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A. Identify a nursing theory that has influenced your values and goals.
1. Explain how nurses apply the identified theory from part A to implement excellent nursing practices.
2. Discuss how the identified theory from part A fits your professional practice.

B. Identify the contributions of two historical nursing figures in the nineteenth or twentieth century.
1. Compare the differences in contributions of the two historical figures identified in part B.
2. Describe how the contributions of the two historical figures influence your professional nursing practice.

C. Explain the functional differences between the State Board of Nursing and the American Nurses Association (ANA).

Application of Nursing Theory in Nursing Practice

Interpersonal theory by Hildegard Peplau has influenced the personal values and goals.

  1. This theory is applied by the nurses to develop the nurse-patient relationship through four phases of “orientation, identification, exploitation and resolution.” (D'antonio et al., 2014)
  2. In personal practice the theory is applied for building therapeutic relationship with patients through education and use of interpersonal skills.
  1. Contributions of historical nursing figures identified are-
  2. Virginia Avenel Henderson- contributed to nursing theory  and defined the role of nurses in health care
  3. Florence Nightingale- contributed to towards infection control by emphasising on hygiene and sanitation. Unlike V. Henderson, Florence Nightingale focused on one aspect of nursing care (Masters, 2014).
  4. Contributions of both nurses influence the personal practice. Personal practice is improved by reading the nursing textbooks published by V.Henderson and implementing her theories in patient care. Using the environment theory of Florence Nightingale, the patients are protected from hospital acquired infections. A greater focus is laid on hygiene awareness of patient.

State board of nursing- outlines safe care standards, promotes public welfare and issue nursing license

American Nurses Association- work toward high health care quality, set nursing practice standards and investigate health related complaints and license issues of nurses (Tastan et al., 2014)

State board of nursing influences personal practice as it alerts of any legal notification against nurses and complaints. It ensures adherence to practice standards. ANA helps in reporting any medication error observed in practice and patient issues related to unsafe care. 

License can be renewed if the requirements of the continuing nurse education are fulfilled. Renewal may be cancelled if any criminal background is detected, falsified licence number or default in educational loan is found (Libner, 2016).

  1. a) Failure to maintain the license requirements will lead to discontinuation of nursing practice in the concerned state.

Compact states

Non-compact states

To work in another state nurse may not apply for license.

Involves system of license in multiple states  

Nurse must apply for  license in new state

Nurse must inform both previous and new state about the existing license requirements

It involves single state nursing license

(Source: Siow & Ng, 2013)

FDA or Food and Drug Administration

Centre for Medicare & Medicaid Services

Regulation of selling of food products and medical devices,

Ensures food and drug safety

Administers the Medicaid and Medicare program- health care insurances for children and adults,

Standards for high quality care and insurance portability standards

 

Covers FDA approved devices

(Source: Chambers et al., 2013)

  1. In personal practice FDA helps in ensuring safety with medical equipments and drugs. FDA accepts and responds to complaints against medical devices and products used in patient care. Medicare and Medicaid services in personal practice influence proper medication administration through pay for performance system. It influences advocating the patients about health care facilities and help in health care decisions.  
  2. a) As a patient advocate, I would prevent harm.  I will respect the patients’ wishes and encourage for alternate therapy if it helps to draw on healing power. In doing so I will explain the benefits and side effects (if any) of alternative therapy, based on evidence, to assist in making informed decisions (Choi, 2015).

Nurse practice Act defines scope of practice and nurses’ responsibility for safe and competent practice (Russell, 2012). In the state of Indiana, “The Indiana Nurse Practice Act” governs the nursing practice for the registered nurses and licensed practical nurses.

  1. In my state the scope of practice for RN includes performance of services which are but not restricted to -  
  • Health assessment
  • Nursing diagnosis
  • Nursing actions based on nursing
  • Collaboration with other health care professionals or referrals to advocate the provision of health care services
  • Physician if delivered any regimen are to be executed
  • Evaluate the nursing practice, delegate, supervise, administer nursing practice
  • Delegation of task  that aid in medical, dental, and nursing regime
  • Perform actions approved by board in collaboration with the “medical licensing board of Indiana” (Ic4n.org, 2018)
  1. 2. Delegation is the process of transforming responsibility for components of care to another nurse RN/LPN and unlicensed school staff while training accountability for overall care of the individual (nursing process is not to be delegated) by only the RN. The RN must hold accountability and delegate the tasks as per the assessment of the complexity of the care, health status and educational status of the delegate and demonstrated abilities. RN must supervise and evaluate the willingness of the delegates to perform the task (Ic4n.org, 2018).

I would apply nurse scientist role to my profession by researching on the hand hygiene compliance in geriatric ward and contribute to policy making in organisation

As a detective of healing environment, I would read the face of patients to identify any hidden information or their health beliefs, skilfully ask questions, and observe the sign and symptoms to prevent adverse outcomes.  

I will apply the role of manager by monitoring the patient care given by new nurses in my ward. I will guide them through professional standards and guidelines ensuring the compliance and reporting non-compliance to nurse administer.

Provisions of ANA code of ethics are-

  • Nurse to articulate values, maintain the professional integrity and incorporate the principles of social justice to practice  
  • Nurse to maintain ethical environment and improve condition to safe and quality health care (Lachman et al., 2015)
  1. These provisions in personal practice help to prevent discriminations among patients, ensure fairness in practice, report unethical behaviour and preserve patient dignity.   
  2. Medication error is the common nursing error in nursing practice that may occur during delegation to unlicensed nurse or negligence
  3. As per the first provision, the nurses must work to implement evidence based practice and utilize the experience of advance nurses to maintain professional integrity and increase knowledge of scope and standards of practice to prevent the error

Excellence in nursing is represented by four leadership traits

Leadership traits

As a leader at bedside

Nursing team/interdisciplinary team

Communication skills

Use of active listening skills and sensitivity  to deal with patient’s concerns, assessment and mediate self care

In  nursing team communication skills help resolve conflicts, share strategies,   and overcome miscommunications

Fairness in action

Make decisions related to care at the bed that comes from acknowledging the potential discomfort empathetically

When working in nursing team avoid bias in delegating task and make decision to ensure social justice

Emotional intelligence

Useful for developing  therapeutic relationship with patients

In nursing team, to support fellow nurses to deal with stressors and gain emotional resilience

Problem solving skills

Address patient’s queries before tests and identity crisis if any, language barrier by using medical interpreter and resolve concerns related to medication side effects  

Useful in multidisciplinary team to make effective decisions during critical care or deal with problems in care plan

(Source: Thomas, 2015)

My practice demands to using mix of leadership styles depending on situation to promote greater good of patients, staff, team and organisation. I prefer using the mix of transformational, participative, autocratic leadership style and delegate what is appropriate. The work environment promotes the problem solving skills by dealing with chronic illnesses, which positively impacts the decision making in nursing team. There is a positive impact of CPD hours mandated for nurses as it ensures professional development.

References

Chambers, J. D., May, K. E., & Neumann, P. J. (2013). Medicare covers the majority of FDA-approved devices and Part B drugs, but restrictions and discrepancies remain. Health Affairs, 32(6), 1109-1115.

Choi, P. P. (2015). Patient advocacy: the role of the nurse. Nursing Standard (2014+), 29(41), 52.

D'antonio, P., Beeber, L., Sills, G., & Naegle, M. (2014). The future in the past: Hildegard Peplau and interpersonal relations in nursing. Nursing inquiry, 21(4), 311-317.

Ic4n.org. (2018). Guidelines to delegation for indiana school nurses. Ic4n.org. Retrieved 15 March 2018, from https://www.ic4n.org/wp-content/uploads/2015/08/Guidelines-to-Delegation-for-Indiana-School-Nurses.pdf

Lachman, V. D., Swanson, E. O., & Winland-Brown, J. (2015). The new ‘Code of Ethics for Nurses With Interpretive Statements’(2015): practical clinical application, part II. Medsurg Nurs, 24(5), 363-368.

Libner, J. (2016). Priorities for Continuing Education Regarding Regulation: Perceptions of RN-to-BSN Students and State Regulators. Journal of Nursing Regulation, 7(1), 53-58.

Masters, K. (2014). Nursing theories: A framework for professional practice. Jones & Bartlett Publishers.

Russell, K. A. (2012). Nurse practice acts guide and govern nursing practice. Journal of Nursing Regulation, 3(3), 36-42.

Siow, E., & Ng, J. (2013). Internal migration of nurses in the United States: migratory prompts and difference in job satisfaction between migrants and non-migrants. Nursing Economics, 31(3), 128.

Tastan, S., Linch, G. C., Keenan, G. M., Stifter, J., McKinney, D., Fahey, L., ... & Wilkie, D. J. (2014). Evidence for the existing American Nurses Association-recognized standardized nursing terminologies: A systematic review. International journal of nursing studies, 51(8), 1160-1170.

Thomas, T. (2015). Management and leadership for nurse administrators. Jones & Bartlett Publishers.

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