It is my purpose to provide safe and accurate nursing care by educating patients and their families to promote optimal health. It is my goal to assist patients in their journey to self-care by advocating for their health and independence. This nursing mission statement will explain the functional differences between the Idaho Board of Nursing (BRN) and a professional nursing organization (PNO); this will include examples of how the American Nurses Association (ANA) Provisions from The Nursing Code of Ethics influence nursing practice as well as discuss my professional nursing traits described in the Code of Ethics (ANA, 2001).
I will identify and explain Dorothea Orem’s Grand Nursing Theory the “Self-care Deficit Model” that has influenced my professional role as a registered nurse and discuss how Florence Nightingale’s contributions to the profession have impacted nursing practice today (Habel, n.d). Finally, I will discuss how beneficence and respect for autonomy were safeguarded while caring for an obese patient in the clinic where I practice. A. Functional Differences
State Boards of Nursing are government agencies tasked with the regulation of nursing practice. They were created to protect the public’s health and welfare and are responsible for ensuring the safe practice of nursing. State Boards are responsible for issuing and maintaining nurse’s licenses. They ensure practicing nurses are qualified and practice within the scope of their licenses (ANA, 2012). The Idaho State Board of Nursing interprets and enforces the state nurse practice act. Each state has a Nurse Practice Act which are laws defining the qualifications and scope of nursing practice in their state. They are responsible for taking action against those nurses who practice outside their licenses or have exhibited unsafe nursing practice (ANA, 2012). They assist in the accreditation process for approval of nursing education programs (ANA, 2012).
The professional nursing organization, the American Nurses Association (ANA) was developed for nurses by nurses in order to further advance nursing as a profession. It allows nurses to collaborate and share in their best practices; it provides a code of ethics to hold the nursing profession in high standards (Matthews, 2012). What is the difference between the regulatory Idaho State Board and the ANA? The Idaho Nurse Practice Act is comprised of statutes to provide the public with quality health care, ensuring that I am qualified and honest to practice nursing. Nurses like me must maintain valid nursing licenses and practice within the scope of that license according to the nurse practice act of Idaho (ANA, 2012). The ANA supports me in the advancement of my education, promotes my rights in the workplace and lobby government and regulatory agencies on healthcare issues that affect both nurses and the public (Matthews, 2014). B. Nursing Code Examples
The Provisions of the Code of Ethics for Nurses was initiated by the ANA’s board to hold nursing to a higher standard of care (ANA, 2001). I will give two examples of these provisions that influence my career in nursing. Provision three states “The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient” (ANA, 2001). As a nurse I feel it is my duty to advocate for my patients especially when they are naïve to care and services that could better their health, rights and safety. I currently work as a clinical nurse for the Veteran’s Health Administration (VHA) in a small, rurally secluded town. It is important that the Veterans I care for in the clinic get the care they need even though the large medical center is 250 miles away.
The majority of our Veterans are over the age of 60. Traveling long distances for care and long wait periods are simply not a viable option for them. I encourage my provider and the VHA to work together to get the Veterans necessary lab or x-ray testing, annual eye exams and hearing screenings referred locally in a timely manner. The next provision I am influenced by is Provision seven which states “The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development” (ANA, 2001). I participate on the Standard Operating Procedures Committee at the Veteran’s Medical Center where I work.
I serve as a member on the committee to represent five outlying Community Based Outreach Clinics that exist in the smaller communities in two states. It is my responsibility to speak with the nursing leaders in the other clinics to ensure their procedure standards are written documents based on the individual needs of the clinics rather than the medical center. I am also responsible for collecting and reporting for National Patient Safety Goals in our clinic. Goals the VHA works to achieve include standards of care like identifying patients with two identifiers prior to medication administration, nursing procedures and collection of blood work. C. Professional Traits
The ANA lists several professional traits in the Code of Ethics, in this next section we will discuss the four professional traits I bring to an interdisciplinary team found in Provisions three, four and eight. Provision three lists two traits I bring to every patient encounter, privacy and confidentiality (ANA, 2001). In order for me to advocate for my patients it is important that I am able to safeguard their privacy and confidentiality. I work to ensure patient’s physical, auditory and written privacy with the Advanced Nurse Practitioner and the LPN in our clinic. During any examination that requires a patient to undress they are provided a safe exam room with a lock on the door. When a door is closed to an exam room we knock before entering.
We also use tele-health in our clinic and have created signage for the outside of the door that lets people in the clinic know there is an appointment in progress and not to enter. We use this signage for any encounter a patient has with members of the interdisciplinary team who include primary care providers, dieticians, psychiatrists and other specialty providers. Pt confidentiality is also protected in our clinic by ensuring the conversations between patients and providers cannot be heard by passerby’s when using tele-health technology. Confidentiality of patient’s personal information is kept by shredding documents containing their information; email correspondence concerning patients are encrypted to ensure only intended members of the team get the needed information securely. A strong personal and profession trait I possess is accountability.
Provision four discusses the importance of the nurse accepting accountability and responsibility in nursing judgment and action as well as delegation (ANA, 2001). When caring for a patient I am accountable and responsible for any harm or potential harm that I may cause. If I administered a medication incorrectly I am responsible for the mistake and must report it to the primary care provider and the patient. I am responsible for knowing what nursing tasks may be carried out by the LPN or clerk in my clinic. This is based on what the state practice act allows as well as my judgment for how competent they are in that assigned task. I also must you judgment while carrying out orders from mid-levels and doctors. It is my responsibility to carry out tasks I am comfortable and competent doing and voicing any concerns I may have with the rest of the team.
Provision eight states “collaborates with other health professionals and the pubic” (ANA, 2001). As part of an interdisciplinary team it is imperative that I collaborate with other members so the patient can receive safe and appropriate care. There are times when a patient may have an adverse reaction or allergy to a particular medication prescribed by the primary provider. It is my responsibility to report these issues to the provider in order to rectify the situation and have the patient stop the medication causing harm. Sometimes the pharmacist may be consulted by the primary care provider to find an alternate medication for the patient to take. In collaborating with each other we address the issue together and work to find a solution that is best for our patient.
D. Nursing Theory Resource
The theory I most identify with in my professional career is Dorothea Orem’s “Self-Care Deficit Model: Self-Care, Self-Care-Deficit, and Nursing Systems” (Habel, n.d.). A client does not seek my professional advice, instruction or care unless there is a need or concern. D1. Nursing Theory in Practice
Orem’s general theory of Self-Care, Self-Care Deficits, and Nursing Systems states that when an individual becomes ill for any reason and is unable to care for themselves they have a self-care deficit that requires nursing interventions. Self-care refers to the daily, independent cares an individual performs; they are developed over time and have a purpose. The theory provides the patient with nursing interventions based on the nurses’ assessment of self-care (Habel, n.d). The interventions may provide complete care by the nurse, partial care that both the patient and the nurse complete together, or it may be a matter of educating the patient how they can give self-care. The ultimate goal of the nursing interventions is patient autonomy in order to maximize the patient’s personal level of care; to optimize the patient’s growth and restore health and well-being (Habel, n.d.).
This theory correlates with my professional practice on a daily basis in the VA outpatient clinic where I work. Any patient over the age of 70 is screened annually for self-care deficits. A functional, physical and mental screening is performed to asses any self –care deficits my patients may have. The patients are asked about their daily routines like dressing themselves, using a telephone, managing finances and grocery shopping. The individual is rated on a scale from 0-4 where zero is the ability to perform independently to four, which is needs total assistance. When a self-care deficit is found I intervene. If they are not able to dress themselves they sometimes have a spouse or caregiver to do it for them at home; at the clinic I would assist them completely. If the patient lives alone and it is found they have a complete self-care deficit and lack a support system I put in a referral for home health nursing. I may discuss the option, along with the primary care provider, of a long term care facility for the patient.
If a patient can perform some self-care, but the caregiver or spouse needs assistance in day to day cares of the patient I may refer the patient to the social worker to help them find nursing care or respite care at home. Sometimes the patient is unable to operate a telephone because they are unable to hear so I refer them to get a hearing screening and may get them a hearing impaired telephone. I also screen every 6 months for post-traumatic stress disorder (PTSD) and depression since the Veterans may have participated in combat or experienced some other traumatic insult that they require assistance dealing with mentally. If they screen positive for PTSD or depression then I refer them to the social worker to assist the individual with their mental health.
The majority of my practice involves educating patients and their families about a diseases and disorders such as high blood pressure, diabetes, heart failure, obesity and many other illnesses. This self-care deficit requires education to reach the goal of self-care by the individual. I use written hand outs and instructions to teach individuals how to manage their disease whether it is how to monitor their blood pressure at home or what foods are good sources of nutrition. Patients come to the VA clinic because they have a basic need for care. The nursing system in Orem’s theory describes nursing interventions from wholly compensatory which is total, dependent care; partially compensatory, when the patient can meet some self-care needs with some degree of nursing intervention and finally the nurse acts in a supportive teaching role (Habel, n.d.) All of these nursing interventions are aimed at patient autonomy so the individual can meet the goals to maintain or improve health and restore self-care
E. Nursing Contributions
When I think of historical nursing figures there is always one who comes to mind above any others. Florence Nightingale is possibly the most famous and recognized for changing nursing from domesticated home care of the ill to a respected profession. Florence Nightingale was a pioneer for human advocacy. Although Nightingale did not specifically define advocacy in nursing, she wrote letters of correspondence, government documents and books that describe instances of her advocacy. She believed that all people deserved the same opportunities no matter what religion, sex or ethnicity; she was a strong proponent of equal human rights (Selanders, 2012). Florence Nightingale advocated for nursing by creating standards of care and educating nurses to improve health care for patients. She collected information and used statistics while caring for patients to promote their health.
Her analysis of patient care led to an improved patient environment, changing it from unsanitary to a more sanitary environment which promoted health and well-being (Selanders, 2012). Her leadership in the profession led to establishing her own school of nursing in England which in turn prompted schools in America. This leadership paved the way for nurses to become leaders in a respected profession (Selanders, 2012). Today Florence Nightingale’s vision for the professional nurse continues. Nightingale’s beginnings in statistical analyses of patients and their environments is carried on in nursing practice today. My everyday nursing practice involves the use of evidence-based practice to improve patient care and well-being (Selanders, 2012).
Research in health is accomplished by nurses in order to find better ways for me to care for my patients. For instance, we know that people may be susceptible to high blood pressure and we use evidence-based practice to screen for, prevent and treat it. I monitor my patient’s blood pressure at every visit. If during the screening they have risk factor such as obesity or smoking I educate them on proper nutrition and smoking cessation. I work together with the primary care provider and pharmacists to teach patients how to take their medications properly and how to monitor their blood pressure at home. Nightingale’s work in educating nurses continues with my own education as I try to gain the knowledge to improve myself and my practice of nursing. I work on advancing my nursing by continuing my education to develop my leadership skills and professional growth. F. Principles
In this section I will discuss how I have safeguarded principles of beneficence and the respect for autonomy. The principle of beneficence is an ethical duty to be compassionate in my care of patients and to promote autonomy through positive actions of kindness (Cherry, 2011). A patient of mine has been struggling with obesity for the past two years. He has lost 60 pounds and gained 40 pounds back. I set up a one-on-one appointment with patient to discuss what actions he may take to get back to a healthier weight. Instead of placing blame on the patient and telling him what he is doing wrong, I focus on the things he is doing right. He continues to walk over a mile a day, but he admits he has not been writing in his food diary.
Together we worked to create short term goals, goals the patient felt he could attain in the following weeks. When the patient returned he had increased his walking distance and had started writing in his food diary again. It is my ethical responsibility to have respect for patient autonomy. Autonomy is the personal freedom of a patient and their right to decide what choices to make in their health care. In the example above the patient came to me for help and guidance because he had gained weight. Instead of telling the patient what he should do to get back to a healthier weight we discussed options together.
I provided him autonomy by asking what choices he could make to attain his weight loss goal. We discussed what better food choices he could make and how he could increase his physical activity in order to reach his goal. The patient was able to maintain his autonomy and make the choices he thought were necessary to lose weight. When the patient returned to the clinic he had reached his goal to increase his physical activity and lost 2 pounds. G. Conclusion
This paper has been about my professional journey to create a professional mission statement. The Idaho State Board protects the public by issuing and maintaining my nursing license and the American Nurses Association advocates for the advancement of nursing and patient well-being. I am an advocate for the protection of patient safety and rights and participate in committees at my workplace to advance my profession. Safety, confidentiality, accountability and collaboration with the interdisciplinary team are some of the professional traits I use to care for my patients. I have shown how Orem’s theory of Self-Care has been integrated into my practice and explained how Florence Nightingale’s contributions to professional nursing have been applied in my modern nursing practice. Finally, I have explained how I used beneficence and respect for autonomy in caring for an obese patient in my clinic.
American Nurses Association (2001). Code of Ethics for Nurses with Interpretive Statements. Retrieved from http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf American Nurses Association (2012). Frequently asked questions. Retrieved from http://www.nursingworld.org/mainmenucategories/tools/state-boards-of-nursing-faq.pdf Cherry, B., & Jacobs, S. (2011). Contemporary nursing: Issues, trends & management (5th ed.). Memphis, TN: Elsevier. Habel, M. (n.d.). Nursing theory: At the heart of practice. Retrieved from https://lms.nurse.com/Aspx/CourseObjective.aspx?TopicID=5892 Matthews, J (2012). Role of Professional Organizations in Advocating forthe Nursing Profession. OJIN: The Online Journal of Issues in Nursing Vol. 17, No. 1, Manuscript 3.doi:10.3912/OJIN.Vol17No01Man03. Selanders, L.C., Crane, P. C. (2012). The Voice of Florence Nightingale on Advocacy OJIN: The Online Journal of Issues in Nursing Vol. 17. doi: 10.3912/OJIN.Vol17No01Man01.