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Running Head: C304 TASK 1 PROFESSIONAL ACCOUNTABILITY

C304 RGP Task 1 Professional Accountability Western Governors University 10/07/2020

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Nursing Theory The nursing theory that deeply influenced and impacted my values and goals is one of the most famous yet fundamental theories which is Nightingale's theory of practice. The environmental adaptation theory is the foundation and fundamentals of present-day nursing. Perhaps, modern nursing is built upon Nightingale's theory of practice. The theory follows ventilation and warming, noise, variety, diet, light, chattering hopes and advice, and cleanliness (Cherry, 2019). Nightingale’s theory of practice is implied every day in the hospital for excellent nursing practice and to promote the healing of patients. Hospital is well ventilated, and nurses provide oxygen if necessary. Nurses try to suppress noise and control the light to avoid unnecessary stimulation. Providing adequate diet and a personalized diet is one of the core measures in nursing. The cleanliness of the patient and the environment provide excellent infection control. Like this, Nightingale's theory of practice is applied daily in the nursing field to promote an excellent nursing environment. This theory fits my professional practice too. I work in the Definitive Observation Unit (DOU), and our core values are built upon Nightingale's theory of practice. I strive to practice and provide this theory every day to promote better healing of patients. DOU is often called step down ICU or step up telemetry, thus, many patients are severely ill and illness affects both physically and emotionally. Therefore, I imply the theory of practice to promote a better physical environment and "chattering hopes and advice (Cherry, 2019)" to provide emotional support. Overall, Nightingale's theory of practice is used every day in the nursing field and is what the nursing theory is built upon.

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(B) Contributions of 19th or 20th Century Historical Nursing Figures Jean Watson is an important historic figure of the 1970s who suggested the theory of human caring. Her theory says that "the transpersonal process of "caring," or the caring among nurse, and client, is essential to healing (Cherry, 2019)." The key point of Watson's theory is that through the process of caring and interconnectedness, clients will find and experience balance and harmony physically, emotionally, and spiritually. Another historic figure of the nineteenth or twentieth century is Florence Nightingale. She contributed through environmental adaptation theory, emphasizes the promotion of healing through the surrounding environment. The biggest difference between the two great historic figures is that Nightingale focused on the patient's surroundings for a better outcome, while Watson focused on interconnectedness for better outcomes and balance. Nightingale's theory mainly concentrates on environmental factors that promote healing such as ventilation, quiet environment, variety, diet, natural light, reinforce hopes and advice, and cleanliness to promote health. Whereas Jean Watson's main theory was "nursing is a human science of persons and human health-illness experience that are mediated by professional, personal scientific, esthetic, and ethical human care transactions, (Petiprin, 2016) Although Watson and Nightingale focused on different areas of nursing theory, both great historic figures, Watson and Nightingale, influenced my professional nursing practice. I practice Nightingale's theory of practice to promote healing and make a safe environment for patients every day of my work. Since the day I learned about Nightingale's theory, it becomes by fundamentals and baseline of each day. Providing a healing environment is essential in the nursing field to provide patient-centered care and a safe environment. Watson's theory also influenced my nursing practice. I believe interpersonal relationships and interconnectedness with the patient can greatly increase better outcomes. Therefore I strive to make a good rapport with

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the patient. A large portion of patients come to the hospital for physical needs. However, psychosocial health is something that nurses should not forget. Sense of being cared for, preservation of human dignity, and humanity are essential needs of human beings and change the outcome of the healthcare regimen. Interconnectedness affects patients' compliance with the treatment regimen and promotes better health outcomes.

(C) State Board of Nursing vs ANA State board of nursing is an "appointed board within each state charged with the responsibility to administer the nurse practice act of that state (Cherry, 2019).” The State board of nursing governs and regulates licensing, standards, and safety. The American Nurses Association (ANA) is a non-government organization that represents the interests of registered nurses. The organization's main goal is to foster high standards, promotion of safe and ethical environment, wellness of nurses, and advocating on issues that affect the public and nurses. The major distinction between the two groups is that the state board of nursing is regulated by the state and enforcing rules and guidelines for specific states, and ANA is a non-governing organization that advocates for all nurses from work safety to the promotion of higher quality nursing. Both agencies influenced me throughout nursing. I obtained my registered nurse license through the California board of nursing. I referenced the board of nursing to check my scope of practice and guidelines enforced by the government in California. ANA helped establish and grow workplace safety and patient safety in hospitals. The organization promoted and advocated safe staffing ratio and protection for whistleblowers, and health care reform which greatly affected my daily work. (American Nurses Foundation, 2020)

C304 TASK 1 PROFESSIONAL ACCOUNTABILITY There are some requirements to renew an RN license in the State of California. The renewal cycle is every two birthdays of the license holder not two calendar years. The license will expire the month after the license holder's birthday. For the renewal, 30 contact hours of continuing education are required to renew the license. The education courses should be taken through agencies verified by the Board. It is also required to submit a full set of fingerprints as directed by the California board of nursing unless the license is renewing to inactive status. Lastly, the Board requires license holders to report any conviction of a crime (California Board of Registered Nursing, 2020). There is also a fee for a renewal which is $190.00. Failure to meet requirements means a delinquent license or an inactive license. Practice with such license status is not permitted in California. Nurses with compact state or Enhanced Nurse Licensure Compact, eNLC, can practice multiple states without getting a new state license. Thirty-three states joined eNLC, and if one has a license from any of these states, he or she can practice anywhere in these states without applying and getting a state-specific license. Opposingly, if one has a non-compact state license, one must obtain a state-specific license by following requirements and purchase a nursing license (NCSBN, 2020). Food and Drug Administration and Center for Medicare and Medicaid Services Food and Drug Administration, FDA, is “responsible for protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices (FDA, 2018)." FDA regulates and oversees any food or drug products before marketed for its safety and efficacy. FDA also monitors products for safety and the effect of products. Center for Medicare and Medicare Services, CMS, is a park of the Department of Health and Human Services (HHS). CMS provides and regulates federal health care insurance,

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private insurance, regulates and enforces rules and guidelines, researches, and provides educations. CMS plays important role in providing direction to the healthcare system. CMS's mission is to "ensure effective, up-to-date healthcare coverage and to promote quality care for its beneficiaries (Institute of Medicine, 2009).” CMS also collects and analyzes data from secure electronic health records to arrange medical research and reform healthcare if necessary. Another main focus of CMS is to develop better evidence-based medicines and regulates to provide higher quality care to consumers. In the field of nursing, I encounter both FDA and CMS every moment. FDA allows me to safely administer medications and provide treatments necessary for my patients. With guidelines and researches from the FDA, I can confidently administer the right medication that is safe and effective for my patients. CMS not only provides insurances for many of my patients but also provides guidelines to follow for better outcomes for my patients. CMS provides a variety of statistics and data to support evidence-based practice. AS a nurse, I am obligated to advocate for my patients. When patients requested to use alternatives therapy, I must provide education materials based on evidence-based practice. With an interdisciplinary team, it is my responsibility to provide educations for alternative treatment regimens that a patient requested. After all, it is a patient's choice and I greatly respect his or her autonomy, I would communicate factual consequences of alternative therapy. Nurse Practice Act in California The purpose of the Nurse Practice Act in California is "the body of California law that mandates the Board to set out the scope of practice and responsibilities for RNs (California Board of Registered Nursing, 2020)." It is a set of laws and guidelines for the scope of practice and licensure process. There are thirteen articles under NPA which are administration, the scope of

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practice, nurse-midwives, disciplinary proceedings, intervention programs, nursing corporations, nursing schools, penal provision, revenue, public health nurse certification, nurse anesthetists, nurse practitioners, and clinical nurse specialists. Each article defines and gives detailed rules and guidelines to follow. According to NPA in California, the duties of nurses include direct and indirect patient care that ensures the safety, comfort, personal hygiene, and protection of patients, administration of medications and therapeutic agents, blood draws, immunization, assessments, standardized procedures, and following policies and protocols. Section 1250 of the Health and Safety Code prohibits delegation of performing registered nursing functions such as administration of medication, intravenous therapy, parenteral or tube feedings, invasive procedures, assessment, education, and moderate complexity laboratory tests. California Board of Registered Nursing, CBRN, states delegation must occur within the LVN scope of practice. RN must ensure that the delegatee has the appropriate ability, education, and knowledge to perform the task. RN should also ensure that there is evidence of competence before delegating tasks. Delegation of a task should use the "Five Rights of Delegation" which is the right task, right circumstances, right person, the right direction, and right supervision. RN should monitor performances and supervise delegatee.

Nursing Roles According to Western Governors University's Nursing Programs Conceptual Model, the roles of a professional nurse are to serve as a scientist, a detective, and a manager of the healing environment. The conceptual model suggests nurse as a scientist because nurses use scientific evidence-based practice to make healthcare decisions, critique, and influence practice. As a scientist, nurses should be stay educated with up-to-date knowledge of pathophysiology and

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treatment regimen to provide a factual explanation to patients. Another role that nurses serve is a detective. WGU's Conceptual Model states that "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 (Kthometz, 2020)." The detective role is also critical in nursing because not every disease is distinct or has a name tag. Through thorough and detailed assessment, nurses can provide adequate data for doctors and interdisciplinary team to diagnose the patient and provide accurate treatment. Not all symptoms are always displayed physically or can be felt by the patient. Therefore, like a detective, nurses carefully investigate and uses clinical imagination to detect unseen symptoms or patterns. Another role that nurses serve is as manager of the healing environment. The Conceptual Model defines a healing environment as "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 (Kthometz, 2020)." To fulfill the role of the manager of a healing environment, I communicate and utilize an interdisciplinary environment to provide high-quality care to patients. I also respect and integrate a patient's values and beliefs along with healthcare policy and regulations to provide a customized treatment regimen. ANA Code of Ethics Provisions Provision 1 of the Code of Ethics for Nurses states “the nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person (Steering Committee, 2001).” The third provision states, “the nurse promotes, advocates for, and protects the right, health, and safety of the patient (Steering Committee, 2001).” In my professional nursing practice, every provision in the code of ethics is important guidelines to follow all the

C304 TASK 1 PROFESSIONAL ACCOUNTABILITY time. Provision 1 influenced my profession to practice with compassion and respect patients and treat them as a human being at every moment. Sometimes, the relationship between nurses and patients can be vertical or hierarchy because nurses provide care and educate patients on what to do. However, Provision 1 guide me to always be respectful of each unique human being. Provision 1 protects patients’ dignity, worth, and attributes regardless of their health condition. Provision 3 also influenced and guided me to advocate for patients of their rights, health, and safety. Nurses provide care, administer medications, and integrate interdisciplinary care regimen; however, Provision 3 enforces us to protect and promote patient safety from questionable practice, a culture of safety, and privacy (Steering Committee, 2001). Provision 3 always reminds me to protect the rights of privacy and confidentiality, advocacy, and safety. Because of social media and advances in technology, it is extremely easy to compromise confidentiality and privacy. Provision 3 also protects patients' rights to privacy and confidentiality. The most common errors in nursing are perhaps errors with medication administration. Errors include administering to the wrong person, dosage, route, time, or drug. Because of safety mechanisms and electronic health systems, medication errors declined compared to the past. However, errors remain because nurses administer medications that should be on hold due to the change in patient condition or laboratory results. Another reason for medication error can be erroneous order by the physician. Fortunately, provision 3 can be applied to this error. Sometimes, nurses are scared to question the orders of doctors, or overly trust physicians. However, doctors are human just like anybody, and the possibility of errors or mistakes still exists. Provision 3 states nurses to protect patient health and safety by intervening in questionable practice. Provision one can also protect patients from medication errors by guide nurses to preserve dignity and respect the uniqueness of each patient. Following provision one

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allows nurses to carefully examine, spending adequate time, cultural consideration, and catching potential allergies. Also, provision one guides nurses to protect and respect the patient's right to self-determination, which protects patients from being administered with medication or have a treatment that is against their values or beliefs. Leadership Qualities or Traits Many qualities define excellent leadership. Of these qualities, I believe compassion, emotional intelligence, professionalism, and communication make exceptional leaders. These qualities make great leaders at bedsides and within interdisciplinary teams. Compassion is often illustrated through acts of kindness, empathy, and interconnectedness. Hospitalization brings frustration, despair, a feeling of losing dignity, and independence to patients. Showing compassion through act kindly, empathetically, and developing good rapports relieve some of the frustrations that patients experience and thus make patients' worst experience to something better. Nurses' compassion also inspires the interdisciplinary team through an illustration of respect and sincerity to patients, which makes a great leader in the interdisciplinary team too. In the hospital, both nurses and patients face extremely stressful situations often. There are so many things that can go wrong during hospitalization and struggle to stabilize the patients. Without emotional intelligence, patients feel more stressed and anxious by seeing nurses lose their emotional intelligence. At the bedside, nurses should reassure patients and support patients' physical and emotional needs. Therefore, emotional intelligence is one of the important factors required at the bedside. Nurses and the interdisciplinary team also face stressful and emotionally overwhelming situations as much as patients. During these times, true leaders should be able to balance and support peers and the team to develop emotional intelligence.

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Professionalism another trait of exceptional leaders in healthcare. Professionalism can mean many things such as competence, confidence, accountability, and representation. At the bedside, patients feel more secure with the professional representation of nurses. Professionalism at the bedside means higher quality care and competent care for patient safety. Professionalism also plays a critical role as a trait of leaders in an interdisciplinary team. It integrates values to a team such as a positive attitude, patient interaction, responsibilities, teamwork, and integrity. Professionalism strengthens leadership by emulating the higher qualities and behaviors of nurses. Communication occupies a huge leadership role. After all, a major part of nursing includes communications such as how to talk to patients, family, interdisciplinary teams, doctors, social workers, and more. Excellent communication with a patient at the bedside greatly reduces patient's questions and frustrations. Dissatisfaction about the care provided at the hospital usually comes from a lack of communication or misunderstanding. Good communication skills play a critical role in developing positive rapport, patient educations, discharge educations, and much more. Communication also plays an exceptional role in the interdisciplinary team. Nursing is about constantly communicating patients’ status and advocate for the patient among the healthcare team. Excellent communication means less misunderstanding thus direct interdisciplinary team smoothly. I am currently working as a Definitive Observation Unit Nurse in California. My work environment is very positive for nursing leadership. The hospital reminds and ...