Running head: SELF ASSESSMENT

American Nurses Association Standards and Ethics: Self-Assessment Erin White Ferris State University

SELF ASSESSMENT Abstract

The American Nurses Association scope and standards of practice (2010) and the Code of Ethics (2001) provide a guide to treat patients with dignity. The standards and ethics guide the nurses in a professional manner throughout their career. Throughout this paper it will discuss the sixteen standards of practice and nine codes of ethics from the American Nurses Association (ANA).

SELF ASSESSMENT American Nurses Association Standards and Ethics

The American Nurses Association (ANA) developed the scope and standards that apply to the practice of all professional nurses and serve as a template for nursing specialty practice (American Nurses Association, 2010, p. 1). In the Scope and Standards of Practice (ANA, 2010) the first six standards describe the nursing process while the last nine standards focus on the quality of care provided to the patients. The codes of ethics from the ANA discuss the ethical obligations nurses have to treat their patients. This paper will demonstrate how I have met many of the standards of practice and code of ethics through learning in the classroom and incorporating into the clinical setting. Nurses Standards of Practice Assessment The first standard of practice according to the American Nurses Association is the registered nurse collects comprehensive data pertinent to the healthcare consumers health and/or the situation (ANA, 2010, p. 32). The nurse collects data on each individual patient at the time of admission and during frequent nursing assessment required by the facilities policy. The admission assessment starts with a physical and cognitive assessment of the patient. The nurse is required to ask numerous admission questions which will cover the patients health history, medication, financial concerns, emotional concerns and spiritual beliefs. At the beginning of the nurses shift they receive a report on the patient and start the shift by completing a physical assessment. The data collected must be easily accessed by other healthcare providers, while providing the patient with proper legal, ethical and maintain privacy to the patients information (ANA, 2010).

SELF ASSESSMENT I have met this standard when assessing patients during their admission or completing their physical assessment during my clinical shifts. Having access to power chart during my shift at the hospital allows me to look at the patients chart I am assigned to gather pertinent information. For example, at the beginning of the shift after I receive report from the previous nurse I will look at the patients chart to check lab values, vital signs and orders from the physician. I have completed numerous admissions and physical assessments during this program. Any time I am discussing the patients progress, completing the assessment or going through the admission questions; I ensure the door is closed and if visitors are present ask the patient if they would like them to leave the room. In having access to power chart with the patients medical information available, I make sure I do not leave information with patient information out in the open and log off the computer every time I access power chart. Diagnosis According to the ANA (2010) this standard is when the registered nurse analyzes the

assessment data to determine the diagnoses or the issues (p. 34). This standard allows the nurse to validate the medical diagnosis or address issues found during the assessment. The nurse will document the diagnosis or issues to assist towards the expected goals and interventions to the patient as an individual (ANA, 2010). Through proper communication between the interdisciplinary team, fellow nurses, patients and their family members an effective nursing diagnosis is developed to assist the patient in achieving set outcomes. I have met this standard by applying the knowledge I have gained in my nursing theory course in developing nursing diagnoses and care plans to my experience in the clinical field. During clinical I have developed nursing diagnoses, interventions I plan to implement during my shift and expected outcomes. As a student nurse I share my care plan with my assigned nurse for

SELF ASSESSMENT the day. I work on the interventions throughout the shift with my assigned patients to work towards expected outcomes. Outcomes Identification In this standard the registered nurse identifies expected outcomes for a plan individualized to the healthcare consumer or the situation (ANA, 2010, p. 35). The nurse collaborates with the patient, family members and interdisciplinary teams to formulate expected outcomes to correlate with the nursing diagnosis (p. 35). The outcomes are individualized to benefit each patient and developed through the interventions. The outcomes will have a time frame to assist the patient in achieving measurable goals. I have not met this standard of practice due to the limited time I have had in the clinical

setting as a student nurse. I have followed the expected outcomes individualized for each patient according to the nursing diagnosis. For example I had a patient who was admitted to the unit I was assigned for a post-surgical observation after laparoscopic surgery. One of the outcomes I developed was the patient to independently complete breathing exercises, including the incentive spirometer, coughing and deep breathing exercises using a pillow to splint the incision. I plan on making one to two realistic outcomes as a student nurse I can assist my patient in achieving during my twelve hour clinical shift. In setting realistic outcomes I will gain confidence in writing efficient care plans and increase my awareness on achievable outcomes for specific time frames. I plan to make more of an initiative to collaborate with the interdisciplinary team to provide holistic care to my patients. I plan on meeting this goal by the time of graduation on May 9th, 2014. Planning

SELF ASSESSMENT According to the ANA (2010) in standard four of practice the registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes (p. 36). Each patient is designed a nursing diagnosis, along with developing a diagnosis the care plan is individualized with consideration of the patients characteristics or situations (p. 36). The care plan is designed to promote health, a preventative measure, to alleviate suffering and a

supportive care for the patients who are dying (p. 36). The nurse will individualize the expected outcomes and implement a time frame for the patient to reach the measurable goals. I have met this goal by creating individualized care plans for each patient I was assigned. I was assigned a patient who was on comfort care with family by bedside. At the beginning of the shift I created a nursing diagnosis suitable to the patients condition. In my care plan I included the patients spiritual practice and after talking to the patients family members I designed an outcome for the hospital chaplain to meet in the patients room while family was at bedside. I chose to put this in my care plan to assist the family with coping measures. Implementation In this standard the registered nurse implements the identified plan (ANA, 2010, p. 38). The registered nurse in this standard of practice uses the latest evidence-based practice (EBP) research for interventions and expected outcomes specifically for the nursing diagnosis created for the patient. The nurse accommodates the patient and family to ensure communication is effective while focusing on implementing the plan in a safe, realistic and timely manner (p. 38). I have met this standard of practice while participating in my home health rotation in Newaygo County. I was assigned a patient who recently had a permanent colostomy bag in place. The nurse I was assigned to work alongside with for the day had me change the bag while providing education on proper technique to prevent infections during changing the bag. The

SELF ASSESSMENT patient was receptive throughout the education and before we left the patients home, she demonstrated proper technique. In the care plan for this specific patient included patient to demonstrate independence caring for her colostomy. Evaluation

According to the ANA (2010) the registered nurse evaluates progress toward attainment of outcomes (ANA, 2010, p. 45). The registered nurse is continuously evaluating progress towards the expected outcomes, while considering the time frame to complete the outcomes. The nurse will collaborate with the patient, family and other healthcare employees to evaluate the progress the patient toward the outcomes listed in the care plan. The nurse will document the patients progress throughout continuous assessments. I have not fully met this standard of practice due to limited opportunities to work with the same patient for more than one shift. Halfway through this program our clinical schedule was changed to back to back shifts. This experience has allowed me to care for the same patient the next day to continue to evaluate the progress of the expected outcomes I set the day before for the patient. I feel since the time I am at clinical is limited I have not met this goal to collaborate with other healthcare professionals to evaluate the patients progress in a holistic approach. I plan on meeting this standard by evaluating each patient I have in clinical as though I have been working with them for a few days. Obtaining progress throughout the shift and encouraging the patient to meet a specific goal by the end of my clinical shift. I plan on accomplishing this goal by graduation May 9th, 2014. Ethics In this standard of practice the registered nurse practices ethically (ANA, 2010, p. 47). The nurse is an advocate for the patients health and speaks up when necessary for the safety and

SELF ASSESSMENT quality improvement of the care being received (p. 47). The nurse delivers a care to promote

autonomy and encourage the patients participation in self-determination and decision making (p. 47). I have met this standard of practice by advocating for my patients health in the clinical setting. I was assigned a patient who was curious on the status of her lab values and course of action the healthcare provider wanted to take. I mentioned to my assigned nurse the patient was anxious and felt as though no one was updating her on her medical status. The assigned nurse mentioned this patient was an anxious patient and she did not have time to discuss the patients update. I mentioned to the nurse if I was the patient I would want an update and it would ease my anxiety. The nurse went into the patients room and took ten minutes to discuss the lab values. The patient was informed the doctor would make his round and talk about the course of action to her medical progress. As a student nurse I advocated for my patient to be updated on her health and progress during her hospital stay. Education According to the ANA (2010) the registered nurse attains knowledge and competence that reflects current nursing practice (ANA, 2010, p. 49). The nurse demonstrates a commitment to lifelong learning and participates in ongoing educational opportunities to advance their knowledge (p. 49). The nurse will maintain a record of the continuing education throughout their career as a nurse. I have met this standard of practice. I feel as though I am applying the knowledge I am learning in the classroom into the clinical setting. For example, each day I am at clinical I am applying evidence-based practice from the knowledge in the classroom I have gained. I had a patient who had an order from the physician to use the incentive spirometer to improve lung

SELF ASSESSMENT function. I educated my patient on the importance of using the incentive spirometer and the benefits of the instrument through evidence-based practice. However I feel when I am a registered nurse I will be able to continue my education in the specialty I chose. I have not

demonstrated researching educational opportunities to advance my knowledge, because I am still in school. I feel when I am a registered nurse after graduation, I will hold myself accountable to continue education and find the latest evidence-based research. I am planning on a specialty in the nursing field, so I will gauge my continuation of education to enhancing my knowledge in that specific field. Evidence-Based Practice and Research In this standard of practice the registered nurse integrates evidence and research findings into practice (ANA, 2010, p. 51). Through current evidence-based nursing knowledge the registered nurse utilizes the latest research in their clinical practice (p. 51). The nurse will research evidence-based skills and knowledge to share with colleagues to ensure the best quality of care is given to the patients. I have met this standard of practice, however I feel as though I will continue to improve utilizing evidence-based research in practice to give my patients the best quality of care. In the clinical setting my patient had gastroenteritis and was extremely ill. My patient was dehydrated and felt dizzy whenever she stood up. I mentioned to my patient the evidence shows hydration during the flu is the key for feeling better. I let my patient know through hydration she will start to feel better and will decrease her dizzy spells upon standing. I also mentioned to my patient through evidence-based research hand hygiene is imperative in prevention and reducing gastroenteritis. I feel as though this standard of practice will be an ongoing journey for me throughout my career as a registered nurse.

SELF ASSESSMENT Quality of Practice According to the ANA (2010) the registered nurse contributes to quality nursing

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practice (ANA, 2010, p. 52). Throughout the nurses shift the quality of care is documented in a responsible, accountable and ethical manner (p. 52). The nurse will document the patients progress to include the nurses findings through assessments, the patients safety throughout the shift and the effectiveness of the nursing process. I have met this standard by improving my documentation skills throughout this year. I have focused on ensuring my documentation is correct in the general assessment part as well as documenting hourly rounding on my patients to ensure safety and comfort. I have continued to improve my plan of care at the end of my shift to ensure the next nurse and interdisciplinary team members are aware of the patients progress towards the expected outcomes during my shift. Communication In this standard of practice, according to the ANA the registered nurse communicates effectively in a variety of formats in all areas of practice (ANA, 2010, p. 54). The registered nurse is continually assessing their communication skills with patients, family members and colleagues (p. 54). The registered nurse ensures the patient and family understands the care plan from the interdisciplinary team members. I have met this standard of practice throughout my clinical practice. I have completed numerous education tasks with patient and their families to facilitate their improvement. For example a patient I was assigned to have an order for use of the incentive spirometer (IS) postsurgery. I started my assessment and noticed the patient did not have an incentive spirometer at bedside. I went to get one out of the clean utility room and when I came back to my patients

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room he mentioned no one has mentioned the incentive spirometer. I educated my patient on the benefits post-surgery in using the IS. I went through proper technique of the IS with my patient and ensured to put a focus note in power chart for nurses and patient care assistants to encourage using the IS throughout their shift. Leadership According to the ANA (2010) in this standard of practice the registered nurse demonstrates leadership in the professional practice setting and the profession (ANA, 2010, p. 55). The nurse is constantly overseeing the care the patient is receiving by others and being held accountable for the quality of care given throughout their shift (p. 55). The registered nurse is responsible to treats colleagues with respect, trust and dignity (ANA, 2010, p. 55). Throughout the nurses shift they are constantly communicating with the patient, family and interdisciplinary team to ensure the treatment is the highest quality. I have met this standard of practice in leadership overseeing the quality of care my patients are receiving during my clinical shifts. I ensure my patients are receiving offers of daily showers and having their requests met. I complete this by communication with the patient care assistants to ensure they have time or if they are feeling overwhelmed; I complete the task. I treat my fellow colleagues with respect and dignity throughout my shift. I feel as though my leadership will continue to improve when I start my career as a registered nurse. Throughout my career I will continue to build leadership skills and participate in the professional organization I employed through. Collaboration In this standard of practice the registered nurse collaborates with the healthcare consumer, family, and others in the conduct of nursing practice (ANA, 2010, p. 57). The nurse

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collaborates with the interdisciplinary team members benefit the patient with positive outcomes. Through engaging in teamwork and team building processes the registered nurse ensures all team members are on the same page regarding the patients care. I have met this standard as a student nurse. Every shift I complete at Mercy Cadillac Hospital I collaborate with the patient care assistants to promote positive outcomes for my patient. However, I am not at employed full time at the hospital and to collaborate with the physicians is extremely difficult due to they have no clue who I am. I have attempted to update the physician on my patients progress when they ask my nurse for an update. My plan to continue to focus on collaborate the progress of my patients with my colleagues to promote quality of care. Professional Practice Evaluation According to the ANA (2010) 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). The nurse continually engages in self-evaluation of practice from patients, family members of the patient and healthcare professionals. In caring for a diverse population the nurse provides a culturally sensitive support. The nurse participates in peer reviews and appropriately reflects to take action to improve their care to the patients. I have not met this standard on a professional level as a nurse. As a student nurse I feel as though I have met this standard of practice. I participate in self-evaluations of the clinical week that I turn into my clinical instructor, evaluating my ethical and professional performance. I constantly self-evaluate after clinical to improve the quality of care given to my patients and future patients. Before I leave clinical I ask my assigned nurse to give constructed feedback on how to improve my patient care, time management, and communication skills.

SELF ASSESSMENT Resource Utilization In this standard of practice the ANA (2010) states the registered nurse utilizes

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appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible (ANA, 2010, p. 60). Through the nursing assessments provided throughout the shift the nurse is constantly assessing the patients care needs and available resources to make progress towards the patients expected outcomes. The nurse will advocate for resources to be available on the unit to enhance the nursing practice and patient care (p. 60). This standard of practice I have met by utilizing the resources available during clinical. I have used the technology the hospital has established to inquire on new medications, used medication books to determine the intravenous push rate and utilized the healthcare interdisciplinary team. For example, I had a patient who wanted to be discharged home; however her home was not a suitable living situation. She would not be able to drive to fill prescriptions and follow up with appointments. I called the social worker who worked with the client to ensure a positive outcome in the patients home setting. Environmental Health According to the ANA (2010) the registered nurse practices in an environmentally safe and healthy manner (ANA, 2010, p. 61). The nurse promotes an environment to reduce health risks for patients, family members and healthcare workers (p. 61). Ensuring a safe environment for the patient during their stay at the hospital is pertinent to quality of care the patient is receiving. The nurse communications environmental risks to the healthcare consumer and colleagues to promote a safe atmosphere. I have met this standard of practice by promoting hand washing to my patients and holding myself accountable washing my hands in and out of every patients room. I have

SELF ASSESSMENT communicated the importance of hand hygiene to my patients and their family members. For example, I had a patient who had a positive sputum culture for Methicillin resistant Staphylococcus aureus (MRSA). The patients family members came to visit and I instructed them on the importance of hand hygiene upon entering and leaving the room. I also educated the family on wearing the protective personal equipment, including gowns, mask and gloves. Code of Ethics Ethics Provision One This standard of practice requires the nurse to practice with compassion and respect, regardless of the patients socioeconomic status, age, ethnic and cultural background (ANA, 2001, p. 3). The ANA also states nurse provides the patients healthcare needs and values without biases (ANA, 2011, p. 3).

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I believe I have met this code of ethic by providing non-judgmental care to my patients and continue to self-evaluate my practice as a nurse. I treat all of my patients and the patients on the unit with respect and dignity. This standard of practice will be ongoing throughout my nursing career and I will continue to self-evaluate during my career. Ethics Provision Two According to the ANA (2001) the nurses primary commitment is to the patient, whether an individual, family, group, or community (ANA, 2001, p. 5). A nurse creates a care plan which is individualized to each patient. In the care plan the nurse collaborates with the interdisciplinary team to ensure a holistic approach is directed towards the patient. I have met this standard by creating an individualize care plan for my patients to ensure a holistic approach is met by all interdisciplinary staff members. The patient I was assigned to

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was not allowed to have caffeinated coffee due to the heart monitor. The patient was stating they were having headaches because they were used to having caffeine on a daily basis. I spoke with the nurse and physician and they decided a splash of caffeinated coffee with the decaffeinated would not be harm to that patient. I educated the patient on the effects of caffeine and the heart; the patient was receptive and appreciated our collaborated thinking. The patient did well on a splash of caffeinated coffee, eventually towards looking at discharge the physician mentioned she could have half caffeinated and half decaffeinated coffee. Ethics Provision Three As stated in the ANA (2001) the nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient (ANA, 2001, p. 6). The nurse is responsible for maintaining the patients information private and remaining confidential regarding the patients diagnosis, progress and expected outcomes. I believe I have met this standard by constantly making sure I have closed my power chart where I access the patients information. I follow the privacy code at the hospital and allow the patient to determine who has access to their progress. At clinical I make sure the door is closed and if visitors are present when I enter the patients room, I ask the patient if they would like them to wait in the hallway. I have followed this procedure which promotes the rights of the patient in the clinical setting. Ethics Provision Four According to the ANA (2001) the nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurses obligation to provide optimum patient care (ANA, 2001, p. 8). The registered nurse acts upon the code of ethical conduct to promote dignity, worth and self-determination of patients (p.8).

SELF ASSESSMENT During clinical I have met this standard of practice by promoting excellent care of my

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patients and providing appropriate delegation to provide great care to my patients. At clinical I make sure my patients are offered daily showers and ambulation in their room or hallway by requesting the patient care assistants (PCA) to ensure the tasks are complete. If the PCAs are shorthanded or running behind I will complete the task or take a different task such as blood sugar checks off their plate, so they are able to complete the patients activity of daily living tasks. Ethics Provision Five In this standard of practice the nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth (ANA, 2001, p. 9). I have met this standard and will continue to make progress on this code of ethic throughout my nursing career. I provide a safe and dignified environment for the patients I am in contact with throughout my clinical shift. I will continue to gain competency and the skills need for improving patient care in my career. I have learned the importance of education and continuing education in nursing school; however I feel I need to continue to develop the whole character of myself personally and professionally. Ethics Provision Six In the code of ethics provision six, it states 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).

SELF ASSESSMENT I have met this code of ethic throughout my clinical experience. Whenever I start my shift at the hospital I ensure the patients room is free from hazards, such as cords, wet floor,

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debris on the floor and the patient is aware of using the call light for assistance. I have had some nurses who do not care for having students and I just try to learn as much as I can from them without annoying the nurse. From some of my bad experience I have realized when I am practicing in the field to be patient and help educate new nurses coming into this career. Ethics Provision Seven In the code of ethics, provision seven states, the nurse participates in the advancement of the profession through contributions to practice, education administration, and knowledge development (ANA, 2001, p. 12). I have met this code of ethic and will continue to strive to meet this code of ethic during my career as a nurse. I was recently at clinical and I was working alongside the dietician at Mercy Cadillac Hospital. The dietician was trying to come up with a solution for the patient who did not like nectar thick liquids and was not drinking anything for a few days. I mentioned the ensure shakes are nectar consistency, since I knew this from my previous profession and I know as a nurse this will come in hand. The dietician was amazed when she looked up the consistency and it was nectar thick. The patient was given a milkshake with ensure as the base. The dietician then taught me about total parental nutrition (TPN), so it was a learning experience from a different perspective of a health care team. Ethics Provision Eight In this code of ethics from the ANA provision eight is the nurse must collaborate with the other healthcare providers to promote community efforts to meet health needs (ANA, 2001).

SELF ASSESSMENT This ethic is regarding the nurse committed to promoting healthier lifestyles to the community and patients.

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I have met this standard by participating in a group activity involving decreasing the rate of women who smoke while pregnant in Mecosta County. Our group planned on providing the community with smoking cessation programs and counseling to assist in quitting smoking while pregnant to decrease infant mortality rates. Ethics Provision Nine According to the ANA (2001), this ethic of provision states, the profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy (ANA, 2001, p. 13). I have not met this standard because I have not joined a professional organization yet. I plan on joining when I pass my state board exams and enter the professional work field. I will continue to focus on maintaining the integrity for this profession and educating myself as a nurse. Professional Development Plan The first part of my plan is to perform self-evaluation periodically on myself to ensure I am continuing to meet the American Nurses Association standards of practice and code of ethics as a nurse. The ANA (2010) handbook will be essential to remain familiar with as a nurse to continue to provide care within our scope of practice and care that is ethically appropriate. Areas for Improvement I need to continue to improve my standards of outcome as a nurse. I believe with increased time in the clinical setting I will improve identifying and assisting the patient with their

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outcomes according to their nursing diagnosis. It will be easier for me to meet this standard once I am employed and working full time. I will have more chances of seeing the same patient if I work two days in a row and further assessing their outcomes. Throughout my career my evaluation of the patients progress will continue to improve. I plan on continuing to improve my evaluating by improving my nursing diagnosis and interventions. I feel as I become more confident in myself as a nurse my evaluation process will continue to improve. I plan to continue to improve utilizing evidence-based research into my career as a nurse. I have met this standard however I feel there is room for improvement in applying this to the care I am providing to my patient. I plan on participating in programs on the unit I am employed to keep up on my evidence-based practice and utilizing the research into my career. I met the standard of professional practice evaluation in the clinical setting with my clinical instructor constantly rating my performance as a student nurse. However, I feel as though when I start my career as a nurse I will participate in self-evaluation as a nurse, peer evaluation and my manger will evaluate my performance. These evaluations will be crucial to continue to improve the care I am providing as a nurse. Conclusion Nursing is a profession that requires continuous improvement and education to provide effective care being provided to our patients. As a nurse it is important for constant evaluation to improve therapeutic communication and a safe environment for the patients. The ANA handbook of the scopes of practice and code of ethics will continue to assist nurses in providing effective and safe care to patients.

SELF ASSESSMENT References American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/ CodeofEthicsforNurses/Code-of-Ethics.aspx American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Nursingbooks.org.

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