Running head: SELF-ASSESSMENT

Nursing Standards of Practice Self-Assessment Emily Vance Ferris State University

SELF-ASSESSMENT Abstract This paper will look inside my role as a student nurse and whether or not I have met the American Nurses Associations (ANA) Nursing: Scope and Standards of Practice sixteen

standards and the Code of Ethics for Nurses with Interpretative Statements nine ethical standards. This paper will determine my readiness for nursing practice based on experiences from clinical and education from Ferris State University. For the standards that have not been met I will devise a plan of action to eventually meet them.

SELF-ASSESSMENT Nursing Standards of Practice Self-Assessment Nursing was not my first career choice. After graduating from Alma College in May 2011, I was hoping to attend a Physicians Assistant program. Sadly, I did not meet the

requirements and had to look elsewhere. This is when I found the accelerated nursing program at Ferris State University. Before attending my first class there were still had serious doubts about becoming a nurse. When I experienced clinical for the first time, I found out I enjoyed it very much and I was actually kind of good at it. Through feedback from my instructors I have improved many of my nursing skills considerably. This feedback has also allowed me to discover my strengths and weaknesses. The purpose of this assignment is for me to assess how I have met or not met these standards based on the American Nurses Association (ANA) Nursing: Scope and Standards of Practice sixteen standards and the Code of Ethics for Nurses with Interpretative Statements nine ethical standards. I will also address how I will improve on the standards I have not yet met. Standards of Practice in Nursing According to the American Nurses Association (ANA) (2010), The Standards of Professional Nursing Practice are authoritative statements of the duties that all registered nurses, regardless of role, population, or specialty, are expected to perform competently (p. 31). To become a competent nurse I must become proficient in all of these standards. Being accomplished in these will prevent malpractice and give the patients and their families the best care they deserve. Standard 1. Assessment Patient assessment is by far the most important standard for a nurse to learn. An assessment is a systematic, dynamic process by which the registered nurse, through interaction

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with the patient, family, groups, communities, populations, and healthcare providers, collects and analyzes data (ANA, 2010, p. 63). The assessment allows the nurse to pull valuable information from the patient that will assist in their care. Data the nurse must collect about their patient includes; physical, functional, psychosocial, emotional, cognitive, sexual, cultural, age-related, environmental, spiritual/transpersonal, and economic assessments in a systematic and ongoing process while honoring the uniqueness of the person (ANA, 2010, p. 32). During clinical I have assessed many different patients which have helped me meet this standard. An example of meeting this competency was during my orthopedic rotation at Munson Medical Center (MMC). During this rotation I had a patient that required frequent neurovascular checks. To complete these checks I had to assess movement, sensation, color, and pain in both the patients upper and lower extremities. If there had been any changes in her neurovascular assessment I would have reported immediately to my preceptor. Standard 2. Diagnosis When you hear diagnosis you think of a medical diagnosis that a doctor gives not one from a nurse. This is one reason why it took me a long time to understand this standard. When I was first learning these I could not separate a nursing diagnosis from a medical diagnosis. Even after practicing this multiple times in clinical and Nursing 240 it was still difficult for me to grasp the concept. I believe this is mainly because I used Mosbys Guide to Nursing Diagnosis book to develop my diagnoses instead of learning to write them. Recently, however, during my mental health clinical being able to write nursing diagnoses clicked. The instructor helped explain the whole process in a way that made it make complete sense to me. I developed two nursing diagnoses for my patient with major depressive disorder. An example of one such nursing diagnosis is; Ineffective coping skills related to anxiety as evidenced by patient stating

SELF-ASSESSMENT he has increased anxiety due to his ICD firing multiple times per day. As of recently I have met this standard. Standard 3. Outcomes Identification The ANA (2010) states, The registered nurse identifies expected outcomes for a plan individualized to the healthcare consumer or the situation (p. 35). The goals the nurse develops for the patient should be SMART goals. This means they must be specific, measurable, achievable, relevant, and timely. Outcomes have to be something that the nurse and patient develop together. While at Pine Rest I developed a care plan for a male patient that had major depressive disorder along with suicidal ideations. He had been admitted two days prior and had yet to develop effective coping strategies for his depression and anxiety. One of the outcomes I developed was that the patient will develop three effective coping strategies 48 hours prior to discharge. With more practice I feel that developing outcomes for patients will become second nature instead of taking hours to identify just one, but for now am competent in this area. Standard 4. Planning According to the American Nurses Association (2010), a plan is a comprehensive outline of the components that need to be addressed to attain expected outcomes" (p. 66). Discharging the patient is the main priority in planning the patients care. Planning begins at the time of admission and continues throughout the entire hospitalization. After outcomes are developed by the patient, it is the nurses job to help the patient achieve them. Planning can change throughout a patients hospitalization. When the patients health status changes so will their plan for discharge.

SELF-ASSESSMENT Again, while I was at Pine Rest making a care plan for my patient, I developed a few interventions to help the patient attain the outcomes that had been established previously. Some

of the interventions were to encourage the patient to attend group therapy and help explain to the patient how to set realistic goals. With the amount of care planning I have done in this program I believe I have met the needed competency for this standard. Standard 5. Implementation Implementation is when the nurse must put the plan into action. On the orthopedic unit at MMC I saw the nurses implement patient care plans all the time. Patients on this floor had a short hospitalization stay. To help the patients meet their outcome the nurses must work quickly due to the short time frame. The registered nurse would help get the patient walking after surgery, give them pain medications so they can perform their activities of daily living (ADLs), and cared for their incision sites to prevent infection. As a student nurse I have helped implement the plan set forth for these patients. For example, I had a patient that was directly admitted to the orthopedic unit from the ER for a fall. The patients pain was a 10/10; her goal was to remain pain free. The staff nurse and I got orders for pain medications and administered them to the patient. The patients pain was reduced to a 4/10. Standard 5A. Coordination of Care In order for a nurse to implement care the nurse will have to obtain help from other healthcare professionals. On the orthopedic unit the nurse utilized the physical therapists and occupational therapists to get the patient functioning well enough to return home. If the patient is not functioning well enough to return home the nurse needs to advocate to the healthcare provider that there is a need for additional care. This could mean that the nurse will have to coordinate with the case manager to find an alternative path for the patient. As a student nurse I

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have not yet completed this standard. After securing my first RN job following orientation I will be competent in this area. Standard 5B. Health Teaching and Health Promotion Health teaching and health promotion are essential parts in getting patients on the road to recovery. As a student nurse I have had numerous opportunities in the clinical setting teaching patients. At MMC patients receive education about their health and medication daily. Nurses must provide healthcare consumers with information about intended effects and potential adverse effects of proposed therapies (ANA, 2010, p. 44). With the guidance from my clinical instructor I was able to educate my patient about what bridging was, why they were on it, and how long they would have to use Lovenox injections. I have also done discharge education for patients on both an orthopedic and neurological floor. The discharge education included medication education, education about their care, when to seek medical help, and follow-up visits with their physicians. After doing repeated discharges and having to give daily education I believe I am competent in this area of nursing. Standard 6. Evaluation Evaluation is the process of determining progress toward attainment of the expected outcomes, including the effectiveness of care (ANA, 2010, p. 65). Nurses can do this by reviewing the patients progress notes and comparing it to what they have assessed or what they have seen previously. I have met this standard by administering an antihypertensive medication to a patient with hypertension and then rechecking the blood pressure to see if it had lowered. I have also observed how surgery has reduced the amount of pain a patient felt from moving a joint. However, I would still like to improve upon this by evaluating the effectiveness of a patients long term goals instead of their short term goals.

SELF-ASSESSMENT Standard 7. Ethics Practicing ethics includes treating patients with autonomy, dignity, rights, values, and beliefs (ANA, 2010, p. 47). I have met this standard by caring for patients at varying stages of their diseases. During my hospice rotation I had a patient that had passed away. Dignity is a big concept with end-of-life care. The nurse and I cleaned the patient and kept her covered which is some ways to help maintain dignity. Other ways I have met this standard is by keeping my patients health information confidential. Standard 8. Education The ANA (2010) states, The registered nurse attains knowledge and competence that reflects current nursing practice (p. 49). Whether the nurse is a baccalaureate, masters, or doctorate prepared nurse there is always something new to learn and improve on. To stay up-todate on nursing research, nurses need to attend continuing education sessions plus maintain certification that may have received. As of right now I am still trying to achieve this standard by attending Ferris State Universitys nursing program. Even after I graduate I will need to obtain certifications in specialty areas of nursing. Nursing education is a constant endeavor and I must maintain this standard to stay on top of current nursing care. Standard 9. Evidence-Based Practice and Research To provide the best patient care, nurses must utilize current evidence-based nursing

knowledge, including research findings, to guide practice (ANA, 2010, p. 51). Nursing practice is constantly changing because someone finds a better, safer way to perform a skill or procedure. I have met this standard through writing evidence-based research papers in my nursing classes. The class that helped me achieve this the most was Nursing 350, Research in Nursing. The

SELF-ASSESSMENT paper I wrote questioned if the use of distraction reduced the amount of anxiety and pain felt compared to not using distraction in pediatrics. Standard 10. Quality of Practice The ANA (2010) defines quality as, the degree to which health services for patients, families, groups, communities, or populations increase the likelihood of desired outcomes and are consistent with current professional knowledge (p. 67). To me quality of practice means giving the best care to your patients that you can possibly give. One way for a nurse to do this is to participate in a quality improvement (QI) project (ANA, 2010). In Leadership in Nursing, I developed a QI project to improve end-of-shift reporting on the oncology unit at MMC. Although, I have had a chance to write a paper about QI I have not had a chance to actively participate in a QI project; because of this I have not fully met this standard. Standard 11. Communication

Nurses communicate with a wide variety of people that are included in the patients care. Some of the people the nurse will need to effectively communicate with are the patient, family members, other nurses, doctors, and other interdisciplinary staff. They have to communicate a patients health status, the patients needs and concerns, and they explain procedures and side effects of medications. Nurses must also listen to make the communication circle complete. Miscommunication between staff members is one of the main reasons errors in patient care are made. This is why it is so important nurses to communicate efficiently. I have met this standard by giving and receiving end-of-shift reports at MMC as well as giving report over the phone when transferring a patient to inpatient rehab, listening to my patients when they had concerns and I have also communicated a change in my patients health

SELF-ASSESSMENT status to his doctor. Nonetheless, there are many forms of communicating that I have not yet mastered and I will continually need to reassess this standard. Standard 12. Leadership According to Yoder-Wise (2014), a leader is an individual who works with others to

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develop a clear vision of the preferred future and to make that vision happen (p.39). In Nursing 440, Leadership in Nursing, the class discussed what makes a person a leader. As a class an agreement was made that some people are born leaders and others need to learn to become leaders. In nursing there needs to be people who are leaders and then there needs to be some that are followers. Nursing leaders must oversee and mentor fellow nurses and treat all with respect. I have not met this standard because at this point in my nursing career I am more comfortable in a nurse follower role due to the lack of experience I have as a nurse. Standard 13. Collaboration As a nurse it is imperative to work with others to successfully reach an understanding that will allow a patient to benefit. Collaboration involves analyzing situations and defining conflict at a higher level where shared goals are identified and commitment to working together is generated (Yoder-Wise, 2014, p. 473). Nurses collaborate care of their patients with doctors, other nursing staff, respiratory therapy, physical therapy, and case managers. I have been able to collaborate with peers while working on group projects in classes such as Leadership in Nursing, Health Promotion, and Community Nursing. While in the clinical setting I have met this standard by communicating with physical therapy about the status of my patient. The patient I had was on an orthopedic unit after fracturing her hip and she also had dementia. When transferring the patient from the bed to a chair she had a hard time understanding directions and nearly fell. I had

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to work with physical therapy to find an effective way to safely transfer the patient in a way that she would understand. Standard 14. Professional Practice Evaluation The ANA (2010) states that the registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines (p. 59). When I was a nurses aide we had yearly evaluations to ensure that we were competent with our skills. I think this has made me a stronger person by having this previous experience because as a student nurse I am constantly being evaluated by my instructors and peers. Most people fear being told they need to improve, but I use it as a tool to grow in my clinical practice and better myself. It is harder to evaluate myself, but it is something I will have to be doing throughout my career as a nurse. Standard 15. Resource Utilization The registered nurse utilizes appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible (ANA, 2010, p. 60). One component of resource utilization is delegation. By delegating tasks to UAPs nurses will have more time to accomplish tasks that only they can do and increase patient safety because they are not overwhelmed. For example, nurses at MMC usually have four patients. If the nurses were to do all patient care plus medications and other treatments they can become overwhelmed and get behind on their other jobs. If the nurse could delegate certain patient care tasks to the UAP it would prevent the overwhelming feelings the nurse could be feeling and in turn decrease errors made in patient care. I have had little experience in delegating as well as other aspects of resource utilization in my clinical involvement. Due to this lack of experience I need to still meet this standard.

SELF-ASSESSMENT Standard 16. Environmental Health

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The ANA (2010) defines environmental health as the aspects of human health, including quality of life, that are determined by physical, chemical, biological, social, and psychological problems in the environment (p. 65). This includes knowing facility protocols about isolation precautions and disposal of sharps and blood borne products, identifying hazards within patients homes, and upholding hand washing techniques. I have met the most basic aspect of this standard by being able to identify unsafe conditions, knowing when to wash and how to dispose of sharps, but for the more complicated situations I have yet to discover how to fix these problems. Code of Ethics in Nursing Ethical Provision One The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems (ANA, 2001, p. 3). All patients should receive the same quality of care regardless of things that they have done, but that doesnt always happen because personal views get in the way. While at Pine Rest I met a patient that was a new nurse and had made a medication error that resulted in her psychotic break. It was hard for me not to judge her, especially since I am in nursing school and know how important it is to know medications and to double check. Then I began to think how easily that could be me after I become a new nurse. In that regard I believe I have met this standard. Ethical Provision Two The nurses primary commitment is to the patient, whether an individual, family, group, or community (ANA, 2001, p. 5). Care for a patient needs to be individualized because not

SELF-ASSESSMENT every patient experiences the same thing as the next patient. And when you treat a patient you

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can develop a relationship with that person. These relationships need to be kept professional, but I have witnessed several nurses cross that line. During our mental health rotation we were taught the importance of therapeutic relationships with patients. On the mental health unit we were told that we are not there to be a patients friend because it will not help them heal. After this rotation I feel that I have I met this standard. Ethical Provision Three The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient (ANA, 2001, p. 6). One way to protect the rights and safety of the patient is to keep the patients health information confidential. I have met this standard by upholding HIPPA and not discussing patient information outside of the hospital. It was also met by protecting the patients right to privacy by closing the curtain when performing care on the patient and keeping the patient covered with a blanket. Ethical Provision Four The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurses obligation to provide optimum patient care (ANA, 2001, p. 8). I have not met this standard because as a student nurse I do not have the ability to delegate much more than having a UAP grab vitals for my patient. Nursing 440, Leadership in Nursing, is giving me the education to understand the concepts of delegation. Ethical Provision Five No one wants to be cared for by a nurse that cannot care for themselves. This is what I took from provision five, which states the nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to

SELF-ASSESSMENT continue personal and professional growth (ANA, 2001, p. 9). This is why it is important to practice what we preach and take care of ourselves. Nurses must also continue to maintain competency in skills that we first learned. At Munson, some charge nurses do a few shifts as a floor nurse to maintain their skills. As a nursing student I am constantly practicing my skills because they are all still new to me and consistency is the key to becoming a competent nurse. Ethical Provision Six The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment to the provision of quality health care and consistent with the values of the profession through individual and collective action (ANA,

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2001, p. 11). I have always tried to be professional and courteous will working with other people. Even when I work with peers that have conflicting ideas I try to work through the situation because the patient would suffer if I did not. I have also met this standard by maintaining healthcare environment within the patients room. I wash down the patients bedside table before they have meals and I pick up clutter from the floor so the patient does not have the risk of falling. Ethical Provision Seven The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development (ANA, 2001, p. 12). I am working on this standard now as I make my journey through nursing school. Afterwards, I plan to continue on to become an advanced practice nurse. Even after finishing my schooling, my education will still continue in order to stay up-to-date my nursing practice. Ethical Provision Eight

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The ANA (2001) states that a nurse must work with others in the community to meet the health needs of the population. I met this standard during my public health rotation in Osceola County. A peer and I had the opportunity to educate parents about the amount of sugar in popular drinks given to children. We had gone and bought examples of what were considered good and bad sugars to show to the parents. It was a small class, but the parents were very receptive to what we had to say. Ethical Provision Nine The profession of nursing, as representing by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy (ANA, 2001, p. 13). Being part of a professional organization promotes a sense of responsibly toward the nursing profession. I have not met provision nine because I have not joined a professional nursing association and have not worked toward social reform. Professional Development Goals for Improvement I need to improve my competency in leadership. This is a standard that will increase the longer I am a nurse and the more confident I become. I plan to become competent in leadership after one year of being a nurse. The next standard I need to become competent in is resource utilization. I believe I will become competent in this area after completion of this program. In clinical, we will be expected to manage four patients and use delegation prior to graduation. Lastly, I will need to join a professional association to become competent in ethical provision nine. This will be accomplished by the time I enter into my first job as a nurse.

SELF-ASSESSMENT Evaluation Plan To evaluate my progress in becoming competent in the standards I have not met I will setup a timeline of when evaluations should occur. The first self-evaluation would be when I

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graduate from Ferris State University. The next time would be the NCLEX examination when I try to obtain my license. After this evaluations will occur yearly from me and possibly from my employer. These evaluations will help maintain a safe environment for both the patient and I and that I can provide the best patient care possible. Conclusion This self-assessment has been a really opened my eyes. I can see that I have come a long way since my first day as a nursing student. With the end of my BSN training coming closer I have been trying to find a nursing job that will allow me to gain both experience and knowledge. Two jobs that I have considered are becoming a nurse in the military or becoming a part of the Nurse Residency Program at Sparrow Hospital in Lansing. With the tools and skills I have developed through this program I believe I can accomplish these.

SELF-ASSESSMENT References American Nurses Association (2001). Code of ethics for nurses with interpretive statements. Maryland: American Nurses Association.

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American Nurses Association (2010). Nursing: scope and standards of practice. (2nd ed.). Silver Spring, Md.: American Nurses Association. Yoder-Wise, P.S. (2014). Leading and managing in nursing. (5th ed.). St. Louis, MO: Mosby.