C304 Task 1
When I think of nursing theory the first person that comes to mind is Florence Nightingale. She is well known for her environmental adaptation theory. In her theory she discusses ventilation and warming, noise, variety, diet, light, cleanliness, and chattering hopes and advices. I feel that her theory influences my values and goals. Her theory is also used every day in the hospital facility I work in (Cherry and Jacob, 2017).
Nightingales theory has influenced my nursing values by ensuring that I provide a safe environment for my patients. Patient rooms should be clean, well lit, and free of clutter to implement non-maleficence. Her theory has influenced my values such as altruism and dignity. I provide individualized care to my patients while respecting their morals. Every person is different and their care needs to be catered to their needs. As a nurse I am always concerned with the patient’s altruism. Safety is key and the driver in everything I do as a nurse. If safety is not up held then everything else fails.
Nurses apply Florence Nightingales theories in their practice to promote excellent nursing practices in many ways. There are restricted visitor’s hours to promote rest and reduce noise. Patients are put on specific diets depending on their health history to promote healing and further harm. For example, Nurses monitor the amount of fluids that patients take in that are admitted for Congestive Heart Failure to ensure they do not further complicate their disease process. In the morning nurses raise the blinds to let in the natural light so patients are aware that is a day time and time to be up and not sleeping. This helps to combat delirium in patients and helps them get the proper rest. Nurses also ensure the rooms are clean, linens are changed daily, patients are bathed daily and as needed, and housekeeping tends to the patient rooms every day. Not only does cleanliness apply to the patients but it also applies to the nurses. In current practice nurses must wash their hands with antimicrobial soap before entering and after leaving a room. To combat boredom of patients and have a variety of activities nurses can offer art therapy, music therapy, or pet therapy. There are many other things that nurses can do for patients in their nursing practice that are influenced by Florence Nightingales nursing theory.
Currently in my professional practice I also do many of the mentioned things above that align with Florence Nightingales nursing theory. When I bathe my patients I implement the use of CHG wipes that not only clean the patient but also provide cleanliness to help prevent infections. I also wash my hands prior to entering a room, assessing a patient, and upon exiting a room. While in a patient room I try to limit noise and distractions to help promote rest and healing. At the facility I work at we do not have strict visiting hours but we do have quiet time where we dim the lights and try to limit visitors to advocate rest. I am upfront with my patients about their care but at the same time am respectful of their feelings. I do not fill them with false hopes or tell them things that are untrue about their care or diagnosis. Everything that I do in my practice relates to Florence Nightingales nursing theory in some sort of way.
There were many influential nurses in the nineteenth and twentieth century. The two that I would like to discuss are Linda Richards and Lillian Wald. Linda Richards was born in 1841. Richards was America’s first trained nurse in 1900. She is known for creating the first system of keeping written medical records. Prior to her creating individualized written records nurses were expected to report important facts orally from memory. Richards contribution helped to change the process of giving report and keeping medical records. By keeping written records nurses are now able to keep an accurate history on the patient. When information is given by mouth facts can be misconstrued or completely left out. Richards contributions differ from Wald’s because Richards changed the process of nursing. Wald’s contribution recognized the need to expand nursing to a more in need population. Both women made drastic changes for the nursing community (Campbell, n.d.).
Lillian Wald was born in 1867. Wald is considered to be the founder of public health nursing. Wald recognized that poverties areas needed access to affordable healthcare. Patients were charged based on a fee sliding scale. She also started the first American public school of nursing in New York City and founded the Henry Street Settlement. The Henry Street Settlement was known for its large playground in the lower east side. The Settlement opened more branches in New York to provide services such as health care, community programs, and employment to everyone. She was recognized in the New York Times as “one of the 12 greatest living American women” and received the Lincoln Medallion for being an “Outstanding Citizen of New York” (Hansan, 2018)
The works of these two ladies influence my professional nursing practice in many ways. Richards introduction of charting patient information helps with effective communication skills. With the help of my charting I am able to effectively communicate the patients care to the oncoming nurse and members of the healthcare team accurate information. By charting the information items are not as easily missed and I am able to look back throughout my shift to ensure I didn’t miss anything. Charting is used in the court of law as proof to what did and did not happen. The rule of thumb in nursing is “if it wasn’t charted, it didn’t happen”. Having the ability to chart patient information also allows for implementation, interventions, and evaluations. I am able to see what the Doctors chart and view their orders which allows me to implement their plan of care and provide interventions that align with the plan of care. I am also able to evaluate things that have happened on different shifts like when wound care was last done and when it needs to be redone.
Wald’s recognition of the need for public health nursing and providing care to everyone in a community has changed nursing in a drastic way. By providing extended care to everyone in my practice I am able to provide nursing care to everyone in my community. Due to the diversity of my community I am able to care for people from all different walks of life and see a variety of different disease processes. I am also able to provide care to people who may not have received care before if it wasn’t for Wald. As a nurse I also volunteer in my community for a variety of things that offer public health nursing to members of my community. By doing this I am able to implement education to these individuals that they may not have ordinarily received (Hansan, 2018).
The State Board of Nursing and the American Nurses Association (ANA) differ in various ways. The State Board of Nursing is state specific. It is a regulatory body that sets the standards for safe nursing care, decides the scope of practice for nurses in its jurisdiction, and issues licenses to qualified candidates. The State Board of Nursing covers issues such as public health, safety and welfare, and help to develop nursing licensure exams (“What is a State Board of Nursing?”, 2018). While the ANA is a professional organization that represents the entire RN population. The ANA requires RN to pay a fee to become a member. The ANA helps to advance nursing and be the “voice” of its members. Once a member of the ANA you are given resources to further your career, access to journals, discounts on certification exams, discounts on personal benefits, ANA meetings and conferences, live webinars, and many other benefits. The ANA is a nationwide organization (“About ANA”, n.d.).
The State Board of Nursing is in every state and each state has its own individual set of rules. These rules are established by the Nursing Practice Acts (NPAs). The NPA set rules and regulations into place that establish the qualifications for state licensure. The State Board of Nursing is responsible for issuing and renewing nursing licenses, reviewing applications for nurse applicants, and enforcing disciplinary action (“What is State Board of Nursing?”, 2018).
The ANA is a membership only professional organization. It prides itself in improving the quality of healthcare for all. It currently has members in all 50 states and U.S. territories. The ANA has two types of membership. The lowest type of membership has limited access. The ANA collaborates with other nursing organizations to address and solve issues that affect the nursing profession. The ANA recognizes problems within the nursing profession and finds solutions to improve the practice. They also offer many benefits to their members (“The History of the American Nurses Association”, n.d.).
Both of these organizations influence my nursing practice. The ANA helps to make changes to better nursing. The changes that they make allow me to practice safely and have adequate resources in my nursing practice. I am actually a member of the ANA. By being an ANA member I received a discount on the CMSRN exam. I am now a CMSRN. I frequently receive education opportunities from the ANA which allow me to have advanced knowledge in specific areas. They also send me CEU opportunities at a discounted rate which I need to maintain my RN license. The State Board of Nursing (BON) helps my nursing practice by requiring education to maintain my license. This education helps to ensure I am up to date with the frequent changes in healthcare. BON is also responsible for allowing me to renew my license which I need in order to practice as an RN.
I live in the state of Virginia. In the state of Virginia you are required to have continued competency hours which must include 15 contact hours and 640 practice hours or 30 contact hours. Licensure is required to be renewed every 2 years. In order to renew a fee is applied. If license requirements are not maintained then disciplinary action such as probation or loss of license can occur (Kluwer, 2018).
In the United States there are compact and non-compact states. Compact states allow you to practice in other compact states without having to obtain an additional license, but your original residence needs to be located in a compact state (Douglas, n.d.). If you reside in a non-compact state, then you are not able to practice in any other state. In order to practice in other states then you have to obtain a separate license for that state. You are allowed to obtain as many single state licensures as you want. You are required to adhere to the rules and regulations in the state that you are working (Papandrea, 2016).
The Food and Drug Administration (FDA) and the Center for Medicare and Medicaid Services (CMS) both play vital roles in the healthcare system, but they do differ. The FDA is responsible for making sure that drugs and devices are safe and effective. The FDA monitors things such as medications, vaccines, medical devise, and blood products. CMS is responsible for deciding if the product is needed for the condition of the patient or can improve function to the patient. CMS is also responsible for determining the amount that healthcare providers get reimbursed (Richardson, 2015).
The FDA influences my clinical practice by the types of medications I administer to patients. The medications I administer have to be approved by the FDA. They also decide what medical devices are safe and effective for patients. Their determinations play a factor in what I have available to adequately care for my patients. If a patient is on a medication that has been taken off of the market by the FDA it is my responsibility to inform the doctors that the patient is taking this medication. Which means that is up to me to be aware of medications that I administer.
The CMS is the main decider in determining if patients qualify for certain medications and equipment. This plays a role in my clinical practice when it comes to safely discharging a patient. There are times when a patient needs certain medications or equipment in order to be discharged but CMS doesn’t feel it is necessary, so the patient gets denied. This then can possibly make the discharge unsafe. It is then up to me to work with the medical team and social worker to troubleshoot how we can get the patient the things that they need in order to be discharged safely. This also comes in to play when a patient needs physical therapy services at discharge, but CMS doesn’t approve them because they are out if rehab days or don’t feel it is necessary. It again is up to the whole medical team including myself to figure out how we can get the patient what they need to have a safe discharge. This plays a large part in my advocacy for my patients.
As an RN one of my major roles is being a patient advocate as well as promoting patient safety. When a patient request to use alternative therapy I have to use my clinical judgement to determine if this option is safe. There are times when a patient requests alternative therapy that will not jeopardize the care or safety and are beneficial to the patient. I have to advocate for my patient to the medical team that the patients request is feasible and would benefit the patient. However on the other hand if a patient request alternative therapy that I feel is not safe then it is up to me to educate the patient on their decision and possible consequences.
The Nurse Practice Act in the state of Virginia is to ensure that there are criteria that is met in regard to healthcare professionals. The Nurse Practice Act covers things such as licensure requirements, responsibilities of healthcare professionals, Board of Nursing member requirements, legal matters concerning nurses, requirements for schools that would like to open a nursing school, etc. The Nurse Practice Act plays a role in my professional practice by setting rules that I must abide by as an RN. In my practice if I break rules outlined in the Nurse Practice Act there can be consequences such as suspension or permanent loss of my RN license. Also the Nurse Practice Act states what my scope of practice is as an RN. This guides me in my practice to make sure that I am not practicing outside of my scope. It also states the amount of continuing education I am required to maintain in order to maintain my license. In my practice I make sure that I accrue the proper amount of continuing education to maintain my license. The Nurse Practice Act of Virginia outlines the scope of practice of an RN. As an RN in the state of Virginia RNs are responsible for administering medications and treatments as long as it has been prescribed by an authorized person, delegate tasks to unlicensed persons that is defined by the board, to receive compensation for services while caring for people with illnesses, those who are injured or those who require health maintenance, and also responsible for teaching and educating those who will be providing nursing care. In the state of Virginia RNs are allowed to delegate tasks to unlicensed persons that are defined by the board. Even if the task is delegated it is still the responsibility of the RN to ensure that the task gets completed (Douglas and Hershkowitz, 2018).
As an RN I play many roles and wear many hats. One of those roles is a scientist in my professional practice. As a scientist I am always investigating different outcomes and treatments. I am always asking the team about the disease process and how different interventions work in different ways. When I come across things that are unfamiliar to me or rare I frequently research to find out more about the symptoms or disease process. I also use scientific based evidence when providing care to my patients.
As an RN I also play the role of detective in my professional practice. I frequently am asking a lot of questions like a detective does. I am investigating my patient and their disease process. Certain answers I get can help to answer things that we may not have known before or to help the patients healing process or decrease their length of stay. I also pay a lot of attention to detail when I care for my patients. Any slight change in a patient could be an indicator of an underlying cause such as a urinary tract infection that causes an elderly patient to suddenly become confused. In my professional practice I also document everything like a detective. In the nursing world if it wasn’t documented then it didn’t happen.
Lastly as an RN in my professional practice I am also a manager in the healing environment. In my professional practice I am responsible for providing a healing environment. I try to ensure that my patients get adequate rest by clustering my care. I try to minimize noise when coming in and out of the patient’s room and limit interruptions. I administer medications in a timely manner to ensure that things like antibiotics aren’t missed. If an antibiotic is consistently late then over time that causes a patient to miss a dose. Before leaving a room I always make sure to check that my patient is comfortable since this promotes rest which promotes healing.
The ANA Code of Ethics has nine provisions. Two provisions that I am going to discuss are Provisions two and three. Provisions two states that “The Nurse's Primary Commitment Is to the Patient, Whether an Individual, Family, Group, Community, or Population”. The third provision states “The Nurse Promotes, advocates for, and Protects the Rights, Health, and Safety of the Patient” (Hegge, 2015).
Provision two plays a role in my professional practice by not only caring for the patient but also caring for the family involved. While caring for my patient I also care for the family member if they are present. I check in on the family member just as I check in on the patient. I make sure that they are comfortable, don’t need anything to drink or eat, and provide them essentials if they do not have their own. It is important to not only help the patient but also the family member at this critical time in their lives.
Provisions three speaks to my everyday practice. Everything I do as a nurse follows provisions three. As a nurse it is my responsibility to keep my patients free from harm, protect their rights, and advocate for them. When speaking with a patient I ensure to keep their information confident. Where I work the rooms are semi-private, so it is very important to ensure patient privacy. When administering medications I ensure that the patient doesn’t have any allergies listed to the medications that I am giving. When patients have been NPO for an extended amount of time I always ensure that they are placed on fluids for proper hydration and talk with the team to advocate when we can get them off NPO status.
In clinical practice medications errors can happen. Sometimes a patient can be given a wrong dose of medication or a completely wrong type of medication. In this type of error, provisions two can be applied since it states that the nurses primary concern is the patient. In this scenario the nurses primary concern would be the patient. As the nurse you would want to monitor the patient for any adverse reactions to the medication error. If family was present, you would notify the family of the error as well as the patient since you are caring for them as a whole like provision two states. The nurse would be responsible for notifying the team of the error and informing the patient of the error. Making sure that the patient is safe and that the patient has medications available in case an adverse reaction occurred would tie into provisions three. Advocating to the team the error and the need for any additional monitoring from the nurse would have the patient’s safety at the forefront.
Four leadership qualities that I think represent excellence in nursing are respect, trustworthiness, critical thinking, and a team player. As a leader at the bedside your teammates and your patient should be able to respect you. If you are not respected as a leader then people will not value your opinions, follow your lead, or ask you for help. If patients do not respect you then they will not be compliant with your care. Respect should be given all around and in order to be an effective leader you need to be respected. As a leader at the bedside you should be trustworthy. In order to work effectively as a team you need to be trustworthy. If your teammates cannot trust you then the team will fall apart. You should be able to talk to leader and know that what is discussed will be confidential and kept between the two of you. If a patient does not trust you then they will not trust you with their care or to be an advocate for them which may hinder their healing. As a leader at the bedside you must have critical thinking skills. As a nurse it is very important to have critical thinking skills. Nursing is not black and white and a lot of the times the answer is not always in front of you. As a leader newer nurses should feel comfortable going to you when they need someone with more experience to help them critically think. One of the most important traits as a leader at the bedside is being a team player. A leader needs to be willing to help out and not afraid to get their hands dirty. In nursing you need to work well as a team to help get through difficult situations. A leader should be willing to help out in times of need. As a leader there may be things that you may not want to do but you do them because you are part of the team. The team not only consist of nurses but include everyone on the interdisciplinary team. Nursing is very stressful and having a leader with all of these qualities helps make the job a little bit easier.
Within the nursing and interdisciplinary team it is important to be respected. These teams work together to provide the best care possible to patients and if any member of that team is not respected then the patient is the one who suffers. If there is no respect, then things may not be taken seriously or done in a timely manner. If the person giving an order is not respected, then the order may not get done to it’s full potential which can cause patient harm or a delay in care. It is also important to have a trustworthiness in the nursing and interdisciplinary team that you are working with. Not only does the nurse need to trust them but the patient does too. If the nurse is not trusted, then the team may not believe what is reported by the nurse. If the patient doesn’t trust the nurse or the team then they may be reluctant to share information that is pertinent to their diagnosis. As a nursing team or interdisciplinary team critical thinking is a must. If you are not able to critically think then things may be missed when assessing a patient. Critical thinking is what nursing is about. It is especially important to be able to critically think in emergency situations. When there are new graduate nurses that are working, they may have not developed the skill to critically think so it is important to have that skill as a seasoned nurse. Lastly being a team player is important when on a nursing or interdisciplinary team. There may be times that a fellow nurse has fallen behind or needs additional help and that is where being a team player comes into play. If you are not a team player, then that nurse will continue to struggle, and her patients will suffer as a result of this. Eventually nurses get burnt out if they do not have a nursing team that are willing to help out. On a nursing team you should be willing to help out fellow nurses. I always say that teamwork makes the dreamwork! No matter how bad the day is if you have a group of nurses that have good teamwork then ultimately the day will not seem as bad.
Work environment is impacted by nursing leadership, decision making, and professional development. If the work environment has poor nursing leadership then the turnover rate will be high on the unit. However if the work environment lacks communication, teamwork, and effectiveness then this may drive nursing leadership away. Leadership may not have the energy or ability to fix a team that is dysfunctional. Decision making is also affected by the work environment. If there is always high stress situations and lack of support, then decision making will be affected in a negative way. If nurses are always stressed, then the decisions that they make will not be of best judgement. If there is a lack of seasoned nurses on a unit then that will also negatively affect decision making. New graduate nurses do not have the experience or gained the skills to always make right decisions. Their decisions make be impacted by their knowledge in the situation. On the other hand if the unit works well together and there is less stress then the decision making would probably be more adequate. When your brain is well rested and under minimal stress it makes better decisions. Professional development is impacted by the work environment as well. If I am constantly stressed, then I am not going to think about professional development because my free time is not going to be spent on advancing my career. If you have leaders that push for professional development and help you along the way, then you may be more prone to advancement. I personally have a nurse educator that is a big advocate for professional development and walks with you every step of the way. She meets with you weekly to check on your progress and to answer any questions. This helps the process for advancement run more smoothly and help with any barriers that may come across. Prior to knowing how much she helped I was not wanting to advance professionally because the amount of time I would have to spend outside of work on the paperwork. As a nurse education is a continuous thing since healthcare is always changing.
About ANA | ANA Enterprise. (2018). Retrieved December 13, 2018, from https://www.nursingworld.org/ana/about-ana/
Campbell, J. (n.d.). Linda Ann Judson Richards. Retrieved December 12, 2018, from https://vermonthistory.org/research/vermont-women-s-history/database/richards-linda
Cherry, B., & Jacob, S. R. (2017). Contemporary nursing: Issues, trends, & management (7th ed.). Elsevier.
Douglas, J., & Hershkowitz, L. (n.d.). Nurse Licensure Compact. Retrieved December 11, 2018, from http://www.dhp.virginia.gov/nursing/nursing_compact.htm
Douglas, J., & Hershkowitz, L. (2018, July 1). Virginia Board of Nursing Laws and Regulations. Retrieved December 11, 2018, from http://www.dhp.virginia.gov/nursing/nursing_laws_regs.htm
Hansan, J. (2018, February 27). Wald, Lillian. Retrieved December 12, 2018, from https://socialwelfare.library.vcu.edu/people/wald-lillian/
Hegge, M. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: American Nurses Association.
Kluwer, W. (2018). License Renewal Requirements by State. Retrieved December 11, 2018, from https://www.nursingcenter.com/ceconnection/ce-state-requirements#virginia
Papandrea, D. (2016, January 15). Nursing Compact States Map & Details. Retrieved December 14, 2018, from https://www.travelnursing.org/nursing-compact-states-what-you-need-to-know/
Richardson, E. (2015, August 27). Aligning FDA and CMS Review. Retrieved December 12, 2018, from https://www.healthaffairs.org/do/10.1377/hpb20150827.132391/full/
The History of the American Nurses Association. (n.d.). Retrieved December 11, 2018, from https://www.nursingworld.org/ana/about-ana/history/
What is a State Board of Nursing? (2018). Retrieved December 13, 2018, from https://www.graduatenursingedu.org/state-board-of-nursing/