Running head: Self-Assessment of Nursing and Ethical Standards of Practice

Self-Assessment of Nursing and Ethical Standards of Practice Emily W. Kosmicki Ferris State University

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Abstract The American Nurses Association (ANA) developed sixteen standards of practice and nine ethical standards to which nurses are responsible to uphold. This paper will examine my (Emily Kosmicks) opinion on if these standards are currently being met and provide rationale on each standard and provision. For areas not being met, a plan of development and goals will be discussed as to how standards and provisions will be met in the future.

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Self-Assessment of Nursing and Ethical Standards of Practice The American Nurses Association (ANA) set forth sixteen standards of practice as well as nine ethical provisions that nurses are responsible to know, understand, and abide by in order to provide adequate care to their patients. This paper will examine each standard/provision to determine if each is being met. If standards are not currently being met, a plan will then be discussed on as to how each standard/provision will be met in the future to ensure that I am meeting the standards and ethical provisions of nursing. Assessment Thus far in nursing school, I have been taught competent assessment skills are crucial to being a successful nurse. Through thorough assessment, a nurse is able to establish a patients base-line condition and notice any pertinent health changes. The better developed a nurses assessments skills are the better she will be able to provide optimal care for patients. According to the ANA (2010), the nurse is responsible for the ongoing collection of assessment data that includes but is not limited to: physical, functional, psychosocial, and emotional while identifying any barriers that may interfere with quality care. Assessment data can then be synthesized and the nurse can prioritize tasks to be done using evidence based best practice. Although I have had limited opportunities to practice my assessment techniques in the clinical setting, I feel this is a skill I am competent in completing with my patients. My assessment technique includes a full head to toe analysis while focusing on any admitting diagnosis problem area. For example if a patient came in with a small bowel obstruction, it would be important to ask about localized pain in the abdominal area and pain rating as well as if they have passed any gas. During my physical assessment, conversation will allow me to assess the patients cognitive and emotional status as well asking questions regarding environmental

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and support systems. As my experience as a nurse grows, I understand that my assessment skills will continue to improve as I become more knowledgeable on the disease processes of my patients. However, I feel that I have created a sound assessment technique for myself that will only continue to improve as I care for each new patient. Diagnosis The second standard discussed by the ANA (2010) discusses the need for the nurse to analyze the assessment data in order to diagnose and detect any additional issues that will be relevant to patient care. Steps of diagnosis include: developing diagnoses from assessment data, validating diagnosis with the interdisciplinary team, patient, and patient family, identifying potential risks or barriers, and lastly to document the diagnosis that clearly lays out the expected plan of care (ANA, 2010). I currently feel I have met this standard in that with each patient I follow the above discussed ANA expectations. My knowledge base of diagnoses at this point is not as vast as an experienced nurse, yet I feel that I thoroughly analyze assessment data, read progress notes from the interdisciplinary team and ask questions as needed, develop a plan to overcome any potential boundaries. If I have questions that are unable to be answered through the ANA diagnosis process, my clinical instructor does a wonderful job of answering questions regarding diagnoses and assessments while utilizing patient information found in Cerner. Outcome Identification The next scope of practice as identified by ANA is for the nurse and patient to identify outcomes that are desired based on diagnosis. This will be done through including feedback from all members of the interdisciplinary team, considering risks and potential barriers, using evidence

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base best practice, identifying cultural/ethical considerations, an estimated time for outcome, and for the nurse to document outcomes and progress as measureable goals (ANA, 2010). As a student nurse I have limited input to develop specific outcomes with measureable goals, but I feel that it is my responsibility to be as involved in the process. I aim to ask questions of the therapists, dieticians, physicians, discharge planner, etc. to understand their rationale for certain decisions. This action on my part has been beneficial to the patient in that when questions may be asked, I am able to answer with an educated response. At this time, I believe I am meeting this standard to the best of my ability and with my continued clinical experience this skill will strengthen my outcome development skills. Planning For optimal health for the patient, a plan must be established in order to reach the desired outcome. As stated by the ANA, the nurse develops an individualized plan in collaboration with the patient, family, and interdisciplinary team that incorporates the diagnosis, promotion of health, continuity of the plan, and to modify the plan as needed (ANA, 2010). The plan should include strategies that will not only help reach goals in the hospital setting, but also will help attain a better quality of life in the home environment. A timeline for goals should be laid out and discussed with the patient so that expectations are known. Throughout the planning process, patient involvement is key so that health practices, preferences, coping mechanisms, cultural considerations, and potential barriers can be taken into account when developing and plan for desired outcomes (ANA, 2010). I feel I am currently meeting this standard because, as we learned in class, the (discharge) planning process begins as soon as a patient is admitted. It is important to discuss with the patient the expectations and goals for themselves and then collaborate a plan accordingly. For

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example, a patient of mine had expectations for herself to return home after her stay for a total hip replacement yet it was highly recommended by her physician and therapist to attend subacute rehab for more therapy. As a student nurse, I was able to discuss expectations of how her overall goal to return home could be met by developing a timeline and overall plan to reach optimal well-being. Implementation After a plan is formed by the nurse and patient, it must then be implemented. This standard is divided into two groups; coordination of care and health teaching/promotion. The nurse is responsible to: organize, manage, assist, communicate, and advocate all aspects of the plan to all parties involved. Health teaching and health promotion implementation strategies for the nurse include: using teaching methods appropriate for patient, being open to feedback and evaluation, and to provide patient with information on intended effects and potential barriers of given information (ANA, 2010). I feel I am currently meeting this standard on a regular basis in my clinical setting. At the beginning of every shift, the patient is asked their goal for that day. It is my responsibility as a student nurse to help that patient achieve goals and develop a plan as to how that goal will be implemented throughout the day. While achieving the short-term goal of the day, it is also important to take into consideration long-term goals and implement care accordingly so that goals can be met and the patient can recovery in a timely manner. Evaluation Evaluation is an ongoing process throughout the implementation phase of the plan. Assessment and evaluation uses continuing assessment data to change diagnoses, outcomes, plan, and interventions as needed (ANA, 2010). With input from the patient, the nurse can then

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make appropriate changes to treatment and communicate with appropriate individuals involved in care. The nurse is responsible to constantly evaluate the progress towards meeting a patients goals. Collaboration with the patient on the effectiveness of the plan is key to help achieve desired goals (ANA, 2010). I feel I have not met this standard at this point in my nursing career. It is hard to evaluate the effectiveness of a plan developed for a patient due to limited involvement in the planning process. Many of the patients I have taken care of in the clinical setting, I meet the same day that they are discharging home. This hinders my involvement in the planning and evaluation process of the patient meeting their goals. Although I am able to review the patients chart to track their progress throughout their hospitalization, I feel it is not as beneficial as being involved from admission. I am eager to maintain a continuity of care with patients when I am able to be involved from admission to discharge and evaluate progress along the way. Ethics Upholding an ethical integrity is important in any profession, however a nurse is ethically responsible for all patients. The nurse must act in ways that protects the patients autonomy, dignity, rights, and values (ANA, 2010). By law, a nurse must withhold patient privacy and confidentiality and respect healthcare choices being made with bias (ANA, 2010). The nurse must serve as the patients advocate and may question actions that may jeopardize the patients health and safety (ANA, 2010). I feel I have fully met this standard. In the clinical setting, I strive to do what is ethically right in every aspect of patient care. I advocate for my patient(s) on a daily basis on tasks as simple as getting a diet upgrade up to questioning a medication that may have potential side effects. As my experience in the field grows, I am sure I will be placed in situations that may

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question my own morals, however it is vital to always advocate for the patient and provide the best quality care. Education In order to give the most competent care that reflects current nursing practice, nurses must commit to lifelong learning (ANA, 2010). Educated nurses stay in-tune with current professional issues and take the initiative to engage in experiences that reflect current best practices. Through involvement in formal and independent learning experiences, the nurse is able to develop and maintain professional knowledge and apply to a given setting or population (ANA, 2010). Nurses can educate peers in an informal setting to better the practice of the work environment. A detailed record of taken educational opportunities should be maintained to provide evidence for upkeep of nursing knowledge and skills competencies (ANA, 2010). I feel I have not fully met this standard. My education thus far in my nursing career has been under university curriculum. Once I have graduated and find a job, I will be constantly trying to better myself as a nurse through conferences, teachings, and classes. For the remainder of my time in school, I will continue to educate my peers on beneficial information as well as take advantage of every learning opportunity possible in the clinical setting. Evidence-Based Practice and Research Through participation in education, the nurse is expanding their knowledge in evidence based practice. The nurse then, utilizes current evidence-based nursing knowledge, including research findings, to guide practice (ANA, 2010, pg. 71). Interventions deemed best practice have been researched and incorporated evidence when implemented in practice. As with education, it is ethical for the nurse to share knowledge and research with peers to provide best care (ANA, 2010).

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At this point in my nursing career, I feel I am meeting this standard to the best of my ability. In the class-room setting, I am being taught evidence-based practice but then am put in a hard place if the nurse I am following in the clinical setting may have a different way to perform a skill. I believe I will meet this standard completely when I am able to incorporate evidence base skills into my own practice. Quality of Practice In order to deliver effective care, the nurse must contribute to quality nursing practice (ANA, 2010). The nurse can provide quality care to patients by demonstrating the nursing process in a responsible and ethical manner, using creativity and innovation to improve care, and by an ongoing participation in quality improvement. Participation in quality improvement can include collecting and analyzing data, using indicators to monitor quality and safety of care, communicating recommendations, and evaluating overall care and services being implemented (ANA, 2010). I feel this is a standard I have partially met. While I am involved in the quality of care for my patients on the days I am able to interact, my experience with the whole quality care process has been limited. I have not had the opportunity to be a part of quality control measures implemented for a certain problem or to improve quality care on a particular unit. While I am on the floor as a student nurse, I am able to overview a quality of practice change and implement the changes to the best of my ability. In the future, I hope to be part of committees responsible for improving quality care wherever I am employed. Communication As stated by the ANA (2010), the nurse must communicate effectively in a variety of formats in all areas of practice (pg. 74). The nurse should be constantly evaluating

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communication techniques of self and to co-workers, patients, and families to ensure continuity of care and to minimize risks. If the nurse were to ever question rationale being presented, the nurse should communicate concerns in a professional manner to the appropriate individuals (ANA, 2010). At this point in my nursing career, I feel I have fully met this standard. I strive to maintain open communication with my patients, physicians, patients families, therapists, etc. Through open communication, I am not only to educate myself on the sequence of events but also am able to provide informative answers to patients and family members. Leadership The ANA (2010) states that, the registered nurse should demonstrate leadership in the professional practice setting and the profession (pg. 75). Qualifications of a nurse leader include overseeing the nursing care given to others, abiding by the values, mentoring others, treating colleagues with dignity and respect, and participating in professional organizations. A nurse leader is constantly striving to better educate self and share any obtained knowledge with others (ANA, 2010). I do not currently meet this standard. With my limited experience in the nursing field, I have not yet had the opportunity to oversee others, mentor others, and or participate in professional nursing organizations. As I establish myself in the nursing field, I am confident that my leadership skills will grow with experience. Collaboration In order to deliver quality effective care to the patient, the nurse must collaborate with the patient, family, and all healthcare professionals involved (ANA, 2010). This can be done by sharing knowledge with others that can effect change to produce a positive outcome. Throughout

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the collaboration process the nurse must adhere to the standards and codes of conduct to create a desirable work environment. Through team-work and effective communication, the patient will receive optimal care towards desired outcomes (ANA, 2010). I believe I have met this standard. In my clinical setting, I am constantly collaborating with CNAs, physicians, therapists, discharge planners, patients family and patient. In order to communicate effectively, all involved individuals must collaborate on a daily basis to ensure quality care. For example, during clinicals I was caring for a post-op patient that requested a diet upgrade. I had to collaborate with the physician, speech-therapy, and the dietary department to ensure that the request was not only safe but feasible. Professional Practice Evaluation The registered nurse evaluates her own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules and regulations (ANA, 2010, pg. 79). A nurse should be constantly engaging in self-evaluation to identify areas of strength and areas where professional growth is needed. Interaction with peers, patients, and professional colleagues can provide informal feedback and can enhance the nursing process. It is the responsibility of the nurse to take action to achieve set goals throughout the evaluation (ANA, 2010). I believe I have partly met this standard. My interactions with peers, patients, and other nurses help to provide feedback on how I can better my practice, although my experiences so far have been limited. I feel I am constantly evaluating myself and how I could have handled situations differently. Constructive criticism from others will help to improve my practice of the nursing process. Once the patients needs are identified, the nurse must then collaborate with the appropriate health care professionals to delegate elements of the task.

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Resource Utilization In order to provide optimal care, the nurse will utilize appropriate resources that are safe, reliable and financially feasible for patients (ANA, 2010). The nurse must assess the patients needs and resources available to reach desired goals. Throughout the continuum of care, the nurse is to help the patient and family in factoring cost, risks, benefits, availability, and securing the needed appropriate services. The nurse can then modify the practice along to way to best fit the patients needs and to maintain continuity of care (ANA, 2010). I currently meet this standard. When discharging patients, I have had to opportunity to work with the discharge planner to ensure proper resources have been set up for the patient prior to going home. These resources could include setting up home therapy, visiting nurses, scheduling follow-up doctor appointments, providing education on Meals on Wheels or any other resource benefiting the patient. Environmental Health The registered nurse practices in an environmentally safe and healthy manner (ANA, 2010, pg. 81). The nurse is constantly assessing the environment to reduce potential health risks. Any potential risks must then be communicated to colleagues, the community, and patient/families as deemed appropriate. As the nurse continues to attain knowledge on environmental health concepts there should also be participation in strategies to promote healthy environments (ANA, 2010. I feel I currently meet this standard. At my clinical site, I constantly assess ways to reduce potential health risks. The task may be as small as closing the door for a patient if there is

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noise in the hallway, making sure I am using proper hand washing technique, or using sterile technique when placing a catheter. Ethical Provision 1 The nurse, in all professional relationships, practices with compassion, and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems (ANA, 2001, pg.1). Under this provision, the nurse must respect dignity while forming a therapeutic relationship with patients and co-workers regardless of the nature of health problems or work environments. The nurse serves as the biggest advocate for patient rights and must respect the patients right to self-determination once educated on possible outcomes (ANA, 2001). I believe I have met this provision in both my personal and professional life. Every aspect of my life, I try to keep in mind treat others as you would want to be treated. Regardless if I agree with a patients beliefs, lifestyle options or treatment plans after education, it is still important to advocate and show compassion through quality care. Ethical Provision 2 The nurses primary commitment is to the patient, whether and individual, family, group, or community (ANA, 2001, pg.1). The primary role of the nurse is to advocate for the patient. Each patient will have different and unique needs and it is the responsibility of the nurse to reflect the uniqueness in the plan of care. The nurse should include the patient in the planning process of setting goals for optimal outcomes (ANA, 2001). The nurse must recognize any conflict between personal beliefs, beliefs of co-workers, and values of the patient. After any conflicts are resolved, collaboration between members of the interdisciplinary team is essential to meet the outcomes identified (ANA, 2001).

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I believe I have met this provision. In the clinical setting, I am in constant communication with the patient, patients family, nurses, and other members of the interdisciplinary team. Advocating for the patient is always my top priority. For example, a patient was adamant about not going to a nursing home to continue rehab. Although, I felt it was not in the best interest go home instead of sub-acute rehab, I still had to respect the patients decision. Once her decision was made, I collaborated with the discharge planner to set-up home therapy to maintain quality care regardless of the conflict. Ethical Provision 3 The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient (ANA, 2001, pg. 1). At all times the nurse must safeguard the patients right to privacy and maintain privacy of all information. The patient will not be involved in research without fully understanding and consenting to partake. The nurse is also held responsible to ensure that those treating the patient maintain standards of the given profession and must act on questionable practices (ANA, 2001). At this point in my nursing career, I feel I have partially met this provision. It is important patients are educated on HIPAA and that they know their privacy and confidentiality are always kept. As a student nurse, I always make sure to shut the patients door before conversing, educating, or providing care. I have not yet had the opportunity to educate patients on participation in research opportunities nor have I had to question another health-care professionals practice as I am still becoming oriented to the nursing process. Ethical Provision 4 The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurses obligation to provide optimum

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patient care (ANA, 2001, pg.1). This provision states the nurse is responsible and accountable for direct care activities, acts of delegation, and leading, teaching, and administration (ANA, 2001). The nurse is also responsible to delegate nursing care tasks to other workers. An effort must be made by the nurse to evaluate the knowledge, skills, and experience of the individual that tasks are delegated to because ultimately the nurse is held responsible and accountable for the patient to receive optimal care (ANA, 2001). At this time, I feel I have not completely met this provision. I completely understand that I am responsible and will be held accountable for my actions in the clinical setting. However, I am almost always working with an R.N. that voices opinions or educates me on certain aspects of practice. I have been able to delegate tasks (vitals, showers, ambulating patients, etc.) to the C.N.As at clinicals when I have been tied up in other obligations. Ethical Provision 5 The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth (ANA, 2001, pg.1). Through maintaining moral self-respect, competence, wholeness of character, and preservation of integrity, the nurse is able to better interact with patients, coworkers, and feel confident and knowledgeable. A competent nurse is constantly evaluating personal and professional values and ethics to ensure that care is not being jeopardized (ANA, 2001). Although I have limited experience, I feel I have met this provision. I strive to treat each person I meet with the respect they deserve and I believe this stems from having moral selfrespect. I have a sound base of my own personal ethics and values, which will help with constant

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evaluation of professional ethics. Nursing is a field where one is constantly learning and I have made the commitment to life-long learning to provide the best possible care to my patients. Ethical Provision 6 The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action (ANA, 2001, pg.1). The environment that a nurse works in plays a role on moral virtues, values, and ethical obligations. Virtues allow nurses to fulfil their ethical obligations. In order for this to be done, nurses are responsible to create, maintain, and contribute to environments that attribute to ethical responsibilities. A positive work environment, health and safety initiatives, respectful interactions, and identification of issues to be addressed all contribute to quality health care (ANA, 2001). I feel I have partly met this provision. As a nursing student, I have had limited opportunities to have a direct influence on changing the health care environment. I do what I am able to create a desirable environment for the patient, nurses, and co-students by offering assistance, positive interactions, and discussing issues that may arise on the unit. Ethical Provision 7 The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development (ANA, 2001, pg. 2). Nurses are expected to advance the profession through active involvement in committees, politics, teaching, and serving as leaders. Continuing education through the development, evaluation, dissemination, and application of knowledge will uphold the obligation for best practice.

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As I am still in school for my Bachelors Degree for Nursing, I have not met this objective. I have witnessed at clinicals, nurses that have been working for over 10 years, still learn something new on a daily basis. As a nurse, it is important to understand the value on staying current and knowledgeable on evidence base research in order to provide the best patient care. Ethical Provision 8 The nurse collaborates with other health professionals and the public in promotion community, national, and international efforts to meet health needs (ANA, 2001, pg. 2). The nurse is to be aware of health needs and concerns of people on a community, national and international level. Barriers to health can be identified and the nurse can collaborate with other health care professionals to support initiatives to overcome (ANA, 2001). I feel I have met this provision. While I collaborate with social workers, physicians, therapists and discharge planners to ensure health care needs are met before returning to the community it is also important to evaluate other potential barriers that may be encountered in the community setting (homelessness, abuse violence, and lack of access to healthcare). I make an effort to truly get to know the patient to try and identify any potential barriers to then educate and provide resources. Ethical Provision 9 The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping public policy (ANA, 2001, pg. 2). Nurses can act individually or collectively through organizations to develop ways to clarify accountability, assert values, uphold professional integrity, and be involved in social reform (ANA, 2001).

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At this point in my nursing career, I have not had the opportunity to participate individually or through an organization (such as the ANA). However, when I am working in the field I plan to join ANA to be involved in the progressive nursing practice. Development of the Plan and Goals At this time, there are several practice standards and ethical provisions that I am not meeting. Standards of practice and provisions that I have not fully met include evaluation, education, evidence base practice, leadership, and ethical provisions 4, 6, 7, and 9. Through recognition of not fully meeting these standards, I have developed a plan to meet these in the future. Although I am not sure where I will begin my career as a nurse, I have been told that many local hospitals have a quite lengthy orientation process of up to 5 months. This will help to fine tune my assessment skills, outcome identification, and evaluation process which will help meet the evaluation practice standard. Once orientation is complete, I plan to participate in continuing education opportunities that are offered by my employer and also seek out learning opportunities on my own that will allow me to keep up on evidence base best practice. Continuing education will always be ongoing as long as I am working as a nurse. Through doing this, I will meet the continuing education and evidence base practice standard. I hope that after 3 years as a nurse, I will have naturally developed leadership skills to mentor others, work as a manager, and serve on committees or policy change boards. Through increased self-assurance and knowledge, I will have the confidence and understanding to delegate tasks to co-workers and feel poised in my decisions. I feel that ethical provision 4 and 6 will be met by the time I have worked as a nurse for at least 4 years.

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After graduation, I plan on joining the American Nurses Association. Membership in this organization would allow me to be a part of policy changes, evidence base practice, and new procedures. Through involvement, I would be meeting ethical provision 7. At this point, it is hard to determine my direct involvement but I aim to maintain this provision throughout my nursing career. I feel that it will be beneficial to my nursing career to review the standards of practice and ethical provisions on yearly basis and truly reflect on if I am currently meeting each point. Although curve balls may be thrown along the way, it will be important to remember the reason I become a nurse in the first place and question if I am holding myself to the highest standards of care possible. Conclusion Nurses have a great responsibility to uphold to serve patients, the community, and themselves. Nurses must provide ethical and competent care as stated in the ethical provisions and scope and standards of practice set forth by the American Nurses Association. The practice of nursing is constantly changing and nurses are to keep up with changes to provide the best care. Through working through this assignment, I have identified potential challenges that I will face as a nurse and developed a plan to be the nurse I am capable of becoming.

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References
American Nurses Association [ANA]. (2001). Code of ethics for nurses with interpretive statements. Retrieved from http://www.nursingworld.org/MainMenuCategories/ EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf American Nurses Association (2010). Nursing: Scope and Standards of Practice (2nd ed.). Silver Spring, Maryland: Author.

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