C304 Task 1 K.Bilow 11 PDF

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C304 Task 1 Kellie Bilow Western Governors University November 2, 2020

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A. Nursing Theory Hildegard Peplau’s Interpersonal Relations theory has greatly influenced the way I approach every patient. Peplau’s theory resonated with me and how I related to people naturally. It is based on the idea that nursing is “An interpersonal process of therapeutic interactions between an individual who is sick or in need of health services and a nurse especially educated to recognize, respond to the need for help.” It is a “maturing force and an educative instrument” involving an interaction between two or more individuals with a common goal” (Petiprin. 2020) Since becoming an RN in 1998 I have always endeavored to develop a relationship with the patients that I am caring for. Somehow in my innermost being, I knew that my patients would be more compliant and have better outcomes if we had a good relationship. The nurse – patient relationship is so important. We are partners in the healing process so relationship based care has always been something I have placed a high priority on when caring for others.

A1. Excellent Nursing Practice Nurses apply Peplau’s theory of Interpersonal Relations everyday while relating to patients. Peplau’s theory is based on 4 sequential phases, the Orientation phase, the Identification phase, the Exploitation phase and the Resolution phase. The Orientation phase is when the nurse and patient get acquainted and the problem or need is defined. The nurse assesses the patient, reviews data received and identifies what the patient’s needs are. This requires participation of the patient, the patient asks questions and shares their prior experiences and works together with the nurse so that the patient’s needs can be clearly identified. The Identification phase is when the actual nursing plan of care is developed based on the patient’s needs and goals. The patient is in integral part of this phase as needs and resources are identified. During the Identification phase the patient begins to feel empowered and their sense of despair of hopelessness dissipates. The Exploitation phase is a time when the patient is actively involved in the implementation part of the plan of care. Patients take responsibility for seeking out help and for setting and meeting goals. The nurse supports and helps the patient to identify and utilize available resources. The Resolution phase is when the patient’s needs have been addressed and the goals have been met. At this time the patient – nurse relationship can be terminated. During this phase, the nurse and patient evaluate the nursing process and if goals were met (Petiprin. 2020). All of these phases require collaboration between the nurse and the patient.

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A.2 Professional Practice Nursing Theory Hildegard Peplau’s Interpersonal Relations theory fits into my practice every time I stepped into the ER and care for patients at the bedside. As a nurse manager I don’t get to do hands on care most of the time but I always love the times that I get to go into the ER and work alongside our amazing ER team of nurses and doctors. I approach all my patients with the idea that for however long this patient is in my care I need to have as good of a relationship with them as possible to ensure the patient has a good outcome. I view patients as a partner in care and place a high priority of developing and maintaining a good rapport with them. Quite truthfully, I don’t only apply this theory to my interactions with my patients but with my colleagues and others that I work with outside the hospital as well. I have heard it said by a pastor that “ministry flows out of relationship” well, I view nursing as a ministry and understand that forming relationship with the patient and working with them through the process will indeed yield the best outcomes.

B. Historical Nursing Figures One cannot talk about influential nursing figures without Florence Nightingale coming to mind. Florence Nightingale is indeed one of the most influential nurses ever to live. Florence developed the theory of environment of care while she was caring for wounded soldiers during the Crimean War. Nightingale is recognized as the first nursing theorist. She is widely known for her theory on Environment of Care. Her theory, Environment of Care focused on five environmental factors that influenced the healing process and thus impacted over all patient outcomes. Those factors noted by Nightingale were fresh air, pure water, efficient drainage, cleanliness/sanitation and light or sun light Nightingale’s theory is still relevant today (Petiprin. 2020). Nightingale is also known for her work in advancing the nursing career by establishing the first science based program for nursing education. Clara Barton is a famous 20th century nurse who is known for her work with the American Red Cross. Clara first discovered her knack for nursing when she was only 10 years old and devoted her time to caring for her brother who had sustained a severe head injury after falling from the roof of the barn. Doctors had basically given up on her brother David ever recovering but Clara continued to care for him and did so for quite a long time until he finally recovered completely. Clara was a remarkable young lady, after her brother was fully recovered in order to satisfy her desire to help others, Clara became a teacher at the age of 15 and eventually opened a school in New Jersey (Biography. 2020). At the outset of the American Civil War in 1861 Barton was working in Washington DC where injured men were being transported from the first riot which took place in Massachusetts, there she would provide support and care anyway she could. She had no formal nurse training as there

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was no formal training during that time so Clara was self-taught. She was remarkable in so many ways. She was a nurse, a teacher, humanitarian worker and a civil rights advocate at a time before women had voting rights (Wikipedia. 2020). Today the American Red Cross is still carrying on the work she began so long ago.

B1. Difference in Contributions Both Nightingale and Barton had notable contributions to the nursing profession. Today, their contributions still continue to improve patient outcomes and make the world an all -around better place. Florence Nightingale is known as the founder of modern nursing. Prior to Nightingale nurses were learning skills on the job, there was no formal training. She “raised the standard of nursing by incorporating education and responsibilities, paving the path for a respected and appreciated profession” (oaapn.org, n.d.). It was in 1860 that Nightingale founded the first formal school of nursing in London called The Nightingale School for Nursing. Nightingale also made history as also known as the first nursing theorist. Her Environmental Care theory is still practiced today. The environment of care takes into consideration cleanliness, fresh air, pure water, effective drainage, and light. “Nightingale was tireless in her efforts to improve the hospital’s conditions. Her efforts reduced the hospital’s death rate by two-thirds” (Nightingale’s Environmental Theory, 2/20/2020). Clara Barton was also a remarkable person. She first discovered her gift for nursing while caring for her brother who was badly injured and needed nursing care. When the doctors had all but given up on him getting better Clara continued patiently working with her brother until he eventually regained his strength and was fully recovered. Clara later served during the Civil War caring for wounded soldiers. Her desire to help never left her after the war. Clara was a humanitarian at her core and this trait resulted in her seeking out places that she could make a difference. During her travels in Europe Barton learned about the Geneva Treaty and was introduced to the Red Cross. Upon returning to the US she founded the American Red Cross in 1881. To this day, the American Red Cross continues to serve those in need. “It seems that her whole life led up to that moment” (Petiprin. 2020). What an incredible legacy of care and humanitarian work Barton left behind, a woman to be admired and honored for sure.

B2.Description of Historical figures My nursing practice has been greatly influenced and shaped by both Clara Barton and Florence Nightingale. Nightingale has shaped how I approach and provide care for every patient encounter I have regardless of what environment I am in. So whether I am in the ER, the Clinic,

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in-patient unit, or whether I am the first responder to a car accident in my community, I take into consideration the environment of care and how I can improve the patient experience by ensuring that the environment is clean and free of clutter, that it is safe, the air is clean and fresh, the water provided for patients is clean and that the patient is exposed to light, especially sun light. When I walk into a patient area I am diligent to make sure that the area is clear, free of clutter or potential hazards to the patient, I like to open the blinds so that natural light comes into the room. A peaceful and quiet environment is also helpful to patients, so working with our nursing leadership team a few years ago I implemented the “Quiet Campaign” which aimed to reduce noise coming on the nursing unit that came from general staff chatter and a multitude of overhead paging that was occurring. Interestingly enough, after implementing the Quiet Campaign we began rather quickly to see patient satisfaction scores improving. Clara Barton has influenced and shaped my practice by inspiring me to further my education and to give back. I participate in a variety of humanitarian organizations and use my nursing skills to help those in need not only here in the US but in other countries as well when I go on medical missions trips. I also give financially to organizations that are doing this type of great work.

State Board of Nursing versus ANA

Roles of Organizations Every state has a Board of Nursing that serves at the regulatory and licensing body for the nursing profession. There are four areas of oversight that board of nursing has: Education, nursing scope of practice, licensing, and last but not least discipline. The Board of Nursing exists to protect the public by ensuring that those who are issued nursing licenses have completed the proper education and are competent to provide safe care. It is the job of each Board of Nursing to determine their standards for nursing practice in their state. The New York State Board of Nursing influences my practice by ensuring that I meet educational and licensing requirements and by defining duties within my scope of practice. As a nurse manager in my organization I must often refer to the nurse practice act for our state when delegating duties and when writing policies for our nursing departments. The American Nurses Association is a non-profit organization that represents Registered Nurses in the United States. At its inception in 1896 it was originally called the Nurses Associated Alumnae and in 1911 the name was changed to what we know today as the American Nurses Association. The mission of this professional organization is to advance and protect the nursing profession. They do that by “fostering high standards of nursing practice; promoting a safe and ethical work environment; bolstering the health and wellness of nurses; and advocating on health care issues that affect nurses and the public (ANA, n.d.).”

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Influence of the State Board of Nursing and ANA

The New York State Board of Nursing influences my practice by ensuring that I meet educational and licensing requirements and by defining duties within my scope of practice. As a nurse manager in my organization I must often refer to the Nurse Practice Act when writing nursing policy and procedures for our organization. The ANA is a respected and accomplished organization that is a strong voice advocating for all nurses. They help protect and advance this phenomenal profession. My nursing practice has been impacted and greatly shaped by the various workshops, webinars and educational opportunities accessible through the ANA. My practice was also greatly impacted with changing laws that impacted nurses, improving our work conditions and improving the quality of care we give by safer staffing ratios.

Requirements for Professional License Renewal In the state of New York were I reside, a nursing license is renewed every 3 years. In order to renew a nursing license, a fee of $73.00 is paid and in addition to that every 4 years we are required to take an infection prevention course and attest to it (NYSED. 2020).

Failure to Maintain License Requirements According to New York State Office of Professions “Your nursing license is valid for life unless it is surrendered, revoked, annulled or suspended by the New York State Board of Regents. Your registration certificate will authorize you to practice as a nurse for up to three years. You must renew your registration every three years to continue to practice nursing. You are not legally allowed to practice nursing while your registration is expired. (NYSED, para 14)” Failure to maintain a nursing registration certificate will prohibit you from legally practicing as a registered nurse in New York State.

Compact Versus Non-Compact State I am very familiar with compact vs non compact states. I became in RN in 1998 and was first licensed to practice in the state of Missouri. After working for 2 years in a teaching hospital I decided to take up travel nursing. I had to obtain a nursing license for the state of Arizona at the time of my first travel nursing contract. Back in 2000 Nursing Licensure compacts were gaining momentum but there were still only a handful of states in the compact.

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After practicing in Arizona for a full year, I decided to build a house there and base my travel nursing out of Arizona. Since Arizona was a compact licensure state, I was able to take travel nursing assignments in other states that had states that allow reciprocity of my Arizona nursing license. If memory serves me right, I believe that there were only 12 or so compact states when I first started travel nursing. Currently there are 34 states in the compact. I was able to travel to New Hampshire and Maine on my Arizona nursing license. When traveling to non –compact states such as California, Vermont and New York I would have to apply for a nursing license in each of those states. At one point in my travel nursing career, I was maintaining nursing licenses for 5 states that I often took travel assignments in. NLC, Nursing Licensure Compact states are wonderful as they allow for reciprocity, meaning that if you live in a state that is part of the Nursing Licensure Compact then you can legally practice in other states that are also part of the Nursing Licensure Compact. Non- compact states require the nurse to go through the finger printing and the whole process of getting a new license when a nurse wants to practice in their states. The NLC, Nursing licensure compact was a big step forward for our profession.

Agencies Functional Differences The FDA’s primary function is to protect the public be ensuring that products such as medications, food, vitamins, medical devices, cosmetics, radiation emitting products, tobacco products, veterinary food, medications and medical devices meet evidence based safety standards. The FDA is essentially the gatekeeper for the aforementioned items coming into the US (FDA.gov. n.d.). CMS is an agency within the Department of Health and Human Services. CMS acts as the administrator for Medicare, Medicaid, CHIP (Children’s Health Insurance Program as well as the health insurance exchanges. They determine the reimbursement rates for medications, therapies and medical devices that the FDA allows into the US (Kagan. 2020). Both agencies have a shared interest and goal of protecting the public by ensuring safety and quality, and improving health care for everyone.

Influence on Professional Practice The FDA and CMS influence my practice as a nurse every day because I can have confidence in knowing that the FDA has approved the medications I am administering and the equipment I use with my patients on a daily basis. As a nurse and patient advocate it is important to me that the care I provide and treatments I administer are safe for my patients and that they will produce the best outcomes for my patients.

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I look to the CMS often in my current role. As a nurse leader in my organization, I must ensure that not only I, but our staff nurses also follow CMS regulations. We gather our data for our quarterly Sepsis reporting based on the standards put out by CMS.

Nurse’s role as a Patient Advocate When I have a patient that requests an alternative therapy such as a nutritional supplement or perhaps a patient that requests to take her CBP supplement to help her sleep, I will bring the patient’s request to the provider and our pharmacist so that together they can review the medications that are ordered for the patient and determine if the patient’s home protein shake or home CBD supplement will have any adverse effect based on the medications that the provider has ordered. Ultimately, it is up to the provider to make the decision but as far as my role, I can share information with the provider and advocate for my patient’s wishes. In almost 25 years of nursing practice, there have only been a few times that a patient has requested alternative therapy. Most recently, a patient requested to have his acupuncturist to come to the hospital to do a treatment for his restless leg syndrome and that occurred during the spring when Covid-19 was at its peak in New York so I did advocate for the patient by sharing his request with the doctor but also had to explain to the patient that due restrictions in place as a result of the pandemic, that his request would likely not be met at this time as we must protect not only him but our staff and other patients as well. The patient was disappointed but understood why his request was not able to be met at that time. What the doctor did do to address the patient’s restless leg syndrome was to order Gabapentin. The patient was nervous about taking Gabapentin due to what he had read as side effects of that medication but he agreed to try it. I printed off patient education materials on Gabapentin and provided them to the patient as well.

Purposes of the Nurse Practice Act The Nurse Practice Act in New York where I live and practice is established to ensure public safety by ensuring that nurses licensed to practice nursing meet standards for providing safe, competent care. The Nurse Practice Act influences my nursing practice by clearly defining what I am allowed to do as a nurse. It provides protection not only for the public but also nursing as a profession by ensuring that I, and all RNs who are practicing are competent to provide safe, high quality care.

Scope of Practice As an RN in the state of New York, the Scope of Practice outlines and defines the activities and duties that I am licensed and qualified to carry out.

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Per the NYS Scope of Practice I am qualified to preform patient assessments, administer medications and treatment therapies, provide patient education, case manage, provide restorative and supportive care that supports life and well-being.

Rules for Effective Delegation RNs provide compassionate care that is respectful of each patient's values and wishes. They coordinate and supervise care provided by other personnel, such as licensed practical nurses or home health aides. RNs provide health teaching to patients, families, other care providers and the public. They participate in health research and in making health care policies. According to the NYBON, Licensed Practical Nurses function by law in a dependent role at the direction ...