Role And Value

14 Aug Role And Value

A nursing theory that has influenced my values and goals is Dorothea E. Orem’s Self-Care Deficit Theory. Orem’s theory is made up of three related theories: theory of self-care, theory of, self-care deficit, and theory of nursing systems. According to Orem, “the three-part theory focuses not on individuals, but on persons in relations. Each of the three theories has as its focus a specific dimension of the person: the theory of self-care focuses on the self, the I; the theory of self-care deficit focuses on you and me; and the theory of nursing system focuses on we, persons in community” (1990, p. 49).

Nurses apply Orem’s theory all the time in order to implement excellent nursing practices. Nurses use Orem’s theory to collect patient data during the assessment process. This helps nurses examine potential areas of self-care deficits a person may have. Using the Self-Care Deficit Theory in practice also assists the nurse in identifying the nurse’s role in assisting or supporting the person in order to meet those needs.

Dorothea Orem’s theory fits my professional practice by providing a solid basis for assisting my patients and giving them the opportunity to assert independence and control in caring for themselves. When my patients are ready to be discharged I provide them with health education on self-care which comes from the principles of self-care and the concepts discussed in Orem’s theory (Taylor, 2006) (Jr., 2009) (Jr., 2009).

Florence Nightingale is probably the most well-known name in the nursing profession. Of her many contributions she is most known for being the pioneer of modern nursing. Many of our sanitation practices can be linked to Nightingales knowledge and research. Another historical nursing figure was Linda Richards. Richards laid the foundation for modern nursing education.

Florence Nightingale’s focus during her career was on ways to extend health and survival rates of hospitals. She discovered that many soldiers were dying during the Crimean War in the 1890’s because of unsanitary conditions. She addressed the more basic problems of providing clean food and water, ventilating the wards, and providing appropriate medical supplies (Winkel, 2009). In contrast, Linda Richards was not known for her contributions to direct bedside care. She is credited for being the first trained nurse and who’s life work was dedicated to not only training nurses but also in educating them. She also took it upon herself to reorganize and design a better method of record keeping that both the United States and United Kingdom adopted (2016).

Both of these historical figures influence my professional nursing practice. Even though Florence Nightingale did not believe in the concept of bacterial infection, she influenced and created many sanitary practices we still use today (Winkel, 2009). For example, something as simple as providing clean gowns and linens to patients daily came from Florence Nightingale. If it wasn’t for Linda Richards medical records could possibly be a disorganized mess as they once were. Instead we have a very organized interdisciplinary method for record keeping.

The main functional difference between the State Board of Nursing and the American Nurses Association is that a board of nursing regulates the nursing practice while the American Nurses Association advocates for nurses.

It is the responsibility of the state boards of nursing to enforce each state’s nurse practice act with the goal of protecting the public. The role of the American Nurses Association is to advance and protect the profession of nursing (2009).

Both organizations have a heavy influence on my nursing practice. The State Board of Nursing assures that care is being provided by safe and competent licensed nurses by outlining the standards for safe nursing care and issuing licenses to practice nursing. The ANA affects my nursing practice in many different ways. They advocate for nurses on health care issues that affect all nurses from fostering high standards, promoting safe and ethical work environments, to influencing legislation.

There are three requirements a nurse must meet in order to renew their nurses license in the state of Florida. The Florida State Board of Nursing requirements are: One, complete all required CE credits and report them to CEBroker.com; two, complete the renewal application; and three, pay the required fees.

Unlicensed practice is a third-degree felony in Florida. Consequences range from $5,000 in penalties to having your license permanently revoked. Unlicensed practice includes practice without an active license or practice with a suspended, revoked, or void license but not an inactive or delinquent license for up to 12 months. It is a first degree misdemeanor to practice with an inactive or delinquent license for up to 12 months, but for more than 12 months, it is a third-degree felony (Florida Nurse Practice Act, 2008).

A Compact State license, or multi state license, allows nurses to practice in different states without having to obtain multiply licenses or pay additional fees. The registered nurse has to meet the license requirements in the state of their home residence. Fees may vary state to state regardless of its compact state status.

The Food and Drug Administration regulates the marketing and use of medical products; while the Center for Medicare and Medicaid Services regulates reimbursement for healthcare products and services for two of the largest healthcare programs in the country (Medicare and Medicaid).

Both of these regulatory agencies influence my professional nursing practice because of their interest in the safety and the effectiveness of medical products and services and in providing information in order to minimize risks associated with the therapeutic choices made while delivering health care (2009). The FDA has a regulatory responsibility for the drugs and medical devices I use in my practice every day.

It is my responsibility to maintain patient safety when a patient has requested to use alternative therapy. All of which would include me getting permission or approval from a health care provider to begin with, and then providing the patient with more education and resources.   The purpose of the Florida Nurse Practice Act is to ensure every nurse meets the minimum requirements to practice nursing safely.

The scope of practice for a registered nurse in the state of Florida is said to be “the performance of those acts requiring substantial specialized knowledge, judgment, and nursing skill based upon applied principles of psychological, biological, physical, and social sciences which shall include, but not be limited to: 1. The observation, assessment, nursing diagnosis, planning, intervention, and evaluation of care; health teaching and counseling of the ill, injured, or infirm; and the promotion of wellness, maintenance of health, and prevention of illness of others. 2. The administration of medications and treatments as prescribed or authorized by a duly licensed practitioner authorized by the laws of this state to prescribe such medications and treatments. 3. The supervision and teaching of other personnel in the theory and performance of any of the above acts” (Florida Nurse Practice Act, 2008).   Florida says when the RN is delegating they must use nursing judgement to determine suitability of the task or activity being delegated. Including factors such as complexity of the task or activity, potential harm for the patient, and how predictable or unpredictable the outcome will be.

Often in my professional practice I play many roles in order to provide the best care to my patients. Sometimes I act as a scientist, using my nursing process and scientific knowledge of the body and disease processes to inquiry and implement clinical decisions.

In my current role as a professional nurse I am often behaving as a detective. On a regular basis I use nursing knowledge and science to detect the slightest changes in my patients through out a twelve-hour shift. Any change noted about my patient will affect my practice and help me maintain the expected outcomes intended for my patient.

It is a part of my practice to collaborate and participate in an interdisciplinary health care team in order to provide my patients with a cohesive healing environment. Which promotes the overall experience and preserves the patients’ dignity and overall human experience.   Two provisions from the American Nurses Association (ANA) Code of Ethics Provisions I have identified are: Provision one – The Nurse Practices with Compassion and Respect for the Inherent Dignity, Worth, and Unique Attributes of Every Person; and Provision four – The Nurse Has Authority, Accountability, and Responsibility for Nursing Practice; Makes Decisions; and Takes Action Consistent with the Obligation to Promote Health and to Provide Optimal Care (2015).

Provision one is the foundation of my professional nurse practice. For every patient and/or family member, and/or caregiver that I encounter I behave and take actions which promote compassion and respect towards the individual. Always protecting their dignity and basic human rights.

Provision four influences my professional practice every day. As a nurse I follow a code of ethics and only conduct myself within that ethical code. I also adhere to my scope of practice and stick with the standards of nursing practice. This to me is an example of how I make myself accountable and responsible for my nursing practice.

A possible error may occur in the clinical setting if the professional nurse improperly delegates a task to an unlicensed personnel in which they are not qualified to perform and/or also leads to inadvertent harm to the patient.

If the registered nurse had executed the task or activity with provision 4.4 in mind the adverse outcome to the patient could have been avoided. Professional nurses have a responsibility to provide a safe environment that supports and facilitates appropriate assignment and delegation of tasks.   Four leadership qualities or traits that represent excellence in nursing are: communication skills, conflict resolution, empathy, and delegation skills.

As leader at the bedside the nurse must possess superior communication skills. The nurse should be able to explain and listen to a patient in a way in which the patient understands and feels their questions and concerns are heard. All nurses should have empathy for their patients. If the nurse can empathize with a patient and try to understand their perspective, then this also benefits communication with one another. A nurse at the bedside needs conflict resolution skills in case of an upset patient and/or family member, and/or other staff member involved in the patient’s care in order to maintain optimal patient outcomes and goals. The ability to properly delegate also helps a nurse leader at the bedside prioritize and manage time better for the patient’s best interest.

Within a nursing team or interdisciplinary team, the professional nurse uses all four traits to represent excellence in nursing. Empathy towards patients is also useful to have towards staff. Understanding where your team is coming from can guide the professional nurse when communicating with the staff. Conflicts do happen in the workplace and the nurse leader must know how to resolve conflicts quickly and appropriately in a professional manner in order to keep the team focused on providing the best care possible to all the patients. Also a team leader possesses the ability to delegate tasks and activities appropriately to qualified staff members which ensures the best quality care is provided to every patient in a timely organized fashion.

A nurse leader influences the work environment by creating and maintaining a work culture. A work culture is created by behaviors and consequences. It is the nurse leader’s responsibility to make decisions which cultivate a positive cohesive work environment. Sometimes professional development can be hindered by a negative work culture. In contrast, when the work environment promotes ongoing learning, professional communication, appropriate conflict resolution, and an overall positive vibe the staff will benefit from professional growth.

References

Florida Nurse Practice Act, 6-13 § 464-464.003(4) Retrieved 03 16, 2018, from

http://www.thehealthlawfirm.com/uploads/Ch-6%20Florida%20Nurse%20Practice%20Act%20and%20Scope%20of%20Nursing-revised.pdf

Institute of Medicine (US) Roundtable on Evidence-Based Medicine. Leadership Commitments

to Improve Value in Healthcare: Finding Common Ground: Workshop Summary. Washington (DC): National Academies Press (US); 2009. 10, Regulators. Available from: https://www.ncbi.nlm.nih.gov/books/NBK52854/

Linda Richards, Leader in Nursing. (2016). Retrieved March 17, 2018, from

http://www.nursing-theory.org/famous-nurses/Linda-Richards.php

Registered Nurse (RN). (n.d.). Retrieved March 17, 2018, from

http://floridasnursing.gov/renewals/registered-nurse-rn/

(2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: ANA,

American Nurses Association.

Taylor, S.G. (2006). Dorthea E. Orem: Self-care deficit theory of nursing. In A.M.

Winkel, W. (2009). Florence Nightingale. Epidemiology, 20(2), 311.

doi:10.1097/ede.0b013e3181935ad6