Running head: SELF-ASSESSMENT

Self-Assessment of Nursing Standards of Practice Lisa N. Dust Ferris State University

SELF-ASSESSMENT Abstract Student nurses are the next generation of registered nurses that will be involved in the care for healthcare consumers. Hence, the opportunities and knowledge that those student nurses gain through their nursing program and clinical experiences will help to mold future care. This paper

is a brief description of Lisa Dusts current nursing practice as measured to the American Nurses Association (ANA) standards of nursing practice and ethics for nurses. The healthcare field is constantly changing due to new technology and best evidence-based practices, which means that nursing students must start to expand their knowledge and research to ensure that the most beneficial techniques are being used when providing care for patients.

SELF-ASSESSMENT Self-Assessment of Nursing Standards of Practice The nursing profession is constantly changing and evolving due to the increase in

technology and evidence-based practice. This means that as a nurse, I will continually have to be up-to-date and informed about the newest procedures and how those impact the quality of care that is provided to the patient. The standards of practice are authoritative statements of the duties that all registered nurses, regardless of role, population, or specialty, are expected to perform competently (American Nurses Association [ANA], 2010, p. 31). Standards of Practice Assessment From the first day in this accelerated program, I was being tested and taught the appropriate techniques involved with providing the best quality care for my future patients. By collecting data that is specific to this healthcare situation and then critically thinking through the information, it will help to establish a comprehensive assessment. This complete assessment will then help to guide me in using the correct techniques to gain the relevant information to the situation and then apply that knowledge to care for that patient. Assessment skills are continuously being elaborated upon, what I learned from day one is continually being built upon to help me in establishing a knowledge base that will grow, allowing me to care for my patients to the best of my ability. Diagnosis It is important to remember that nurses do not make medical diagnoses; however, nurses are performing the care for the patient. This care involves doing hands-on assessments and conversations with the patient ultimately allowing the nurse to inform the healthcare provider of changes. According to the American Nurses Association (ANA), The registered nurse validates

SELF-ASSESSMENT the diagnoses or issues with the healthcare consumer, family and other healthcare providers when possible and appropriate (ANA, 2010, p, 34). Communication is essential in the workplace and by talking with the healthcare providers, nurses are able to maintain a safe environment for the patient through understanding what the diagnosis is and the signs and symptoms associated with the medical diagnosis. Outcomes Identification The registered nurse identifies expected outcomes for a plan individualized to the healthcare consumer or the situation (ANA, 2010, p. 35). Understanding that each patient will respond differently has been the most difficult to learn in the classroom. This is where my clinical experiences have helped me to understand that each plan of care for the patient must be tailored to them. Building a relationship with the patient will help to create a rapport that will be instrumental in creating goals that are measurable, but also attainable for the patient. Planning Planning starts right at the beginning, because it is necessary to promote and restore

health, prevent injury, and consider the patients personal beliefs and family involvement (ANA, 2010, p.36). Interdisciplinary communication becomes an important feature during planning, because as a student nurse, it seems to me that this is where all the different healthcare disciplines come together and help to devise a plan of care that will help the patient to recover. However, I think that this area also gets overlooked in the aspect of doing it individualized for each patient. It can be difficult not to make a routine, especially for new nurses, but it is more than just documenting it on their electronic medical record. Planning should be individualized for each patient and appropriate to their situation, as well as clear and concise. This will allow the

SELF-ASSESSMENT patient to understand what their plan of care is and help to alleviate some of the anxiety that can be associated with being in the hospital. Implementation As defined by the ANA, The registered nurse implements the identified plan (ANA,

2010, p. 38). While applying the plan of care it is important for me as the nurse to provide a safe environment and to ensure proper preventions are taken, such as placing a gait belt on. While being on an orthopedic floor for my clinical rotation I thought that this was the perfect time to provide motivation for the patient and to be able to inform them of their progress. I was also able to see that it was very important to document this progress to inform interdisciplinary teams, such as physical therapy and occupational therapy. Documentation in the patients medical record is essential, but timeliness and accuracy can hinder its usefulness. My clinical instructor is very particular about those two areas and ensured that a course was provided to teach us how to use the charting system properly, finding information and where to put it. Implementation also includes coordination of care, health teaching and health promotion, consultation, and prescriptive authority and treatment (ANA, 2010, p.40 -44). Communication is essential and the nurse must be able to relay what the doctor says to the patient and family as well as the other way around. Nurses are instrumental in executing the plan of care, because they are the teachers and want to ensure that the patient understands and is able to perform as much self-care as possible. Nurses can only do so much and it is important for me as a student nurse to know when to have consultation done, because patient care is the top priority. Knowing the rules and regulations of the facility that I am working at will help to define the treatment and authority that I have for that patient. Evaluation

SELF-ASSESSMENT The registered nurse evaluates, in partnership with the healthcare consumer, the

effectiveness of the planned strategies in relation to the healthcare consumers responses and the attainment of the expected outcomes (ANA, 2010, p. 45). My clinical experiences have been instrumental in demonstrating to me if patients have or have not met their expected outcomes. It can be very easy to write these outcomes down in a plan of care, but when it comes to the patient completing them, that is another story. This is where I was taught that documentation is very important to be able to back up the reasons why this person did not meet that outcome, whether it was due to pain or another issue. This creates a timeline that allows for the nurse to instill accountability of the patient in progressing toward their outcome. I found it to be helpful when I would receive shift reports and then also read the shift summaries, because it is stated what was accomplished. Then once the patient is up I am able to give an agenda of what I would like to see them achieve. This helps them to keep moving forward in achieving their goals and outcomes for promoting their healing and independence. Ethics The registered nurse delivers care in a manner that preserves and protects healthcare consumer autonomy, dignity, rights, values, and beliefs (ANA, 2010, p. 47). I think that this can be the most difficult area that nurses encounter. It is easy to want to be done with your shift at a particular time and state that this is good enough or close enough, but choosing to put the patient first and complete their care to the highest standards possible is very important. Nursing is not like other professions where certain things can wait till tomorrow, it is about doing patient care here and now and completing that care to the fullest and documenting it. This entails anything from what the person likes to be called, maybe they have a nickname that they would rather have used, or their beliefs that they want nurses to know about. Passing on this information aides in

SELF-ASSESSMENT elevating the quality of care provided, because it is those little things that can make the biggest difference. Education According to the ANA, The registered nurse attains knowledge and competence that

reflects current nursing practice (2010, p. 49). For me, attaining a bachelor of science in nursing (BSN) is assisting me to be on par with what is required of the nursing profession. A BSN is now becoming a standard for nurses that are hired within healthcare facilities. This education requirement is helping to ensure that the standards are high for knowledge. By having a previous bachelors in health profession and a biology minor, I feel as though I have been able to incorporate many facets of learning into my nursing degree. Education as well as my upbringing has molded me into the person I am today and by pursing nursing I want to continually grow upon my experiences and knowledge to provide the best patient care I can. Evidence-Based Practice and Research Healthcare is constantly changing and in order to stay up-to-date with the new evidencebased research, student nurses must be involved in doing research on articles and reading journals. The registered nurse integrates evidence and research findings into practice (ANA, 2010, p. 51). By staying informed, patient care can be positively impacted and this is why as a nurse I must take time to read current evidence-based practices and be engaged with my continuing education credits. Knowledge is power and by using this nursing program to establish my basics I can continue to develop my nursing style from those skills. Quality of Practice The registered nurse contributes to quality nursing practice (ANA, 2010, p. 52). Safety, responsibility, accountability and ethics are components that help to provide quality

SELF-ASSESSMENT nursing care. The nursing program is teaching me the correct methods to provide quality, safe and efficient care to my patients. Through mixed methods of delivery; being in classroom, at clinical, and in simulation lab, I am able to develop and improve the quality of practice before I am in the real setting. The nursing program is always providing learning opportunities and even

if I consider it a failure, the professors reiterate the fact that it is a learning opportunity and a safe environment to do so. Communication According to the ANA, The registered nurse communicates effectively in a variety of formats in all areas of practice (2010, p. 54). Communication is the backbone to consistent quality care. It is very important for nurses to be able to talk with the patient, family members, coworkers, management, other departments and community. This communication allows for optimal patient care; without it, areas can be overlooked and misunderstandings can take place. I believe that I am easy to get along with and that helps me to build a professional relationship with my patients that includes trust and allows for them to ask questions without feeling inadequate. Leadership The registered nurse demonstrates leadership in the professional practice setting and the profession (ANA, 2010, p. 55). As a student nurse, I think that this is the most difficult area to do right now, because we do not have the licensure or the knowledge to back it up, yet. I believe that in order to be a leader, an individual must know how to follow. Knowing that experienced nurses can be leaders to new nurses and new nurses are leaders to their patients, family and friends, this is an area that continues to grow and that I need to improve upon. I think that for me it is easy to sometimes let my leadership ideas diminish in order to allow someone elses to be

SELF-ASSESSMENT used. This will require me to continually practice and be assertive for these leadership roles that will enrich my future nursing career. Collaboration

The registered nurse collaborates with the healthcare consumer, family, and others in the conduct of nursing practice (ANA, 2010, p. 57). The nurse is not the only one participating in patient care. There must be communication among colleagues, healthcare providers, family members and the patient. In order to ensure the highest quality of care is provided, communication and teamwork must happen. I have seen many instances at the clinical setting when individuals do not get along, creating no teamwork, ultimately impacting the care provided to the patient. Professional Practice Evaluation 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). Workplace evaluations for the nurse are ways in which that person is able to see their strengths and weaknesses. Those weaknesses are then areas that can be improved upon in order to create a well-rounded and experienced nurse. I feel as though I am able to take feedback on my performance and then utilize that to improve. This nursing program has made me realize that I can be my worst enemy, but through the evaluations, I am able to see what my professors and clinical instructors see as my strengths and what areas I need to improve upon to increase my nursing performance. 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). Currently this is a very

SELF-ASSESSMENT important area of nursing, because healthcare insurance has changed and the cost for medical supplies, like medicine, has increased. As a nurse it is very important to establish during the

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intake assessment if that individual has financial concerns and if so, then provide resources from the facility that they would be able to talk with and gain knowledge from. As a nursing student I still have to learn about many of the resources available to patients and those resources will change with each facility that I am employed at. Environmental Health The registered nurse practices in an environmentally safe and healthy manner (ANA, 2010, p. 61). As a nurse I want to be able to be a source of knowledge for my family, friends and community. I would like to be able to volunteer time at a community health center or school and make a difference. Nurses have many roles and being able to reduce the risk of harm to colleagues and healthcare consumers will help to promote healthy individuals and communities. Code of Ethics for Nurses Provision 1 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). It can be very challenging to put aside your own personal judgments while caring for individuals who need compassion and respect at this time in their life. I was recently told by one of my patients that you actually care about me and that stuck with me, because I want to keep that in the way I provide care compared to other nurses. I think it is a great reminder that if you can make a difference in a persons time while caring for them, by maintaining these ethics and standards, then positives will come from it.

SELF-ASSESSMENT Provision 2

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The nurses primary commitment is to the patient, whether an individual, family, group or community (ANA, 2001, p. 5). The nurse is an advocate for their patient and they must be able to support their patients wishes. As a student nurse it is very important to remember to keep a professional relationship with your patient. In my clinical, I had a younger girl who wanted to add me on facebook to keep in touch and that is when this code of ethics struck me. Technology in this day and age makes it very easy to cross boundaries and this is an area that nurses must constantly be aware of and taking protective measures against. Provision 3 The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient (ANA, 2001, p. 6). Patient confidentiality is a major topic for healthcare facilities and how to maintain their privacy. I think that this is major issue and it is an area of nursing that I am constantly worried about. As a student nurse you must remember to not have patient identifiers on you when leaving the hospital or even when doing clinical homework assignments. Provision 4 The nurse is responsible and accountable for individual nursing pra ctice and determines the appropriate delegation of tasks consistent with the nurses obligation to provide optimum patient care (ANA, 2001, p. 8). Delegation is a very difficult skill to understand as a nursing student. I am expected to complete total care on my patients all while doing the nursing tasks. This is very challenging, especially when having multiple patients. However, I think that when delegation occurs, patients receive the highest quality of care. Provision 5

SELF-ASSESSMENT The nurse owes the same duties to self as to others, including the responsibility to

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preserve integrity and safety, to maintain competence, and to continue personal and professional growth (ANA, 2001, p. 9). This provision is the hardest for me, because I always want to take care of others and I put them before myself. Understanding that I must take care of myself in order to take care of others will be essential for a lifelong career in nursing. I must remember to do the little tasks, such as raising a bed higher to help decrease the stress on my back. Provision 6 The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action (ANA, 2001, p. 11). Nurses have a major impact on the environment for their patients and can positively or negatively influence their healing. It is important to remember this and know that as a nurse we have a responsibility to treat our patients and colleagues with respect and integrity. I feel as though I am able to treat every part of the healthcare team and the patients with respect and my clinical experience has demonstrated that to me via the feedback I received from my clinical instructor. Provision 7 The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development (ANA, 2001, p. 12). Being a nurse is more than just taking care of patients, it is about growing your knowledge base. This includes being up-to-date on the most recent evidence-based knowledge and applying that to the care that is provided. I do not plan to go further in the nursing education for a while, but I do

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plan to get additional certifications that will assist me in gravitating towards the areas of nursing that I find captivating. Provision 8 The nurse collaborates with other health professionals and the public in promoting community, national and international efforts to meet health needs (ANA, 2001, p. 12). Nursing is not just about one person taking care of a patient. Nursing is teamwork. I have experienced this both in the nursing program and at my clinical site. Having support from fellow classmates, professors, clinical instructors and from experienced nurses, help to guide my education and experiences from this nursing program to prepare me for when I am on my own as a nurse. Provision 9 The profession of nursing, as represented by associations and their members, is responsible for articulating nursing vales, for maintaining integrity of the profession and its practice, and for shaping social policy (ANA, 2001, p. 13). Once a nurse, always a nurse, is what sticks in my mind from this program. I believe that the information and the experiences from this nursing program and clinical have permanently changed my way of thinking. Nursing is a community and there are different nursing groups that I have already become a part of as a student and I plan to continue. I was inducted into the Honor Society of Nursing, Sigma Theta Tau International in fall 2013 semester and I want to continue my membership because of all the different components that they incorporate into nursing, enhancing the professional development of their members. Goals Nursing is a career that has many avenues for me to pursue. As my graduation date approaches I am constantly thinking about where I want to go and what experiences I will be

SELF-ASSESSMENT presented with. From the pull-outs and different floors that I have worked on at my clinical location, I have been thinking about obtaining a job in the medical-surgical unit and surgery

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pool. I absolutely loved the surgery pull-out that I had, but I want to make sure that I do not jump into a specialty right away. I want to give myself the opportunity to establish a solid set of skills from the medical-surgical floor, because those basic skills are important for me to become proficient at in order to use them later on in my career. I plan to join the Michigan Nurses Association as a registered nurse and then I also want to look into different programs that my future employer has at their healthcare facility. I want to become a part of those and make a difference where I can, which will also include volunteering in my community. I think that it is important to give back, because through this nursing program I have gained a lot and realized that even though this was a very challenging program, I made it through with the support of my family, friends, boyfriend, and nursing professors. Overall, I have many goals that I want to achieve but my main priority is providing the best patient care possible. I want to be knowledgeable and caring to my patients and treat them the way that I would want to be treated if I was in the same situation. And in order to provide the highest quality of care I need to constantly assess myself and the biases that I may have. I need to be aware of them and ensure that I put those aside to provide consistent care to every individual that is my patient. Conclusion The nursing profession has many pathways that I can take after graduation from nursing school, however these options would not be available to me if these standards and ethics were not met. It is important to know the roles and responsibilities that a nurse has, because soon I will

SELF-ASSESSMENT be a registered nurse. Continuing knowledge and growth through self-assessments will help to shape my nursing career in the future.

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SELF-ASSESSMENT References American Nurses Association [ANA]. (2001). Code of ethics for nurses with interpretive statements. Retrieved from http://www.nursingworld.org/MainMenuCategories/ EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf

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American Nurses Association (2010). Nursing: Scope and Standards of Practice (2nd ed.). Silver Spring, Maryland: Author.

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CHECKLIST FOR SUBMITTING PAPERS
DATE, TIME, & INITIAL

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PROOFREAD FOR: APA ISSUES 1. Page Numbers: Did you number your pages using the automatic functions of your Word program? [p. 230 and example on p. 40)]

SG 2-19-14 SG

2. Running head: Does the Running head: have a small h? Is it on every page? Is it less than 50 spaces total? Is the title of the Running head in all caps? Is it 1/2 from the top of your 2-19-14 title page? (Should be a few words from the title of your paper). [p. 229 and example on p. 40] SG 3. Abstract: Make sure your abstract begins on a new page. Is there a label of Abstract and it is centered at the top of the page? Is it a single paragraph? Is the paragraph flush with the 2-19-14 margin without an indentation? Is your abstract a summary of your entire paper? Remember it is not an introduction to your paper. Someone should be able to read the abstract and know what to find in your paper. [p. 25 and example on p. 41] SG 4. Introduction: Did you repeat the title of your paper on your first page of content? Do not use Introduction as a heading following the title. The first paragraph clearly implies the 2-19-14 introduction and no heading is needed. [p. 27 and example on p. 42] SG 2-19-14 SG 6. Double-spacing: Did you double-space throughout? No triple or extra spaces between sections or paragraphs except in special circumstances. This includes the reference page. [p. 2-19-14 229 and example on p. 40-59] SG 2-19-14 SG 2-19-14 SG 7. Line Length and Alignment: Did you use the flush-left style, and leave the right margin uneven, or ragged? [p. 229] 8. Paragraphs and Indentation: Did you indent the first line of every paragraph? See P. 229 for exceptions. 5. Margins: Did you leave 1 on all sides? [p. 229]

9. Spacing After Punctuation Marks: Did you space once at the end of separate parts of a reference and initials in a persons name? Do not space after periods in abbreviations. Space 2-19-14 twice after punctuation marks at the end of a sentence. [p. 87-88] SG 2-19-14 SG 2-19-14 SG 2-19-14 11. Abbreviation: Did you explain each abbreviation the first time you used it? [p. 106-111]. Remember, no abbreviations in the title of the paper. 12. Plagiarism: Cite all sources! If you say something that is not your original idea, it must be cited. You may be citing many timesthis is what you are supposed to be doing! [p. 170] 10. Typeface: Did you use Times New Roman 12-point font? [p. 228]

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SG 13. Direct Quote: A direct quote is exact words taken from another. An example with citation would look like this: 2-19-14 The variables that impact the etiology and the human response to various disease states will be explored (Bell-Scriber, 2007, p. 1). Please note where the quotation marks are placed, where the final period is placed, no first name of author, and inclusion of page number, etc. Do all direct quotes look like this? [p. 170-172] SG 2-19-14 SG 14. Quotes Over 40 Words: Did you make block quotes out of any direct quotes that are 40 words or longer? [p. 170-172]

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15. Paraphrase: A paraphrase citation would look like this: Patients respond to illnesses in various ways depending on a number of factors that will be 2-19-14 explored (Bell-Scriber, 2007). It may also look like this: Bell-Scriber (2007) found that [p. 171 and multiple examples in text on p. 40-59] For multiple references within the same paragraph see page 174 re: use of year. SG 2-19-14 SG 2-19-14 17. General Guidelines for References: A. Did you start the References on a new page? [p. 37] B. Did you cut and paste references on your reference page? If so, check to make sure they are in correct APA format. Often they are not and must be adapted. Make sure all fonts are the same. C. Is your reference list double spaced with hanging indents? [p. 37] D. Formatting of different types of titles: see page 185. E. Check formatting of all types of authors and sources before submitting your paper. PROOFREAD FOR GRAMMAR, SPELLING, PUNCTUATION, & STRUCTURE SG 2-19-14 SG 18. Did you follow the assignment rubric? Did you make headings that address each major section? (Required to point out where you addressed each section.) 16. Headings: Did you check your headings for proper levels? [p. 62-63].

19. Watch for run-on or long, cumbersome sentences. Read it out loud without pausing unless punctuation is present. If you become breathless or it doesnt make sense, you need 2-19-14 to rephrase or break the sentence into 2 or more smaller sentences. Did you do this? SG 2-19-14 SG 21. Conversational tone: Dont write as if you are talking to someone in a casual way. For example, Well so I couldnt believe nurses did such things! or I was in total shock over 2-19-14 that. Did you stay in a formal/professional tone? SG 22. Avoid contractions. i.e. dont, cant, wont, etc. Did you spell these out? 20. Wordiness: check for the words that, and the. If not necessary, did you omit?

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2-19-14 SG 2-19-14 SG 2-19-14 SG 24. Do not use etc. or "i.e." in formal writing unless in parenthesis. Did you check for improper use of etc. & i.e.?

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23. Did you check to make sure there are no hyphens and broken words in the right margin?

25. Stay in subject agreement. When referring to 1 nurse, dont refer to the nurse as they or them. Also, in referring to a human, dont refer to the person as that, but rather 2-19-14 who. For example: The nurse that gave the injection. Should be The nur se who gave the injection Did you check for subject agreement? SG 26. Dont refer to us, we, our, within the paperthis is not about you and me. Be clear in identifying. For example dont say Our profession uses empirical data to support . . 2-19-14 Instead say The nursing profession uses empirical data.. SG 27. Did you check your sentences to make sure you did not end them with a preposition? For example, I witnessed activities that I was not happy with. Instead, I witnessed acti vities 2-19-14 with which I was not happy. SG 2-19-14 SG 2-19-14 SG 2-19-14 SG 2-19-14 SG 32. Did you check apostrophes for correct possessive use. Dont use apostrophes unless it is showing possession and then be sure it is in the correct location. The exception is with the 2-19-14 word it. Its = it is. Its is possessive. 31. Does your paper have sentence fragments? Do you have complete sentences? 30. Did you include a summary or conclusion heading and section to wrap up your paper? 29. Did you have other people read your paper? Did they find any areas confusing? 28. Did you run a Spellcheck? Did you proofread in addition to running the Spellcheck?

Signing below indicates you have proofread your paper for the errors in the checklist: _____________Lisa Dust___________________________________DATE:___2-19-14_____ A peer needs to proofread your paper checking for errors in the listed areas and sign below: ____________Sasha Gapczynski_____________________________DATE:___2-19-14_____