...Domain of Nursing Practice Brenda Amunrud Grand Canyon University Domain of Nursing Practice The question proposed is, “What factors need to be considered when determining whether or not identified actions are within the domain of nursing practice?” One should always ask: 1. “Am I acting within my states defined scope of practice for my title?” 2. “Am I competent to perform the task?” And 3. “Is the task allowed by your hospital’s policy and procedures?” There are four levels of nursing practice within the Professional Framework are based in part on the Benner Model of Knowledge and Skill Acquisition. Level A: An advanced beginner – the new graduate nurse with less than 12 months of experience. Level C: A fully competent nurse who provides care to a full range of patients seen in his/her who has begun to make contributions. Level D: A proficient nurse who provides individualized care to a full range of patients seen in the practice setting while also making contributions to the unit and profession. Develops professional goals and demonstrates attention to own professional development. Level E: An expert nurse who provides highly individualized care to a full range of patients even in the most complex situations, while also making significant contributions within and often beyond the unit as well as the profession. Is goal driven around own professional development with clear evidence of advancing professional identify. (Minerath, 2013, para. 1) References ...
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...whether or not identified actions are within the domain of nursing practice has to do with the role or position that nurse holds in the organization. For example, I am not a nurse manager in the NICU so it would be out of my scope to make decisions reserved for the nurse manager. As the bedside or staff nurse, my domain includes direct patient care, collaborating with the medical team to continue the plan of care for a patient and assessing for signs and symptoms of improvement or decline. The nurse manager may assume my role but I have not been authorized to assume theirs. When nurses stray into areas that have not been released to them, even though there may not be legal ramifications, there may be consequences to assuming authority that has been reserved for nurses with certain educational levels or titles. Certain titles are granted because the individual who holds that title is accepting responsibility and have a particular realm of authority attached to them. Traditional duties and responsibilities of the professional nurse, regardless of practice area or setting, such as the roles of care provider, educator, counselor, client advocate, change agent, leader, manager, researcher, and coordinator of the interprofessional health care team. (2) Duties and responsibilities of the professional nurse that are guided by specific professional standards of practice and usually are carried out in a distinct practice area (e.g., flight nurse, forensic nurse, and...
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...not identified actions are within the domain of nursing practice? One’s scope of practice is ever evolving as experience is gained working in an area of expertise. The American Nurses Associate gives a simple description when thinking about determining scope of practice it is the “who," "what," "where," "when," "why," and "how" of nursing practice. Consideration must be given to the guidelines of the Nurse Practice Act, rules/regulations/guidelines of the state in which the nurse is working, the policy and procedures of the facility in which the nurse is working, community standards of professional organizations, the nurses own educational preparation and clinical experience. Texas Board of Nursing has an algorithm to assist nurses in making a determination of an activity falls in the general scope of practice called the Six-Step Decision-Making Model for Determining Nursing Scope of Practice (TBON, 2010). Six-Step Decision-Making Model for Determining Nursing Scope of Practice 1. Is the activity consistent with the Nursing Practice Act (NPA), Board Rules, and Board Position Statements and/or Guidelines? Yes → Continue No → STOP 2. Is the activity appropriately authorized by valid order/protocol and in accordance with established policies and procedures? Yes → Continue No → STOP 3. Is the act supported by either research reported in nursing and health-related literature or in scope of practice statements by national nursing organizations? Yes → Continue No → STOP ...
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...on your job. These actions are usually within the scope of the “nurse practice act” and “board of nursing”. Most questions are focused on safety. Safety depends on the nurse’s knowledge, training, and skills. A nurse has a duty of obligation to her patients and to herself. She has to protect her license and integrity as a nurse and deliver competent and knowledgeable services to her clients. One rule of the RN is to delegate duties to other registered nurses and licensed practical nurses and nursing assistants. Many times the nurse questions if the assignment is within the scope of practice, especially delegating activities to the nursing assistant. (Kathleen R. Weinberg, n.d.) According to (DL, 1994), the purpose of nursing center influenced the scope of practice in nursing in different areas. These areas are, how nursing affects the faculty, the community, or specialty in nursing practice. The nurse managed center “requires high quality nursing services, public and community support, healthy relationships with other health care providers, and documentation of patient’s outcome through the nursing managed center based on nursing research”. (DL, 1994) The American nursing association describes how nurses should think when deciding what factors are within the scope of practice. Questions to be asked are “who”, “where”, “why”, “what” and “how” of nursing. The guidelines are embodied in the nurse practice acts, rules and regulations, guidelines of the state and in the policies...
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...Nightingale’s concepts sound familiar in vanMaanen’s (1990) description of nursing as helping clients adjust to health and illness consequences. How nursing affects and changes clients’ health status is nursing’s unique contribution (Donaldson & Crowley 1978) and refers to nursing’s effective management of changing situations (Fitzpatrick 1988) The ANA definition is an example of the discipline describing the domain of nursing, which is to protect, promote, optimize, and alleviate suffering . Bishop and Scudder (1997) state, '... the definition of nursing ... is being contested between those who believe that the meaning and direction of nursing should come from applied science and those who believe that nursing is a caring practice that can be best articulated and developed with enlightenment from the human sciences' (p. 83). My nursing definition includes the aspects of art, science, and practice To understand the factors needed to be considereded when determining whether or not identified actions are within the domain of nursing practice we need to understand the Domains of Nusing Practice. The domains of a knowledge system for nursing -- by viewing the question based on Meleis’ (1991) major components of concern for nursing. These components include: 1. nursing client (as a central focus), 2. transitions, 3. interaction, 4. nursing process, 5. environment, 6. nursing therapeutics, and 7. health. The main factors which need to be taken into...
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...Building a Personal Framework I have spent most of career practicing nursing in the surgical setting. I was a staff nurse on an orthopedic surgical unit for the first two and a half years after graduating from an associate’s degree nursing program. I then went back to my home of the Operating Room (OR), previously working as an OR Assistant prior to going to nursing school. I joined the cardiovascular team in the OR during my orientation period and absolutely loved it. Four years later I began my journey in nursing leadership. My first leadership position was the supervisor of an operating room, and was promoted to a nurse manager a few years later. Looking back, I’m not sure how I remained in management, I had little to no mentorship or guidance. Since then I have developed a passion for mentoring nurses and helping them be successful in both staff and leadership roles. Performing both inpatient and outpatient procedures, I get to be involved in the care of healthy and ill adult patients undergoing surgery, endoscopic procedures, and pain management procedures. I have a holistic approach to nursing care, and place the patient in the center of the care they receive during their stay. Of course, there are times during a patient’s stay, the focus must be placed in a particular area, such as patient safety in the operating room. Another important focus while the patient is undergoing surgery is the patient’s family and loved ones. We adopted a standardized process for...
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...Abstract I define my philosophy of nursing within the three nursing domains of person, health, and environment. My goal is to communicate the importance of nursing as a knowledge-based career, depending not only on the nurse fulfilling her role but also on the patient’s compliance. A patient must learn to provide self-care at home in the same capacity as the nurse would provide care in the clinical setting. I discuss various subjects within nursing. I explain why I want to be a nurse, what I believe a nurse’s role is, the different domains of nursing, and where I believe nursing will be in the future. My philosophy demonstrates the interdependence of the nursing domains. You cannot fully evaluate a person without evaluating their health, nor can you contemplate an environment without encompassing the person. Likewise, health cannot exclude the influence of the environment. These factors build upon the concept of nursing and elaborate on what nursing really is. Keywords: nursing, philosophy, health, person, environment, beliefs, nursing domains Philosophy of Nursing My name is Quyen Thi Napiontek, and I am 24 years old. I have a husband and beautiful 2-year-old daughter. I was born in Biloxi, Mississippi, and I have spent most of my life here. I have an innate curiosity about people and science, and I like to combine that curiosity with assisting others. I feel a nursing career would provide the perfect platform to do this. I aim to make a difference in the lives of others...
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...What comparisons can be found between the GCU Mission and Domains/CON Mission and Program Competencies (for your selected specialty track, links located in the Course Materials) with the AACN's Essentials for Master's Education for Advanced Practice Nursing (link located in the Week 1 Topic Materials)? Explain your rational. http://www.gcu.edu/About-Us/Mission-and-Vision.php http://www.gcu.edu/College-of-Nursing-and-Health-Care-Professions.php As for me, the Comparisons that can be found between the Grand Canyon University (GCU) Mission and Domains/College of Nursing (CON) Mission and Program Competencies with the American Association of Colleges of Nursing’s (AACN) Essentials for Master Education for Advance Practice Nursing are as follows: First, Grand Canyon University mission and domains prepares the students to become global citizens, critical thinkers, effective communicators, and responsible leaders by providing an academically challenging, values-based curriculum from the context of Christian heritage (http://www.gcu.edu/about-Us.php), whereas with the American Association of Colleges of Nursing’s (AACN) Essentials for Master’s Education for Advance Practice Nursing focus predominantly on the education of nurses for advanced practice nursing in direct care roles which comprises two elements, Master’s Education: Societal Role , which is practice oriented with a goal that professional s develop advanced skills and knowledge for their professional roles and those programs...
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...Running Head: EXAMINING NURSING: A PERSONAL FRAMEWORK Examining Nursing: A Personal Framework Cortney Airhart The University of Texas at Arlington School of Nursing In Partial Fulfillment of the Requirements of N5327 Analysis of Theories in Nursing Ronda Mintz-Binder, DNP, RN March 27, 2012 Examining Nursing Practice: A Personal Framework After graduating nursing school in 2008, I started working as an Operating Room nurse (OR) at a level one trauma center, which specializes in neurosurgery. I now scrub and circulate neurology, urology, ENT (ear, nose and throat), and plastic surgeries. I am also a charge nurse and in charge of orienting new nurses and graduate nurses. The OR is fast paced and challenging. One never knows what is going to come through the doors, but you have to be ready at any given moment, to do anything from removing tonsils to clipping an aneurysm, in a matter of minutes. In the OR, often times the team gets caught up in tasks that need to be performed to get the case going, and sometimes forget that a human being is lying on the table with both physical and emotional needs. That is why, I teach my new graduates and everyone that I precept to act like it is a member of their family lying on the table. Often times just a friendly word or a smile before the patient is put under anesthesia can make a world of difference. If there is time, I also update the family to what is going on in the OR and try to answer any questions...
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...After graduating nursing school I immediately obtained a position in the Emergency Room at East Houston Regional Medical Center. During my time in the Emergency Center I became an Advance Cardiac Life Support (ACLS) instructor and CardioPulmonary Resusciation ( CPR) instructor for American Heart Association. I stayed in that position until I became pregnant, which was a year and a half after becoming and registered nurse. Then I transferred to Labor & Delivery (L&D) as a staff nurse. I spent all of maybe four weeks in orientation, because of my previous experience prior to becoming a nurse was ten years as a scrub tech in labor & delivery. Shortly after learning the ropes in L&D maybe a month or so I became a charge nurse on that unit. I stayed at East Houston Regional Medical Center as a nurse for seven years until I transferred to Ben Taub General Hospital within the Harris County Hospital District. Once I arrived to this facility it was long before I became a charge nurse as well in the labor & delivery unit. This facility happened to be different, educational and more of a challenge than where I had come from. Ben Taub is one of the two county facilities in Houston. This particular facility has a Level 1 trauma facility therefore our unit was able to see some pretty ill, near death patients in the L&D unit. For example, one night a patient was admitted for a postmortem cesarean section after a very traumatic and fatal car accident. Well while the obstetrical physicians were...
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...functions of caring within the nursing practice, as well as my own personal views regarding caring. I will review the Benner model of Clinical Nursing and the Dreyfus Model of Skill Acquisition in relationship to my own personal skills. I will identify my competencies within each domain of the Benner Model. I will reflect upon my own personal nursing practice in terms of my strengths and weaknesses. Also included will be a discussion of my own professional goals, areas of improvement needed within my practice and solutions for how I can improve in order to help me achieve these personal goals. Caring To me caring and nursing go hand in hand. Caring is an essential part of nursing. As nurses we come in contact with patients having surgical interventions or medical issues or are sometimes are going through a major health event in their life. Patients that have a health event need us nurses to listen and provide comfort whether it be giving pain medications, providing a quiet environment or just listening and letting the patient talk about their illness, anxieties or fears that they are feeling. So many times throughout my career I have seen nurses simply take care of their patients needs but when I was doing staff nursing I was really into it. Some nurses simply go through the motions that a nurse would do and they are detached and have a non caring attitude. As Benner stated, "We do violence to caring when we separate in our practice the distinctions we are able to...
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...Bloom's Taxonomy and its use in Nursing Education NUR/427 October 27, 2014 Dr. Shannon Smith Bloom's Taxonomy and its use in Nursing Education Registered Nurses (RN) make a commitment to being life-long learners. It is imperative that we stay up-to-date and current on standard practice in order to provide optimal education to our patients in managing chronic illness and disease. The origination, revision and domains: cognitive, affective, and psychomotor aspects of Bloom’s taxonomy in education and its use in nursing education will be the main focus of the following essay. In 1956, Benjamin Bloom along with a group of other educational psychologists published Bloom’s Taxonomy of Educational Objectives. Educators of health use Bloom’s taxonomy to classify skills and learning objective for students. A revision of bloom's taxonomy by Anderson and Krathwohl in 2001 offers a range of three domains for learning which include cognitive, affective and psychomotor (Larkin and Burton, 2008). This system remains more effective to adult learners and is widely used by nurses for patient education. According to (Su and Osisek, 2011), education that is practical, relevant, and organized focusing on the problems and tasks that are applied to real life is preferred by the adult learner. Using this system allows nurses to plan for educational opportunities to a particular problem that is clear, concise and is easily understood by the patient. Using this system also allows documenting...
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...another job as a medication assistant at Austin Community College (ACC). This job allows me to collaborate with a nursing instructor by educating level one nursing students in a hospital setting in medication administration safety, basic nursing skills, critical thinking skills, evidence-based practice, core measures, and providing effective and holistic nursing care. My goals as a nurse is to build a trusting relationship with my patients and promote the patient’s sense of control in order to attain quality, holistic health. These goals are very similar with my ACC students. As I assist in teaching them how to reach their potential as a future nurse, I want us to trust each other, and I want them to be autonomous in researching answers themselves to provide quality care. My nursing care before this class was more focused on evidence-based practice since I did not consciously incorporate theory into my bedside practice. This personal framework paper will review my personal values, beliefs, and nursing philosophy in relation to my bedside nursing practice and medication assistant position. I will describe Erickson, Tomlin, and Swain’s Modeling and Role Modeling Theory (MRMT) and how it applies to the nursing metaparadigm and my nursing practice. I will further compare and contrast the theory of Modeling and Role Modeling to my philosophy and approach to nursing, and describe a situation in which my framework could have been applied. Philosophy Empiricism is a philosophy...
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...identify domains associated with educational learning activities. The domains were labeled cognitive, affective and psychomotor. Nursing education is driven by patient outcomes. In the modern era, healthcare providers are not only reimbursed for their care through a series of audits which gather information to justify the patient stay, but are also graded by surveying agencies on their quality of care. This focus has crossed over into the training level of nurses. When I think of Bloom’s application in nursing education, I recall the care plans we developed as student nurses. I do not recall specifically learning about Bloom’s Taxonomy, however this current research into the subject has caused much reflection, which leads me to the conclusion we were taught this concept. Critical thinking is at the heart of self-care just as much as it is at the heart of nursing. Larkin proposed, “some researchers argue critical thinking cannot be taught”, (Larkin and Burtin, 2008). Cognitive Domain The knowledge-based domain of the taxonomy is the cognitive domain. The learner is expected to gain knowledge from various types of stimuli including but not limited to oral, written or graphic information. Utilizing instructions, they should be able to carry out a task. Determining how the parts of a system relate is the beginning of comprehension. Understanding the system components allows the learner to make judgments and reach measureable objectives. Affective Domain Through...
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...The Journey into Cultural Care and Diversity in Nursing: A Personal Framework I have had the opportunity to work in many different areas of nursing, and have learned a great deal regarding cultural care and diversity among patients and their families. I have used my past experiences in each different unit and healthcare facility to improve my communication and rapport with my patients and their families to improve the continuity of care. I have been exposed to patients from different countries, cultures, and religions on a daily basis. I believe that it is crucial for the nurse to build a trusting non-judgmental relationship with the patient and their families to show compassion. When caring for patients I listen to their concerns, decrease the stress levels and improve communication and recovery. As a nurse I must take in consideration the culture and religion in which they come from, and care for them appropriately to avoid upset and miscommunication. My goal and focus is to use holistic care to provide the patient with a successful recovery. My personal framework paper will be expressing my own personal journey as a bedside nurse and using my own personal beliefs, values, and philosophies related to caring for culturally diverse patients. Madeleine Leininger’s Cultural Care Diversity and Universality Theory, and the nursing metaparadigm will be discussed, and shown how it is incorporated into my daily nursing practice. Philosophy In McEwen and Wills (2011), Empiricism...
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