C304 Task 1 - TASK 1 PDF

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C304 – Task 1

Emma Beavers College of Health Professions, Western Governors University C304 – Professional Roles and Values Rachel Lull 03/20/2021

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C304 – Task 1 A: Nursing Theory Jean Watson’s theory of human caring: Transpersonal caring as the fulcrum; philosophy and science as the core of nursing, aligns most with my personal values and goals. Throughout nursing school and for the last two years of my career as a registered nurse a big focus of mine has been caring for the patient. When caring for the patient I am not just taking care of their physical needs but also being there for them for their mental health. As the book states, “The expectation is that the client will experience balance and harmony in mind, body, and soul (Cherry & Jacob, 2019. Pg.85).” By caring for them in whole I am able to help meet that expectation for the client. The reason I became a nurse is because I care and enjoy helping others. Even through the hard days I still go in with a smile and take care of each of my patients the way they need to be cared for. I treat all of my patient’s with respect however I would not say I care for each of them the same but that is because each of them needs support and care in different ways. I enjoy being able to connect with my patients and help them through their hospital stay. A1: Excellent Nursing Practices Jean Watson’s nursing theory can be used to plan excellent nursing practices by nurses because caring for the patient plays a large role in every nursing job. As nurses we develop plans for our patient’s based on their personal goals and current situation. I have seen my coworkers go above and beyond several times for their patients. Whether it is just sitting down and having a conversation with their patient that is feeling lonely or giving them a shower that day. I recently had a patient that was COVID positive who was so worried about his wife

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that was at home sick that I helped him call 911 because he felt that was necessary, which actually ended up with her being admitted to the COVID unit just a couple doors down from her husband. The husband was so worried about her that he was not doing anything to take care of himself. I offered showers and walks around the room, but he kept pushing those off because all he could think about was her and that she needed care. Once she was admitted to the floor and I allowed him to go see her he seemed overall significantly better than the morning because his worries were relieved knowing that she was getting care. A2: Professional Practice Nursing Theory The above theory fits my professional practice because every day I am at work I care for each and every one of my patient’s. My goal is to connect with my patients to help make their hospital stay easier and help them to work towards their goals. I realize that my patients are going through a tough time when admitted at the hospital and do anything I can in order to make their stay easier. Not only do they need nursing care but a lot of them need just someone to sit down and listen to them. I once had a patient that requested I sit in on her conversations with the doctors because she felt more comfortable and due to the pain medication she did not always remember everything and wanted me to help relay information to loved ones and also if she had any questions later on that day I could help answer them.

B: Contributions of 19th or 20th Century Historical Nursing Figures Florence Nightingale is one of many historical nursing figures. She however is probably the most well-known. Florence Nightingale’s theory of environmental cleanliness is still practiced today (Cherry & Jacob, 2019. Pg.8.) Along with her theory of environmental cleanliness she also developed theories for light, chattering hopes and advices, diet, variety, noise

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and ventilation and warming (Cherry & Jacob, 2019. Pg.82.) She went above and beyond to take care of patient’s and also set the standards for care that we still use today. After her work during the Crimean War she established formal nursing education programs that first started in England and eventually migrated into the United States. She is known as the founder of professional nursing for all her work and dedication to the field (Cherry & Jacob, 2019. Pg.9.) Another well-known historical nursing figure is Jean Watson. Jean Watson graduated from Lewis Gale School of Nursing in 1961 and then went on to pursue further degrees (Jean Watson.) As previously stated Jean Watson developed the nursing theory of human caring. She touches base on how nurses should care for their patients and focuses on holistic care. Her theory consists of four concepts which are human being, health, environment/society and nursing (Jean Watson.) B1: Difference in Contributions Florence Nightingale and Jean Watson contributions differ. Florence Nightingale focused on cleanliness of the environment and how it affected patients. She made changes to nursing practice by focusing on the environment in order to improve outcomes for patients. Jean Watson focused tremendously on building relationships with patients. Her focus towards a holistic approach was to improve how as a nurse we care for a patient. She points out that patient’s need so much more than just care of their illness. In order to heal patient’s also need emotional support and that by caring and building a relationship with patient’s we are able to help them heal in other ways. Although both nursing figures differ in contributions, they both work towards one end goal which is helping patient’s in the best way possible.

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B2: Description of Historical Figures Florence Nightingale and Jean Watson have both influenced my nursing practice in several ways. I remember being a student nurse and one of the many parts of my care plans that I would fill out for each and every one of my patients was a safety check list upon entering each of their rooms which I mentally do every day I am at work now. I focused on bed alarms, garbage laying on the floor because the patient missed the garbage can, removing any unneeded equipment that could get in the patient’s way, wiping down things in the patient room that had been soiled and so much more. Not only do I focus on the environment in each patient room, but the importance of cleaning equipment used for patient before going to the next room. Hand washing has also become routine every time I enter a room, leave a room or any time I need to change my gloves. Florence Nightingale focused on cleanliness and still today a large part of every nursing job incorporates her theory. Jean Watson taught me the importance of caring for a patient. In nursing school, I learned the importance of spiritual assessments and that sometimes we just need to sit down and listen to our patient’s. Nursing is so much more than just passing pills, taking vitals and following doctor’s orders. Each and every patient has a need that goes beyond that and by taking the time to address patient concerns and listening to patients, I am able to help fulfill that need. C: State Board of Nursing Versus ANA C1: Roles of Organizations The State board of nursing by definition is an “appointed board within each state charged with responsibility to administer the nurse practice act of that state (Cherry & Jacob, 2019. Pg.63.) The State board of nursing is responsible for nursing licensure, setting standards for safe nursing care, distinguishing scope of practice for nurses within its jurisdiction, and also

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disciplinary actions (2019.) The American Nurses Association (ANA) is defined as a “professional organization that represents all registered nurses. (Cherry & Jacob, 2019. Pg.63.)” The ANA focuses on developing high standards of nursing practice, promoting a safe and ethical work environment, supporting the health and wellness of nurses and advocating on health care issues that affect nurses and the public (About ana: Ana enterprise.) The functional difference of the State board of nursing and the ANA are that the State board of nursing overall deals with legal matters such as nursing licensure and disciplinary actions whereas the ANA deals with advocacy for the nursing profession. C2: Influence of the State Board of Nursing and ANA The State Board of Nursing influences my nursing practice by giving me the ability to practice nursing after I passed the NCLEX as well as setting guidelines for license renewal. The ANA has influenced my nursing practice by helping to fight for patient safety such as safe nurse to patient ratios and continuing to fight for nurses through political action. C3: Requirements for Professional License Renewal I hold a nursing license in the state of Wisconsin. Every even year by 2/28 I have to renew my nursing license. To renew my license, I have to fill out a renewal application through the Wisconsin Department of Safety and Professional Services and pay a fee. CEU’s are not required for renewal in the state of Wisconsin. C3A: Failure to Maintain License Requirements In Wisconsin in order to maintain a active license you must be employed in a position that requires a nursing license or have a current nursing education. If 5 years were to go by without practicing as a nurse, you would have to apply to the Board and complete a refresher course or courses that are approved and then petition for full licensure (Registered nurse.)

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C4: Compact Versus Non-Compact State Wisconsin is a compact state meaning that you can apply for a compact license that would allow you to practice as a nurse in other compact states. States that are a part of the Enhanced Nurse Licensure Compact (eNLC) make it easier for nurses to practice across state lines and also do not burden nurses with varying renewal requirement and fees. Non-compact states hold different requirements in order to obtain a nursing licensure in that state. The states that have not joined the eNLC have decided to abstain due to concern with revenue, threat to public health and safety, varying licensure requirement and belief that will not solve their workforce needs (Gaines.) D: FDA and CMS D1: Function of the FDA and CMS. What do they regulate? The Food and Drug Administration (FDA) regulates the marketing and use of medical products such as drugs, biological products and medical devices (Institute of Medicine (US) Roundtable on Evidence-Based Medicine.) The FDA is responsible for reviewing data of new products and approving them if they meet safety and effectiveness standards. After approved and available for use the FDA continues to monitor the safety and effectiveness of the product. The Centers for Medicare and Medicaid Services (CMS) regulates reimbursement for healthcare products for Medicare and Medicaid (Institute of Medicine (US) Roundtable on Evidence-Based Medicine.) CMS strives to provide access to high quality care at lower costs and that patients receive the right care for their situation. CMS also pushes for use of secure electronic health records, advancements in use of electronic prescribing and creation of disease management programs. They analyze medical care performed and help determine whether or not it was done in a quality manner (Institute of Medicine (US) Roundtable on Evidence-Based Medicine.)

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FDA influences my professional nursing practice by ensuring the safety of the medications and vaccines that I give my patient’s. By knowing that each medication and vaccine has been well researched and deemed safe by the FDA I am able to administer the medications and vaccines with confidence. CMS influences my professional nursing practice by striving for updated, modernized healthcare. They have pushed for more secure electronic health records as well as with electronic prescribing which overall helps with patient safety. D1A: Nurse’s Role as a Patient Advocate Nurses are patient advocates. As a patient advocate, I listen to my patients and help assist them reach their goals. If a patient requested alternative therapy, I would assist them with whatever they needed however I would dig into their “why.” I would openly ask why/how they think an alternative therapy would work. I would educate them on all options and allow for them to make their decision. If needed I would collaborate with other members of the health care team and if involved their support person. I believe patients have every right to make any decisions in their care once they are educated on all options. E: Purposes of the Nurse Practice Act Under the Nurse Practice Act in Wisconsin the Board of Nursing is able to: 1. Approve Nursing Education Programs 2. Approve Licensure 3. Set standards of practice 4. Create rules of conduct 5. Certify Advanced Practice Nurse Prescribers 6. Disciplinary actions

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The Nurse Practice Act’s mission is to reduce risk of harm to patients by ensuring that nurses are competent (board of nursing). The Nurse Practice Act is ultimately like a rulebook that was created by government officials on a federal level in order to regulate nursing practice. The Wisconsin Nurse Practice Act influences my professional practice by setting standards. When I received my associate’s degree my program was laid out by the NPA. The NPA also made it possible for me to come a licensed registered nurse and they also hold me accountable to their standards in order to keep my license without any disciplinary action. E1: Scope of Practice Scope of Practice refers to the services a licensed professional can perform within their role that they are deemed competent in. Example a registered nurse can start an IV whereas a certified nursing assistant cannot because it is out of their scope of practice. In Wisconsin there is a list of standards of practice that a registered nurse must follow. The list includes the nursing process (assessment, planning, intervention and evaluation), performance of delegated acts within the nurse’s scope and supervision of delegated acts (board of nursing, Ch. N6). The scope of practice is different than a nurse practice act whereas the scope of practice distinguishes the exact care a nurse can give within their scope and the nurse practice act focuses on standards of care such as minimum criteria for job proficiency and providing quality care. E2: Rules for Effective Delegation In the state of Wisconsin there are four steps when it comes to Registered Nurses delegating tasks to other staff members. First the delegated task must fit within the scope of practice to who the task is delegated with and they must be competent in that task. Second, RN’s must provide direction and assistance to the person performing the delegated task. Third, the RN must observe and monitor the task (board of nursing, Ch. N6). Lastly, the RN must evaluate the

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completed task. When an RN delegates a task it is ultimately their responsibility to ensure the task is completed appropriately and in a timely manner. In Wisconsin RN’s can delegate to LPN’s and CNA’s. F: Application of Nursing Roles Nurse as a Scientist is defined as “the nurse participates in scientific inquiry to inform healthcare decisions; and critiques; and disseminates and implements evidence to influence practice (Nursing programs conceptual model 2021).” I apply the nurse as a scientist role into my professional practice by incorporating evidence-based practice into my job. A lot of research goes into evidence-based practice in order to give our patient’s the best care possible. Nurse as a Detective is defined as “the nurse uses clinical imagination coupled with nursing science to detect subtle changes and deviations from expected patterns of being to prevent or control adverse outcomes (Nursing programs conceptual model 2021).” I apply nurse as a detective to my professional practice by assessing my patient’s and noticing when a finding is abnormal or abnormal compared to that patient’s baseline. I act upon that abnormal finding by notifying the doctor in order to act sooner in hopes of preventing any adverse outcomes. Lastly is a nurse as manager of the healing environment which is defined as “the healing environment is global in nature and includes considerations of healthcare policy, finance and regulations. Acknowledging this, the nurse creates, coordinates, and advocates for a respectful, interdisciplinary environment that promotes optimal well-being and affirms the dignity of the human experience (Nursing programs conceptual model 2021).” I apply nurse as a manager of the healing environment to my professional practice by caring for my patient’s. I listen and advocate for their choices even when it may go against my personal beliefs and values. I help be a voice for the patient when everyone is trying to “shout” over them.

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Provision 3 of the ANA Code states, “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient (Mary 2015).” Provision 3 is in place to protect patient rights of privacy and confidentiality and also focuses on patient safety. Being a patient has always been a big focus of mine. I listen to my patients and do whatever possible in order to help meet their goals even if what they want does not align with my personal values. I have always told my patient’s they have the right to refuse any treatment, but I will not let them refuse before they are well educated on their options. Also, patient safety has always been a focus on mine. From making sure the bed alarm is on to questioning doctor orders if they do not make sense for the current situation. Provision 4 of the ANA Code of Ethics states “The nurse has authority, accountability and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care (Mary 2015).” Under this provision the nurse is held accountable and responsible for the care they give to their patients. They are also held accountable for the care they delegate. Provision 4 influences my professional practice because it keeps me accountable for the care I provide to my patient’s and also that I will not delegate tasks that cannot be delegated. For example, I will not delegate to a CNA to assess a patient’s pain level. Instead, I will assess the patient myself and then promote interventions based on what the patient tells me.

G2: Clinical Practice Error There are many nursing errors that can occur in clinical practice. There are policies and procedures in place to help prevent an error, but errors are possible. One example of an error is giving the wrong medication to the wrong patient. This error can occur for many reasons such as

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the medication being entered under the wrong patient, the wrong dose being entered, or even just completely giving the wrong medication to the wrong patient due to not completing the 5 checks prior to administration. Another error that can occur is forgetting to turn a bed alarm back on which could result in a fall. As nurses we always need to be aware of our surroundings and that patient safety precautions put into place. G2A: Application of ANA Provisions Part 3.4 of Provision 3 states that nurses should be held accountable for their errors and disciplinary action should take place when needed. If a nurse was to make a med error as described above then she should take immediate action and notify the appropriate person, starting with the patient, and assess and monitor the patient for any adverse reactions. By admitting to the error and following the necessary steps after the error is made the nurse is upholding the code of ethics. The nurse needs to collaborate with other team members such as the doctor and charge nurse in order to properly report the incident and help prevent any complications that could...