursing practice as a set of guidelines for providing high-quality nursing care and criteria for evaluating care (p.1). The American Nurses Association (ANA) provides guidelines or standards of care for the nursing profession to ensure high-quality, evidenced-based nursing care is provided and assessed. The ANA s Standards of Practice include: assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. These guidelines specify the care that the nursing profession provides today. This paper will demonstrate how I have met the professional goals of the ANA s Standards of Practice. Assessment The ANA states, The registered nurse collects comprehensive data pertinent to the patient s health or situation (American Nurses Association [ANA], 2004). At the School Based Health Center (SBHC), I collect information from both the patients and their parents/guardians. I prioritize the assessment based on the patient s needs and urgency of the problem. I document the assessment in an electronic health record (EHR) so it is available for the nurse practitioner. At the SBHC we provide evidenced-based educational programs to the students in a classroom setting. My difficulty is in assessing the need of evidenced-based care at an individual level and seeing the relationship of it. I will implement two evidenced-based nursing interventions in the assessment of care by the end of the 2011-2012 school-year.
NURSING STANDARDS OF PRACTICE 3 Diagnosis The ANA states, The registered nurse analyzes the assessment data to determine the diagnoses or issues (ANA, 2004). My assessment skills are good in achieving a nursing diagnosis and assisting with a medical diagnosis. I document problems in the EHR to assist the nurse practitioner in the diagnosis. Confirmation of the diagnosis is accomplished after the nurse practitioner evaluates the patient. I meet this standard of care. I will continue to maintain competency and expand my implementation of nursing diagnosis as I further my career as a nurse practitioner. Outcomes Identification The ANA states, The registered nurse identifies expected outcomes for a plan individualized to the patient or the situation (ANA, 2004). I involve the patient, parent/guardian, and other members of the intra-disciplinary team when applicable when identifying outcomes. I live in rural, Northern Michigan; we are not culturally diverse, but we do experience health care disparities, such as poverty, that directly affect outcome measures. I pay close attention to insurance health plans and economic means when identifying outcomes for the patients. For example, many of our families do not own a vehicle or have the means to travel to the pharmacy to pick up a prescription for their child. In this case, with permission from the parent/guardian, I have gone to the local pharmacy to pick up the prescription and give it to the child back at the school. I have also informed parent/guardians ways to obtain free or low-cost medications. Although specific nursing outcome measures are not documented in the chart on a timeline, I do follow up with patients at subsequent visits on how the implementation of the identified outcomes was or was not met. This provides valuable information to the nurse practitioner, as the plan of care may need changing. Referral logs are kept to document the
NURSING STANDARDS OF PRACTICE 4 continuity of intra-disciplinary and external referral sources in the implementation of care and measured outcomes. I meet this stand of care and will continue to further my application of identifying outcomes as my nursing career progresses. Planning The ANA states, The registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes (ANA, 2004). Our plan of care at the SBHC is individualized. I pay close attention to the students individualized needs; whom they live with, economic stressors, and psycho-social problems that may interfere with the plan of care. The plan of care involves the parent/guardian when applicable. For example, we do not involve the parent/guardian in the treatment of a sexually transmitted disease of an adolescent, when the safety of the patient is at risk. The plan of care is written by the nurse practitioner and I assist in the implementation of the care. Although I have met this standard of care, it will continue to be a work in progress as I further my nursing career. I will implement two nursing care plans with specific timelines by the end of the 2011-2012 school-year and document progress in the EHR under nursing education. Implementation The ANA states, The registered nurse implements the identified plan (ANA, 2004). At the SBHC, I ensure that the coordination of care is implemented through our intra-disciplinary team and external referral sources. I also work with the nurse practitioner to carry out individualized care plans of our patients. I educate patients individually and classrooms with evidenced-based programs on health promotion. In the past, I have taught obesity and nutrition
NURSING STANDARDS OF PRACTICE 5 classes. This year our focus has changed for the needs of the student population; pregnancy prevention and sexually transmitted disease education. Although I have met this goal within the scope of my practice as an associate-degree RN, this too will continue to be a work in progress as I further my nursing career. I will become a nurse practitioner and implement the areas of consultation and prescriptive authority and treatment by 2016. Evaluation The ANA states, The registered nurse evaluates progress toward attainment of outcomes (ANA, 2004). Currently at the SBHC, each plan of care is evaluated on an individual basis. For example, I follow up with patients on their progress towards their obesity and nutrition goals. These are not timeline specific evaluations, but rather document on subsequent visits in the electronic health record. I will coordinate with our Medical Social Worker (MSW) to establish specific evaluation tools that will be implemented by all nursing staff to evaluate and measure nursing outcomes and goals by the end of the 2011-2012 school-year. (I chose to collaborate with the MSW because at our recent Joint Commission survey, they indicated the MSW was using appropriate and measurable tools for evaluating care plans.)
NURSING STANDARDS OF PRACTICE 6 Action Plan Specific goals related to the implementation of care at the SBHC will become effective January 3 rd, 2012. Personal and professional goals will continue with my plans for obtaining my BSN through Ferris State University. Evaluation Plan I will continue to evaluate my own personal goals on a regular basis. First of all, I will reassess my individual goals at the end of the 2011-2012 school-year. I will also continue with my RN to BSN and anticipate graduation spring of 2013. To further my nursing goals, I will apply to and initiate the nurse practitioner program at Michigan State University by the fall of 2013 and plan for graduation in 2016. Conclusion Nursing standards of care provide guidance to high-quality patient care. This plan of care is exemplified in the American Nurses Association Standards of Practice include: assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. In order to remain competent within the standards of care, I have developed personal goals and for myself to achieve the high-quality patient care that the ANA requires as a nurse..
NURSING STANDARDS OF PRACTICE 7 References American Nurses Association. (2004). Nursing standards of practice. Retrieved from: http://www.nursingworld.org/nursingstandards American Nurses Association. (2004). Nursing standards of practice: The University of Connecticut Health Center Department of Nursing-Structure Standards. Retrieved from: http://nursing.uchc.edu/nursing_standards/docs/structure%20standard%20dept%20of%2 0Nursing%20-%20Appendix%201%20-%20General%20Nursing%20Standards.pdf American Psychological Association. (2010). Publication Manual of the American Psychological Association. (6th ed.). Washington, DC: Author. The Free Dicitionary. (2009). Mosby's Medical Dictionary (8 th ed.). Retrieved from: http://medical-dictionary.thefreedictionary.com/standards+of+nursing+practice