Identify a nursing theory that has influenced your values and goals

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

The theory of nursing is defined as, “A procedure, policy or belief followed or proposed as the base for action”. There are numerous theories of nursing with a common factor that allows an individual to examine an already existing fact while using additional experiences and skills necessary to deliver quality patient care. Theories are used by nurses in their daily practices to care for the patient because different patients have different health needs. As a practicing nurse, the theory of Hildegard E. Peplau is most relevant in my field. Her theory concentrates on the relationship between the nurse and patient, where the nurse is the primary resource for patients from diagnosis to treatment, to the release of the patient. This is termed as the theory of interpersonal relationship, which implies that anxiety is caused by stressful environments that may prevent the improvement of the patient’s condition. To avoid such scenarios, the nurse should reduce stress from the patient by having a therapeutic interpersonal relationship with the patient while mutually setting goals with the patient. The nurse has numerous roles revolving around the patient’s needs. Initially, as a stranger to the patient, the nurse must create an atmosphere for building trust and should be able to be an active leader, counselor, educator, and the primary source for information or answers along with being a technical expert in giving physical care. The nurse also helps in meeting treatment goals set between them and their patients. Peplau’s model requires self-awareness from the nurse and insight into their ethics at work, including how they relate with the patient. In nursing school, I was taught to treat patients individually because diagnosing ailments are part of treating an individual. The illness affects a patient mentally, spiritually, and emotionally, and just because a patient is declared cancer-free does not mean that they are fully recovered. Therefore, as a practicing nurse, I find Hildegard’s theory useful. While temporarily working in rehabilitation units, I see significant positive outcomes concerning the patient-centered care I provide. My patients often unsatisfied when dealing with other nurses, terming them as mere “medication pushers.” It is, therefore, my duty to provide a serene environment where treatment-related concerns, goals, and medication can be addressed as well as stress factors from family members that could be a burden to the patient. Such issues could restrict them from reaching their maximum recovery potential. I also assure my patients that I am on reach whenever needed. Educating patients on the long-term outcomes of their treatment is essential to make sure that they adhere to the treatment given. Providing my patients and their relatives with information necessary for recovery has been effective in improving the health of the patient. For instance, a wife to one of my patients could not understand why her husband’s blood sugar levels were high. However, she was surprised and did not know, when I explained to her that the pasta her husband was taking was being converted into glucose, which would affect his sugar levels. This was a learning moment for me because I was reminded that as simple as education is, it is an integral part in nursing.

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

Historically, there are numerous nursing figures that played a part in the nursing theory by being pioneers in the nursing field. The two unique ones to me are Linda Richards and Dorothea Dix. Linda Richards has greatly contributed to nursing. She is famously known for being among the first professionally trained nurse. Before 1923, nurses were not formally trained but instead gained their training through their family while getting experience as they practiced nursing in the field. They worked long 16-hour shifts and were expected to be on call 24 hours a day (Hanink, 2019). Apart from taking care of the patient, nurses also made sure that the laundry was done and the health care facilities were clean. As a result, most nurses had little to no information on diagnosis and treatment (Hanink, 2019). Richards felt the need for nurses to be educated and their profession respected as it demanded the dedication of their time and knowledge to take care of patients. Thus, Richards started the first training school for nurses at Boston, Massachusetts General Hospital, which was successful. Here, she introduced night duty shifts for nurses to interchange with the ones who had worked the entire day to reduce fatigue in nurses who were initially on call 24 hours. Richards continued to introduce training programs across the country and even established one in Japan. Linda Richards also introduced written records, which is currently in form of electronic data, to track the patient’s progress. Before the introduction of written records, physicians verbally diagnosed and treated patients (Hanink, 2019). This led to confusion and misinterpretation of treatment methods, including instances of giving patients the wrong prescriptions. As a concerned nurse, Richards began presenting her reports in written form, which was recognized by doctors and later included as standard practice when handling patients (Hanink, 2019). Similarly, Dorothea Dix was also a pioneer in nursing. However, her contributions were geared toward the treatment of the mentally ill. While teaching Sunday school at East Cambridge Jail, she noticed the poor living conditions of the prisoners and intervened to ensure that prisoners were warm during the cold months. This motivated her to travel around the state of Massachusetts and analyze the living standards in prisons, including the standards of people living in poverty. She created a detailed report concerning her findings and presented it to the state legislature to increase the budget of expanding the State Mental Hospital at Worcester. Hix started moving around the country to establish more humane and well-conditioned asylums for the mentally ill. She believed that humane and therapeutic care for the mentally ill would result in a positive response in treatment for mentally ill patients (Reddi, 2018). While visiting these institutions, she made it her duty to re-staff, train reorganize, and educate employees (Reddi, 2018). Her actions set a standard for providing quality care for the mentally ill. Both Linda Richards and Dorothea Hix were pioneers in the field of nursing, even though their interests were based in different areas. Richards pushed for formal education and opportunities for women to become nurses, while Hix aimed to educate more nurses to take care of the mentally ill patients. The discovery of written information as a means to store patient’s records influence me as a practicing nurse today because we were informed on the first day of nursing school that part of nursing included proper documentation of patient’s records. Failure to document meant that one did not perform the task as nurses must record everything. Education is an unending process, and it is required in New York that nurses get higher education. I completed nursing school, receiving my degree as an RN, and immediately began my BSN shortly after graduating from nursing school. My current job also provides formal training on everything from wound care to written policy. Dorothea Hix’s theory of delivering a therapeutic atmosphere to the mentally ill for more positive outcomes on treatment is a practice that has been proven effective, which I use in the facility I work. My job has a unit specifically for people with mental illness, and I have witnessed the effects of how a comfortable and friendly environment creates positive responses to treatment in patients. My colleagues are less aggressive and respond better to the treatment of illnesses and wounds, among others.

Explain the functional differences between the State Board of Nursing and the American Nurses Association (ANA).
Define the roles of these two organizations.
Explain how these two organizations influence your nursing practice.
Explain the requirements for professional license renewal in your state.
Discuss the consequences of failure to maintain license requirements in your state.
Compare the differences between registered nursing license requirements in a compact state versus a non-compact state.

The State Board of Nursing (State BON) and American Nurses Act (ANA) are two organizations functioning differently in regulating nursing. The State BON’s focuses on regulations and licensing regarding nursing care and practice. Its focus is setting standards for requirements of education and licensing for one to be considered an RN and outlining the scope of practice for registered nurses (NCSBN, 2019). For instance, all nurses are required to take and pass the NCLEX-RN exam for them to practice as registered nurses. Each state has its specific BON, which defines the kind of practice for nurses required in that state (NCSBN, 2019). They are mainly concerned with the welfare, safety, and public health of the population (NCSBN, 2019). Contrary, the function of ANA is to advance and protect the nursing profession. The ANA represents the interest of approximately four million nurses with their role being to support the wellness and health of nurses, promote an ethical and safe working environment, and advocate for the health care issues that affect the nursing practice (ANA, 2019). To achieve this, they have created programs such as Healthy Nurse and Healthy Nation to address issues like violence in the workplace, opioid treatment, healthcare reimbursement, and safe staffing, amongst other issues (ANA, 2019). Therefore, both organizations have influenced my nursing practice. The ANA has initiated a Magnet program, which is something that interests most hospitals in my area. This promotes advanced development and education, creating increased autonomy for bedside nurses, which ultimately leads to better patient care (ANA, 2019). Most hospitals in New York State participate in the Magnet program. I am affected by this because without my BSN, I am unable to attain a job in a health care facility. Therefore, after graduating from an accredited RN program and passing my NCLEX, I have continued to advance my education to obtain my BSN. My state BON, however, has allowed me to practice in the state of New York as a licensed RN with a two-year nursing degree upon passing the NCLEX. I can now practice as a licensed nurse in an acute rehab facility with the scope of practice for a registered nurse, set forth by the BON. The New York State BON outlines the licensing and renewal process of the RN. To obtain a registered nurse license in NYS you must be of good moral character, be at least 18 years old, graduate from an accredited program, complete the NY child abuse, and infection control coursework. After passing the NCLEX-RN exam, one may apply for licensure (NYSED, 2019). Once given a license in the State of New York, the license does not have an expiry date unless suspended or revoked in instances of poor work ethics, among other valid instances. The cost for NYS licensure is $143, and nurses are registered in the NYS in three-year intervals (NYSED, 2019). Registered nurses in NYS are registered in three-year intervals, and re-registration is done at a cost, and nurses who fail to register are restricted from practicing (NYSED, 2019). New York is a non-compact state, which means my license to practice is limited to only New York State. On the other hand, nurses from compact states can practice in their home state as well as any other compact state without having to obtain additional licensure. Currently, there are 34 compact states (NCSBN, 2019). States considered as compact has adopted the Nurse Licensure Compact (NLC) (NCSBN, 2019). Nurses practicing under this compact are required to follow the Nurse Practice Act (NPA) for each state they practice in (NCSBN, 2019). Advanced practice nurses are excluded from the NLC (NCSBN, 20190. Also, in order to be part of the NLC, you must reside in a compact state (NCSBN, 2019). Nurses living in a non-compact state can obtain a license in a compact state although that license is not part of the NCL and only gives them a license to practice in the specific state (NCSBN, 2019). Also, if a nurse from a compact state moves to a non-compact state, they lose their ability to practice as a compact state nurse (NCSBN, 2019).

Discuss the functional differences between the Food and Drug Administration and the Center for Medicare and Medicaid Services (see the web links below).
Discuss how the two regulatory agencies influence your professional nursing practice.
Describe your role as a patient advocate in promoting safety when a patient has requested to use an alternative therapy.

The Food and Drug Administration (FDA) and the Center for Medicare and Medicaid Services (CMS) are two organizations providing resources to the population in US in different ways. The FDA ensures the safety of the public by regulating food and medication. The CMS gives information on insurances, including Medicare and Medicaid, and state and federal health insurance marketplaces. The FDA influences my nursing practice by ensuring that the medication I administer to my patients has passed their quality test, and proper dosing, including the side effects, are outlined in the history attached to the medicine (FDA, 2019). I feel confident that the medication I give to my patients is not harmful according to the oath I took as a nurse. The CMS influences my practice by allowing me to be an advocate for the patient, which is another duty required of nurses. Since not all patients can afford health insurance, options like Medicare and Medicaid are available for low-income earners, including persons with disabilities that are over the age of 65 (CMS, 2019). The CMS also ensures quality standards in long-term care facilities through its certification and surveying process. Working in a nursing home, I am constantly advocating for quality patient care, and it is my role as an RN to be an advocate for patients who may request the use of alternative therapy instead of the prescribed course of treatment. All patients have the right to autonomy, choose the kind of treatment they want, reject treatment, and enquire about the facts concerning their treatment. My role as a nurse is to ensure patient’s needs are safely met in a safe environment. If a patient requests alternative therapy that is not within their plan of care, I have to make sure they are making an informed decision by providing them knowledge on the risks, benefits, as well as possible out-of-pocket costs for anything that will not be covered by insurance. This may include medications not approved by the FDA.

Discuss the purposes of the Nurse Practice Act in your state and its impact on your professional practice.
Discuss the scope of practice for a RN in your state.
Discuss how your state defines delegation for the RN.

The Nurse Practice Act (NPA) is a statute in each state that regulates nursing practice (text). It is designed to protect the health of the patient by outlining nursing practices. In New York State, the NPA allows nurses to function independently when providing care as long as the nurse practices within their ability. For registered nurses, this means diagnosing and treating health issues through counseling, teaching, case finding by providing care that supports the well-being and life of patients and adhering to the medical regimen prescribed by an authorized licensed professional under the NYS commissioner. Practicing outside of an RN can lead to convictions of misconduct. RNs have the role of delegating while maintaining the responsibility of the outcomes to other staff members as part of their scope of practice (Registerednursing.org, 2019). In NYS, registered nurses can delegate tasks to LPNs and unlicensed assistive personal (UAP) as long as the task they are delegating is within the LPN’s or UAP’s scope of practice (NYSED, 2019).

Apply each of the following roles to your professional practice:

Nurse as a Scientist:

A scientist is defined as, “An individual studying or has knowledge in one or more of the fields of natural or physical sciences” (“Scientist,” 2019). Nurses are constantly studying to gain more knowledge in their field concerning the latest information and advanced practices for them to provide quality care to the patient. The nursing profession incorporates research to use as evidence alongside the clinical expertise gained while studying nursing. As a practicing nurse, I find the use of evidence-based practice allows my patients to access the updated treatment methods, and as a result, I see more positive responses, particularly with wound care.

Nurse as a Detective:

Nurses work as detectives by observing their patients and looking for underlying issues and changes in their condition to prevent adverse outcomes. I consider myself a detective in my practice because I constantly assess my patients for changes in vital signs, mental status, and behavior and use those changes to establish what is going on with my patient. This includes using verbal and non-verbal cues related to their psychosocial well-being. All my patients are treated with a holistic approach, and I believe the mind affects the body. By identifying subtle changes early, I can get ahead of adverse events.

Nurse as a Manager of the Healing Environment:

As the manager of a healing environment, it is my responsibility as a nurse to create a therapeutic atmosphere. I believe that for an environment to be therapeutic, it must be centered on the patient’s needs. Patients should be treated with a holistic approach because treating a disease is not just physical but involves the psychological aspect. A patient’s mental state plays a large part in their healing process. As an RN, I have to be compassionate and respectful. I need to be a counselor, educator, and advocate, respecting their preferences and needs, even if I disagree with their choices.

Identify two provisions from the American Nurses Association (ANA) Code of Ethics
Analyze how the two provisions identified in part G influence your professional nursing practice.
Describe a nursing error that may occur in a clinical practice (e.g., clinical setting, skills lab, or simulation).
 Explain how the ANA provisions identified in part G can be applied to the error discussed in part G2.

Two provisions identified from the American Nurses Association (ANA) Code of Ethics are: Provision One, “The Nurse Practices with Respect and Compassion for the Inherent Dignity, Worth, and Unique Attributes of Every Person,” and Provision Three, “The Nurse Advocates for, Promotes and Protects the Rights, Safety, and Health of the Patient (Hegge, 2015).” Provision One is the base of my nursing practice. I value my relationship with every patient, meaning that I respect their right to healthcare and dignity, regardless of any factors that resulted in their condition. It is my duty to provide optimal health care to each patient without bias. Provision Three supports my duties for Provision One. Because nurses are patient advocates, I advocate for my patients on a daily basis by honoring their decisions regarding their health care and ensuring they are aware of their condition and have the knowledge to make decisions based on the information given. I also ensure their right to confidentiality, even if it means intervening between them and their family members. This can be difficult but is a basic requirement in protecting a patient’s right to privacy.

Promoting patient safety is an important part of nursing, especially when it comes to administering medicine. One of the most common errors in the medical field is administering the right doses. Larger institutions have advanced computer systems that reduce medication errors. However, smaller, less funded establishments rely more on an honor system when administering meds. Working in a small, short-term facility, I am aware of how common medication errors can be. Part of provision three states, “Nurses must participate in the development, implementation, and review of and adherence to policies that promote patient health and safety, reduce waste and errors, and sustain a safety culture (Hegge, 2015).” This means if a policy in a facility states that there need to be certain steps performed to optimize patient safety when administering medication, everyone should adhere to such steps regardless of their feelings towards the process. For example, at my job, we are supposed to identify the patient, triple check the medication we are giving against the MAR, and then re-examine the patient before providing the mediation. Most nurses at my job fail to follow any of these steps because they are time-consuming, and they feel they know the patients well enough that they don’t need to identify them. However, orders are routinely changed by the MD, and there have been instances where discontinued medication was administered. Had the policy in the facility been followed, such medical errors could not have occurred.

Identify four leadership qualities or traits that represent excellence in nursing.

Four leadership traits or qualities that represent excellence in nursing are empathy, advocating for the truth, accountability and good communication skills.

Discuss the significance of the four leadership qualities identified in part H in the nurse’s role as each of the following:

A leader at the bedside: Bedside nursing is the main duty that I envisioned doing when I was in nursing school. In reality, this is a minor part of the job due to short staffing and the increased requirement for documentation. That’s why I must apply leadership skills to ensure quality care in the short time I spend at the bedside with my patients. I am always empathetic to my patients, and I listen to what they have to say while taking their emotional needs into account when coming up with a care plan. Therapeutic communication is important in creating trusts, which is why I give them time to express themselves, ask open-ended questions, and never address them as a professional but rather their confidant. I hold myself accountable for meeting their needs, and I am also responsible if I fail to meet their desired needs. Finally, I make sure that all my patient’s needs are addressed by mobilizing my team while assisting them in the decision-making process

Within a nursing team or interdisciplinary team: I always use my leadership qualities when interacting with the interdisciplinary team. All my interactions with my fellow staff members are centered on the needs of my patients. Good communication skills are crucial when interacting with the medical team, whether in an emergency situation where information must be relayed quickly or in a group report where concerns are addressed. I have learned that communication is important when stating opinions or advocating on taboo issues because people can become offended easily, and a simple situation can escalate into a major issue. Therefore, good communication entails verbal and non-verbal gestures. I hold myself accountable for everything I say, whether right or wrong. Lastly, I use empathy when interacting with my nursing team, especially new nurses. I remember the stress and pressure of being a new nurse, and so I am always empathetic when speaking with new nurses.

Identify how your work environment impacts the following:

Nursing leadership: The staff I work with directly affects my nursing leadership. Nurses have an obligation to delegate and educate other staff members. Certain staff members are more resistant to delegation than others. This can make being a leader challenging because it creates tension in the work environment and can have a spiral effect on the rest of the staff. Being a good leader entails the knowledge of how to handle situations of conflict in the workplace.

Decision making: My work environment supports decision making. In NYS nurses are given autonomy under their scope of practice. My job allows us to use our autonomy when providing care to our patients, as long as our decisions are focused on the effective treatment of the patient. We are allowed to alter treatment orders for wounds if we feel something isn’t working or something would be more effective. We are also allowed to write orders for medications like Melatonin or discontinue orders like Senna Plus, a stool softener if we perceive that it is for the better of the patient’s interests.

Professional development: My job impacts personal development by providing continuous training and room for growth in an organization. Nurses are required to attend routine in-service meetings to discuss the proper use of equipment, wound care, and new products for purposes of delivering quality health care to patients. Working in a short-term facility enables us to handle more responsibilities compared to larger institutions, which is beneficial to us because it gives room for experience. Additionally, there are different nursing positions in the facility where I work that gives nurses an opportunity for growth and experience.