...hospitals were seen as places to care for those who had no one else to care for them. Nursing students staffed the hospital, under the direction of the head nurse, who was usually a training school graduate. Therefore after graduation, graduates eagerly donned their white uniforms, caps, and nursing pins and joined a “registry,” allowing them to practice as private duty nurses in patients’ homes. Nurse registries, operated by hospitals, professional organizations, or private businesses, provided sites where the public could acquire the services of these private duty nurses. Families could contract for the services of a nurse for a day or a few hours to care for their loved ones either at home or in the hospital (Whelan, 2005). Although physicians’ orders were required, private duty in the home provided graduate nurses with the venue and the opportunity to break away from the rigid hospital routine and allowed for a more autonomous practice. These nurses provided care to patients with contagious diseases such as pneumonia and typhoid fever, aided women in childbirth, and supported those with fractures, infected wounds, strokes, and mental diseases. Private duty nurses lived with and worked for their patients, providing 24-hour care, often for weeks at a time (Stoney, 1919). (Creasia 5-6) Creasia, Joan L., Elizabeth Friberg. Conceptual Foundations: The Bridge to Professional Nursing Practice, 5th Edition. Mosby, 2011. VitalBook file. The citation provided is a guideline. Please...
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... Today we continued to practice what we’ve been learning since day one in nursing school. I was assigned to an 88 y.o, African American, non-verbal and bedridden female. That provided an obstacle but I was willing to find a way to overcome it and find a way to provide the best possible care. The fact that no family member was with her presented a challenge, because, not much information was available due to her inability to verbalize anything. After checking the chart it seemed, as they were unable to get much information themselves other than an assessment. My pt was diagnosed with Altered mental status that may have been exacerbated by her Alzheimer’s. She slept most of the day except when awaken to administer her meds which was the only time we could get her to eat and she only ate about 35% of her meals. She seemed very confused and disoriented and she kept muttering “no, no, no” every time she was approached as if to say she was scared or did not want to be bothered. My role in her nursing care was just to ensure her comfort and making sure since she was bedridden to ensure that she was turned frequently as to prevent pressure ulcers. We performed a.m care as well after which I performed and assessment of what systems I could and allowed my pt to rest. She seemed very agitated and I did not want to do anything to heighten her mood. In the care of my patient, I incorporated the five dimensions of man, Maslow’s hierarchy, the nursing process and therapeutic...
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...definition of nursing practice is based by each states rules and regulations to govern the practice of nursing within that state. All nurses practice acts include two essential purposes. First each act includes statements that refer to protecting the health and safety of the citizens in the jurisdiction. The second purpose is to protect the title of the RN. The legal title RN is reserved for those meeting the requirements to practice nursing. (Contemporary Nursing, 2014) The scope of practice for RN’s is to provide individuals and groups nursing care, requiring specialized knowledge, judgment and skill derived from the principles of biological, physical, behavioral, social and nursing science. Such nursing care includes: 1. Indentifying patterns of human response to actual or potential health problems amendable to a nursing regimen. 2. Executing a nursing regimen through the selection, performance, management and evaluation of nursing actions.’ 3. Assessing health status for the purpose of providing nursing care. 4. Providing health counseling and health teaching. 5. Teaching administering, supervising, delegating and evaluating nursing practice. (Law regulating the practice of nursing, dialysis care and community health workers., 2013) (Ohio Board of Nursing) An advanced practice RN is a registered nurse who has completed and advanced graduate-level education program and has passed a national certification examination in order to practice in one of four...
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...Nursing Practice in Maryland Myrnie Johnson Walden University Nurse 3000 Section 6, Issues and Trends in Nursing August 18, 2013 Nursing Practice in Maryland Nurse Practice Acts (NPA’s) are a set of laws that are individualized state-to-state that define the scope of nursing practice. The guidelines of the NPA and its rules provide safe parameters within which to work, as well as protect patients from unprofessional and unsafe nursing practice (“Nurse Practice Act, Rules & Regulations”, 2013). The purpose of this paper is to explore the influence of professional standards and legislation on nursing in the state of Maryland. Scope of Practice New graduate registered nurses (RNs) must fill out an application to take the NCLEX-RN examination in Maryland after they have successfully completed an education program approved by the Board of Nursing (BON). If this program was completed in another state, the program must be comparable to those approved by the BON in Maryland. The Maryland NPA defines an “approved” program as one being “in compliance with the regulations of the board” and “holds a certificate of approval from the Board of Nursing” (Department of Health and Mental Hygiene). If the applicant is from Puerto Rico, they must pass a Spoken English test. All applicants must then complete a Criminal History Background Check application with fingerprinting and declare their primary state of residence (Maryland Board of Nursing, 2011). Effective in 2013, Maryland...
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...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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...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 occupational...
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...Rachel Miley Nursing Roles 1 Nursing Practice Act July 2015 Nursing practice is to do or perform habitually or customarily, make a habit of. (Mosby) But it is also the performance that requires specialized education, knowledge, and judgment of a trained person. This trained individual can be a licensed practical nurse, a registered nurse, a bachelor’s degree nurse, a master’s degree nurse, or a nurse practitioner. But all nurses must be able to observe, assess, and act on what your findings are. The goal of a nurse is to take care of patients to the best of their training and ability. Their ability will be defined in the term scope of practice. Scope of practice is defined as the extent and limits of the medical intervention that a health care provider may perform. (Farlex) Or in other words, staying within the professional nursing knowledge and not practicing above or below your scope of practice. A registered nurse, like everybody else, have responsibilities that come with the job. But they do differ in precise qualifications. A nurse must be able to assess, formulate, plan, implement, initiate, and evaluate nursing actions that are necessary in the field of nursing. They must be able to accept responsibility for their own actions and work well with others in a team setting. Communication is a key factor in nursing. Coworkers, patients, patient’s families, doctors, therapists, and emergency response teams are all the people that should be communicating with. Respect...
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...Nursing Transformation Suzanne Heilbron Grand Canyon University 12/6/2013 There are new opportunities and programs for nurses as a result of the Affordable Care Act of 2010, which aims to increase quality, access and value of care. For this to come to fruition, the nursing scope of practice will be utilized to the fullest capacity, nursing education will include expanded skills and leadership roles will be increased from clinical setting to board rooms. With every decade, nursing has become an increasingly integral part of health care services, so that a future without large number of nurses is impossible to envision. (Institute of Medicine [IOM], 2010, p. 87). Transforming Nursing Practice Nursing practice will have to change from outdated scope of practice policies and procedures to updated ones that will allow for the creation of patient center systems. Health care is centering on more chronic conditions and less on acute and specialty settings. Long- term care and palliative care will be on an upward trend in the coming years due to the aging population. RNs will be better utilized as roles shift and expand to free up physicians from procedures such as IVs and cardiac outputs, health histories and performing exams. There will be increased RNs to patient ratio, which will result in less medication errors and lowered infection rates. On the other hand, given the projected nursing shortage, task shifting to overworked nurses could create unsafe patient care...
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...Outline the process for developing nursing standards of practice and identify the different entities that might be involved in developing a standard of practice. Nursing standards of practice are vital to ensure patients received quality care and encompass the caring and professional aspects of nursing. These guidelines clearly designate what nurses should or should not do and are also a template for excellent, competent care. In order to develop nursing standards of practice one must be mindful of these requirements. The standards of practice shall: 1. Be considered as the baseline for quality nursing care 2. Be developed in relation to the law governing nursing practice 3. Apply to the registered nurse practicing in any setting 4. Govern the practice of the licensee at all levels of practice Nurses should evaluate what area the nursing standard of practice that they are developing fits into. There are six main categories of practice to choose from: Assessment, Analysis, Outcome Identification, Planning, Implementation or Evaluation. The new standard that is being developed needs to clearly outline what the profession expects of its members, how it will promote, guide or direct the nursing practice and how it will assist in improved understanding and response in the nursing role. There are several different entities that might be involved with the development of a new standard of practice. “Federal and state laws, rules and regulation and other professional agencies/organizations...
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...The Future of Nursing Practice If nurses truly “practice to the full extent of their education and training” (Institute of Medicine, 2010, p. 85), then the sky is the limit for how nurses can lead the way in developing positive changes in many different aspects of the healthcare paradigm. Although there are countless relevant literary reports on how to achieve such changes, The Institute of Medicine’s report on the Future of Nursing (2010) is held in the highest regard for the impact it could have on nursing education, nursing practice, and nursing leadership. About 55% of nurses today are prepared at a Baccalaureate Degree level (American Association of Colleges of Nursing, 2014). A key recommendation of the Future of Nursing report is to increase the number of Baccalaureate Degree prepared nurses to at least 80%. This would impact nursing education significantly, by changing the structure of the delivery of entry level nursing education, or possibly eradicating Associate’s Degree nursing programs altogether. According to Sherman (2012): Many nurses don’t realize that as part of the Bologna agreement, which was signed over a decade ago, professional nursing education in the European Union shifted to the baccalaureate level as the standard for professional licensure. Australia and New Zealand also now have BSN preparation as entry into practice. There are a number of states in the United States where there is active lobbying for legislation to require RNs to obtain a...
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...considered when determining the actions of nursing practice. These five domains are clinical skills and knowledge, therapeutic relationships, professional relationships, professional development and the advancing practice through innovation and research (UMHS). As nurses it is our responsibility to know our scope of practice in our home state and any state we practice in. Also, we must continue to educate ourselves in our profession as health care continues to change and stay current with the professional development framework of nursing. As an agency nurse and working in different states it is emperative to know the scope of practice. Even though hospitals have their own policy and procedures, it is always best to refer to scope of nursing practice for that state. I have found in my travels that more times than not, I was asked or told it was okay to perform a practice outside of my scope. Employers as well are responsible for providing nursing with policy and procedures, orientating nursing adequately to ensure the nurse understands her role and responsibilities and given the resources to maintain the ability to provide safe patient care. (CRNM). It is the framework of the domains that guides nurses to keep on the path of continuum care and also up to date on technology and education. Ultimately, it is the responsibility of the nurse to determine what is within the nursing practice based on the scope of practice, standard of practice, nurse practice acts, legal regulations an policy...
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...The knowledge of the foundations of nursing history provides a context in which to understand current nursing practice in various ways, it allows for us as nurses to recognize how far nursing has come since ancient times as far back as the days of Walter Whitman who went to Washington DC to care for his brother a casualty of war. Even further in the past was the St Benedictine order where nursing education was initially recognized among lay persons and religious people who committed their lives to this line of work. It’s good to know that even though nursing remains a calling for many people who practice it, formal education and licensing has elevated it to the level of a recognized profession where it should be. The three trends that come to mind after reading the interactive timeline are; nurse registration by Elizabeth Neal, Legislative bills for the establishment of state supported institutions and specialist hospitals in the care of the mentally ill and the less privileged by Dorothea Dix and last but not the least, the work of Florence Nightingale who fought for reform of sanitary conditions in Military hospitals and the advancement of nurse education, and also her use of statistical data to analyze mortality rates in the treatment and care of the sick. Nurse Registration which is something that is internationally recognized makes the” world our oyster” so to say. Meaning it allows us as nurses to travel and practice the world over and still be recognized in our own right...
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...Compassion and Caring: My Philosophy of Nursing Practice In nursing, it is important to have a personal philosophy of the profession. It dictates how a person deals with the day-to-day tasks and obstacles that nurses will face. Patient populations are ever-changing, with some much sicker than others, and various lengths of stay expected. The nurse will encounter different cultures and beliefs in their practice, some contrary to their own. Their philosophy of nursing will be evident with how they handle the various aspects of the job. One thing that all patients have in common is that they are in a vulnerable situation. They are in the hospital, many confined to their room or bed. Some have family with them. Others must face their sickness on their own. They are in the hospital for nursing care, and that is what should be provided for them. A nurse is a caregiver and advocate for the patient. A nurse is not there only to pass medications and take vital signs. A nurse is there to not only take care of their physical needs, but also to help them when they are at a vulnerable time. A nurse should not only be knowledgeable about healthcare, but also be compassionate and caring to the patient. Choice of Nursing For me, nursing was not something that I had initially thought about doing, even though both of my parents were in and out of hospitals for various ailments and surgeries. I liked history, and was going to study it at a university. Shortly before I left, I had an epiphany...
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...The purpose of this assignment is to discuss how the module content and practice experience has contributed to my development as a nurse. It will involve reflecting on a particular episode of care delivery to a patient by me and my nursing mentor whilst on my 5 week placement and how I felt that the Foundation to nursing practice module helped equip me with both the knowledge and skills. In education for health-care professions it is recognised as an essential tool for helping students to make links between theory and practice and enables you to develop your knowledge and skills towards becoming a professional. Reflective practice is noted as being fundamental to development as a professional. To protect anonymity and maintain confidentiality the patient focused on this assignment will be known as patient A, furthermore consent was gained from patient A and they were provided with clear information on what would be included in this assignment and where informed that no recognisable information would be given, this is done in accordance with the Nursing & Midwifery Councils Code of Professional Conduct (2002) guidelines. Nursing assessment is considered to be the first step in the process of delivering individualised nursing care which is defined by A Dictionary of Nursing (2008) as care that is planned to meet the particular needs of one patient, as opposed to a routine applied to all patients suffering from the same disease. Every person...
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...standard of practice. Outline the Process for Developing Nursing Standards of Practice and Identify the Different Entities That Might Be Involved in Developing a Standard of Practice. When outlining the process for developing standards of practice the American Nurses Association relies on members as the first link in developing an official resource. Members are nominated to a working group that researches the issue at hand and writes a statement before going to the ANA for final approval. This bottom-up approach ensures the standards are current and accurately represent nurses across the nation (ANA 2014). The Department of Health Scope of Practice Tree asks us, Is the act permitted or prohibited by the nurse practice act, Is it consistent with standards? Do you have current clinical skills to perform the act safely? Is the act with in in standard of care? Are you prepared to accept the consequences of your action? The six main categories of practice are assessment, Analysis, Outcome Identification, Planning, Implementation, and Evaluation. By implementing standards of care we are able to provide excellent care to out patients. Different entities that might be involved in developing a standard of practice are The American nurses Association and the Joint Commission on Accreditation of Healthcare Organization (JACHO) have established and recognized standards of care. Standards of care are found at the national and state level. State boards of nursing develop...
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