Research Critiques and PICOT Statement Final Draft Assignment

Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the previous course assignments and the guidelines below.

PICOT Question

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.

The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study) Research Critiques and PICOT Statement Final Draft Assignment .

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Research Critiques

In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative research critique on two articles for each type of study (4 articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Refer to \”Research Critiques and PICOT Guidelines – Final Draft.\” Questions under each heading should be addressed as a narrative in the structure of a formal paper. Research Critiques and PICOT Statement Final Draft.

Proposed Evidence-Based Practice Change

Discuss the link between the PICOT question, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.

 

Research Critique Guidelines

Qualitative Study

Background of Study:

• Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem.
• How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem. Research Critiques and PICOT Statement Final Draft.
• Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.
• List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers Research Critiques and PICOT Statement Final Draft Assignment .
• Were the purpose and research questions related to the problem?

Method of Study:

• Were qualitative methods appropriate to answer the research questions?
• Did the author identify a specific perspective from which the study was developed? If so, what was it?
• Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include?
• Are the references current? For qualitative studies, the author may have included studies older than the 5-year limit typically used for quantitative studies. Findings of older qualitative studies may be relevant to a qualitative study.
• Did the author evaluate or indicate the weaknesses of the available studies?
• Did the literature review include adequate information to build a logical argument?
• When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings? Research Critiques and PICOT Statement Final Draft.

 

Results of Study

• What were the study findings?
• What are the implications to nursing?
• Explain how the findings contribute to nursing knowledge/science. Would this impact practice, education, administration, or all areas of nursing?

Ethical Considerations

• Was the study approved by an Institutional Review Board?
• Was patient privacy protected? Research Critiques and PICOT Statement Final Draft.
• Were there ethical considerations regarding the treatment or lack of?

Conclusion

• Emphasize the importance and congruity of the thesis statement.
• Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice.
• Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice.
• Integrate a summary of the knowledge learned.

 

Quantitative Study

Background of Study:

• Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem. Research Critiques and PICOT Statement Final Draft.
• How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem.
• Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.
• List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers.
• Were the purpose and research questions related to the problem?

 Methods of Study

• Identify the benefits and risks of participation addressed by the authors. Were there benefits or risks the authors do not identify?
• Was informed consent obtained from the subjects or participants?
• Did it seem that the subjects participated voluntarily in the study?
• Was institutional review board approval obtained from the agency in which the study was conducted?
• Are the major variables (independent and dependent variables) identified and defined? What were these variables?
• How were data collected in this study?
• What rationale did the author provide for using this data collection method?
• Identify the time period for data collection of the study. Research Critiques and PICOT Statement Final Draft.
• Describe the sequence of data collection events for a participant.
• Describe the data management and analysis methods used in the study.
• Did the author discuss how the rigor of the process was assured? For example, does the author describe maintaining a paper trail of critical decisions that were made during the analysis of the data? Was statistical software used to ensure accuracy of the analysis?
• What measures were used to minimize the effects of researcher bias (their experiences and perspectives)? For example, did two researchers independently analyze the data and compare their analyses?

Results of Study

• What is the researcher’s interpretation of findings?
• Are the findings valid or an accurate reflection of reality? Do you have confidence in the findings? Research Critiques and PICOT Statement Final Draft.
• What limitations of the study were identified by researchers?
• Was there a coherent logic to the presentation of findings?
• What implications do the findings have for nursing practice? For example, can the findings of the study be applied to general nursing practice, to a specific population, or to a specific area of nursing?
• What suggestions are made for further studies?

Ethical Considerations

• Was the study approved by an Institutional Review Board?
• Was patient privacy protected? Research Critiques and PICOT Statement Final Draft Assignment
• Were there ethical considerations regarding the treatment or lack of?

Conclusion

• Emphasize the importance and congruity of the thesis statement.
• Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice.
• Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice. Research Critiques and PICOT Statement Final Draft.
• Integrate a summary of the knowledge learned.

Reference

Burns, N., & Grove, S. (2011). Understanding nursing research (5th ed.). St. Louis, MO: Elsevier.

Critique and ethical considerations

Article 1.

“Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review. Therapeutics and Clinical Risk Management, 15, 579-588. doi: 10.2147/tcrm.s189833” Research Critiques and PICOT Statement Final Draft.

Summary

Bloom et al. (2019) present the results of a retrospective database review to determine how coexisting medical conditions and non-steroidal anti-inflammatory drugs (NSAIDs) influence treatment modalities as noted in primary care practices. The retrospective approach collected data from the claim databases of three medical facilities with a focus on patients either 18 years of age or older. The data was collected for the period covering 2013. Research Critiques and PICOT Statement Final Draft. The focus was on non-aspirin NSAID-relevant coexisting medical conditions of interest (CMCOI), asthma, cardiovascular risk factors, gastrointestinal bleeding risk factors, and renal insufficiency. Statistical analysis of the collected data determined that patients with musculoskeletal diagnosis reported a significantly higher risk of treatment challenges when compared to their counterparts without musculoskeletal diagnosis. Similarly, age was noted to influence treatment challenges, with an increase in age being matched by an increase in the occurrence of treatment challenges. The reported results indicate that non-aspirin NSAID-relevant CMCOI and age are useful statistical for use among primary care professionals with regards to predicting the occurrence of treatment challenges. In fact, the results show that even as patients advance in age, their medical conditions change and their reactions to different medications also change. Using the information, primary care professionals can identify patients at high risk and offer them guidance on how their age, health status, concomitant conditions, and medication influence treatment modalities (Bloom et al., 2019). Research Critiques and PICOT Statement Final Draft.

Using findings in nursing practice

The findings from Bloom et al. (2019) are useful to nursing personnel who act as primary care professionals. That is because NSAIDs are a common medication that are typically prescribed or recommended for almost all medical conditions. Although commonly used, NSAIDs are associated with substantial side effects and complications for a particular demographic of patients. Despite the labels for NSAIDs listing these side effects and complications, patients and medical personnel would often overlook them thereby presenting opportunities for them to occur with potentially fatal effects. Research Critiques and PICOT Statement Final Draft. Through identifying this demographic of patients, nurses are able to anticipate the care complications and offer appropriate advice on how to either address or prevent the complications. Besides that, they can use their position as primary care professionals to reinforce the importance of the advice contains in the labels as instructions and not simply suggestions. Overall, the findings allow nursing practice to contribute towards the safe use of NSAIDs as well as improving care outcomes through anticipating and addressing treatment challenges Research Critiques and PICOT Statement Final Draft Assignment.

Ethical considerations for the study

Bloom et al. (2019) does not mention how ethical concerns were addressed in the study. However, there is a need to address the ethical aspects of retrospective database review studies, especially with regards to the primary concern of issues pertaining to confidentiality and informed consent. Besides that, the study received approval from The New England Institutional Review Board (NEIRB, 12–284), specifying that the study did not meet the definition of human-subject research thus not requiring its approval.

The study is based on information that is already available as medical records with the researcher only required to retrieve the information. This is an indication that the ethical concern about confidentiality and informed concern is an inherent concern since the researchers do not have direct contact with patients. The concern is further highlighted by the fact that medical records are not collected with the explicit intention of informing research studies. As such, there is no a-priori informed consent for the records to be used in research studies. In essence, using the records is ethically questionable since confidential information is accessed and could be misused thereby jeopardizing the relationship between patients and doctors. This is particularly true when sensitive data is accessed by persons not bound by patient-doctor confidentiality, leading to unwanted disclosure that would distress and cause difficulties for the patient. Research Critiques and PICOT Statement Final Draft. Given the nature of medical records and the difficulty in getting informed consent from patients, retrospective studies using these records can address the ethical concerns about informed consent and confidentiality through four approaches. Firstly, minimal information should be collected and only if necessary. The collected information should only include routine clinical information that does not require informed consent. Secondly, any information that could identify the patients should be eliminated or coded to conceal the patients’ identities. Thirdly, safeguards should be implemented to ensure the ethical use of the collected information, such as having protocols for the information storage and authorized access. Research Critiques and PICOT Statement Final Draft. Finally, ethical clearance should be sought from an Institutional Review Board (IRB) that provides the required oversight (Sarkar & Seshadri, 2014).

Article 2.

“Lai, K. M., Chen, T., Chang, C., Chen, H., & Lee, Y. (2019). Association between NSAID use and mortality risk in patients with end-stage renal disease: A population-based cohort study. Clinical Epidemiology, 11, 429-441. doi: 10.2147/clep.s204322”

Summary

Lai et al. (2019) presents the results of a study that investigated the association between NSAIDs use and risk of mortality for persons diagnosed with end-stage renal disease. It acknowledges that pain is a concern among persons diagnosed with end-stage renal disease and it is not uncommon for NSAIDs to be administered. Research Critiques and PICOT Statement Final Draft. However, it notes that although the pain associated with the disease is a concern and NSAIDs can partially address this concern, of greater concern is the risks associated with the use of NSAIDs. The study seeks to document the risks, providing evidence to show that the adverse effects are tangible thus informing patients and clinicians. Towards this end, the study applies a retrospective approach that collects data from the Taiwan National Health Insurance Research Database. The selected population sample is for 1 million patients records selected from among 27 million patients records covering the period between 1997 and 2013. The study determined that 78% (2,623) of persons diagnosed with end-stage renal disease and requiring long-term dialysis used NSAIDs. During the study period that covered four years, 1,515 patients in the study population died. The study determined that the use of NSAIDs significantly increased the risk of all-cause mortality for persons diagnosed with end-stage renal disease (Lai et al., 2019) Research Critiques and PICOT Statement Final Draft Assignment.

Using findings in nursing practice

The study results are useful for improving care outcomes for persons diagnosed with end-stage renal disease. Using the study results, nursing practice can recommend alternatives to NSAIDs that reduce the risk of mortality. In addition, the results can be used to justify stringent monitoring of patients using NSAIDs so as to reduce the risk of mortality (Lai et al., 2019).

Ethical considerations for the study

Lai et al. (2019) mentions that the study was approved by the Joint Institutional Review Board of Taipei Medical University, and the requirement of patient-informed consent was waived (TMU-JIRB No. N201506025). The approval is an indication that the study did not pose any avoidable risk to the participants. Still, the study makes use of medical records thus raising ethical concerns with regards to confidentiality and informed consent since it would be difficult to obtain consent from all participants before the information was used. Research Critiques and PICOT Statement Final Draft. Although there is no mention of how these concerns were addressed, there is an indication that they were addressed through four approaches. Firstly, minimal information was collected with focus on what was necessary to inform the study and does not require informed consent. Secondly, information was coded to conceal the patients’ identities. Finally, ethical clearance was sought from an IRB that provided the required oversight (Sarkar & Seshadri, 2014).

References

Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review. Therapeutics and Clinical Risk Management, 15, 579-588. doi: 10.2147/tcrm.s189833

Lai, K. M., Chen, T., Chang, C., Chen, H., & Lee, Y. (2019). Association between NSAID use and mortality risk in patients with end-stage renal disease: A population-based cohort study. Clinical Epidemiology, 11, 429-441. doi: 10.2147/clep.s204322 Research Critiques and PICOT Statement Final Draft

Sarkar, S. & Seshadri, D. (2014). Conducting record review studies in clinical practice. Journal of Clinical & Diagnostic Research, 8(9), JG01-JG04. doi: 10.7860/JCDR/2014/8301.4806

 

PICOT statement and research critiques

PICOT statement

The PICOT question is presented as: “In patients with normal renal function who have had recent surgery (P), does the use of NSAIDs (I) increase the future risk of adverse renal effects (O) compared with non-use of NSAIDs (C) during recuperation (T)?”

The PICOT question has five elements as discussed:

• P: patient population – describes the unique demographic qualities that identify the study population. In this case, the study population is restricted to patient who recently underwent surgery and require pain medication for which NSAIDs are an option. Research Critiques and PICOT Statement Final Draft.
• I: indicator/intervention – describes the variable of interest in the study as a prognostic factor. In the present case, the prognostic factor is the use of NSAIDs that is suspected of significantly increasing adverse renal events among the patient population.
• C: control/comparison – describes the absence of the prognostic factor thereby facilitating effective comparison efforts. In the present case, the prognostic factor is the non-use of NSAIDs.
• O: outcome – describes the risk or rate of the adverse outcome occurred that is determined as adverse renal effects for the present study.
• T: time – identifies how long it takes to observe the study participants. In the present case, the time describes the recuperations time when the patient is an invalid and recuperating following the surgery. Research Critiques and PICOT Statement Final Draft.

Qualitative study critique

Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review. Therapeutics and Clinical Risk Management, 15, 579-588. doi: 10.2147/tcrm.s189833

Background of study

The study sought to determine how coexisting medical conditions and non-steroidal anti-inflammatory drugs (NSAIDs) influence treatment modalities as noted in primary care practices. It notes that NSAIDs use has become increasingly prevalent among patients visiting personnel. It further notes that the use of these medication is accompanied by an inherent risk linked to patient demographics that include concomitant medication, age and coexisting medical conditions. Despite the inherent risks and warnings from medical personnel on these risks, it is not uncommon for patients to continue using NSAIDs even when the risk of adverse effects is heightened. The study seeks to address this information gap by identifying the proportion of patients who are at high risk of reporting adverse reactions from using NSAIDs (Bloom et al., 2019). As such, the study seeks to provide qualitative evidence on the extent and distribution of NSAIDs among patients at high risk of reporting adverse reactions. Research Critiques and PICOT Statement Final Draft Assignment.

Method of study

To study applied a retrospective database review approach. The retrospective approach collected data from the claim databases of three medical facilities with a focus on patients either 18 years of age or older. Research Critiques and PICOT Statement Final Draft. The data was collected for the period covering 2013. The focus was on non-aspirin NSAID-relevant coexisting medical conditions of interest (CMCOI), asthma, cardiovascular risk factors, gastrointestinal bleeding risk factors, and renal insufficiency (Bloom et al., 2019). The methodology is appropriate since it focused on collecting the required information from the population of interest.

Results of study

The reported results indicate that non-aspirin NSAID-relevant CMCOI and age are useful statistical for use among primary care professionals with regards to predicting the occurrence of treatment challenges. In fact, the results show that even as patients advance in age, their medical conditions change and their reactions to different medications also change (Bloom et al., 2019). Using this information, primary care professionals can identify patients at high risk and offer them guidance on how their age, health status, concomitant conditions, and medication influence treatment modalities. Research Critiques and PICOT Statement Final Draft Assignment.

The findings from Bloom et al. (2019) are useful to nursing personnel who act as primary care professionals. That is because NSAIDs are a common medication that are typically prescribed or recommended for almost all medical conditions. Although commonly used, NSAIDs are associated with substantial side effects and complications for a particular demographic of patients. Despite the labels for NSAIDs listing these side effects and complications, patients and medical personnel would often overlook them thereby presenting opportunities for them to occur with potentially fatal effects. Through identifying this demographic of patients, nurses are able to anticipate the care complications and offer appropriate advice on how to either address or prevent the complications. Besides that, they can use their position as primary care professionals to reinforce the importance of the advice contains in the labels as instructions and not simply suggestions Research Critiques and PICOT Statement Final Draft. Overall, the findings allow nursing practice to contribute towards the safe use of NSAIDs as well as improving care outcomes through anticipating and addressing treatment challenges.

Ethical considerations

Although the study does not mention how ethical concerns were addressed in the study. However, there is a need to address the ethical aspects of retrospective database review studies, especially with regards to the primary concern of issues pertaining to confidentiality and informed consent. Besides that, the study received approval from The New England Institutional Review Board (NEIRB, 12–284), specifying that the study did not meet the definition of human-subject research thus not requiring its approval (Bloom et al., 2019). Research Critiques and PICOT Statement Final Draft.

The study is based on information that is already available as medical records with the researcher only required to retrieve the information. This is an indication that the ethical concern about confidentiality and informed concern is an inherent concern since the researchers do not have direct contact with patients. The concern is further highlighted by the fact that medical records are not collected with the explicit intention of informing research studies. As such, there is no a-priori informed consent for the records to be used in research studies. In essence, using the records is ethically questionable since confidential information is accessed and could be misused thereby jeopardizing the relationship between patients and doctors. This is particularly true when sensitive data is accessed by persons not bound by patient-doctor confidentiality, leading to unwanted disclosure that would distress and cause difficulties for the patient. Given the nature of medical records and the difficulty in getting informed consent from patients, retrospective studies using these records can address the ethical concerns about informed consent and confidentiality through four approaches. Firstly, minimal information should be collected and only if necessary. The collected information should only include routine clinical information that does not require informed consent. Secondly, any information that could identify the patients should be eliminated or coded to conceal the patients’ identities. Thirdly, safeguards should be implemented to ensure the ethical use of the collected information, such as having protocols for the information storage and authorized access Research Critiques and PICOT Statement Final Draft. Finally, ethical clearance should be sought from an Institutional Review Board (IRB) that provides the required oversight (Sarkar & Seshadri, 2014) Research Critiques and PICOT Statement Final Draft Assignment .

Conclusion

The research applied a qualitative approach that used a retrospective methodology. It notes that NSAIDs use is common among patients. In addition, it notes that although NSAIDs use is typically accompanied by warnings on use, these warnings are typically ignored. It further adds that patients and medical personnel often overlook the labels for NSAIDs listing these side effects and complications. The result is that NSAIDs use remains high among patients at high risk of adverse reactions. Given these results, the study recommends greater awareness of NSAIDs side effects and complications with a focus on identifying patients at high risk of adverse reactions and ensuring that their use of NSAIDs is controlled. Research Critiques and PICOT Statement Final Draft.

Quantitative study critique

Gawande, A., Gupta, G. K., Gupta, A., Wanjari, S. J., Goel, V., Rathore, V., . . . Nijhawan, S. (2019). Acute-on-Chronic Liver Failure: Etiology of Chronic and Acute Precipitating Factors and Their Effect on Mortality. Journal of Clinical and Experimental Hepatology. doi: 10.1016/j.jceh.2019.04.050

Background of study

Gawande et al. (2019) presents research results from a study on etiologies, course, and outcome in patients with acute-on-chronic liver failure (ACLF) was determined. In fact, it presents the results of a study that investigated the prevalence of ACLF as a health issue, the underlying etiology, precipitating factors for the health issue, and the associated mortality. It notes that ACLF is a medical condition that requires greater understanding in order to implement the appropriate interventions. In line with this awareness, the study objective was to collect information that informs ACLF. The underlying intention was to identify an appropriate risk factor and prevention strategy (Gawande et al., 2019). Research Critiques and PICOT Statement Final Draft.

Methods of study

The research applied a quantitative methodology. In this case, the study recruited 208 participants who included 182 males and 26 females. The participants were recruited between October 2015 and December 2017, all from the gastroenterology department of SMS Medical College and Hospital in Jaipur (Gawande et al., 2019). The research methodology is appropriate since it recruited a large sample that improved the results generalizability. Still, the methodology has a shortcoming with regards to not mentioning whether a third party verified the statistical analysis and study results, and the software used to conduct data analysis. These shortcomings allow for researcher bias.

Results of study

The study reported that the most common etiology for ACLF are alcohol (63.94%), viral hepatitis (15.4%), cryptogenic cirrhosis (13.94%), autoimmunity (4.3%), nonalcoholic steatohepatitis (1.4%), and Wilson disease (1%). Research Critiques and PICOT Statement Final Draft. Mortality for inpatients was reported at 37.5% (p<0.05). The study determined that the identified factors (alcohol, viral hepatitis, cryptogenic cirrhosis, autoimmunity, nonalcoholic steatohepatitis, and Wilson disease) are precipitating factors linked with etiology for ACLF, and they should be noted as factors that increase mortality. It concludes that the identified precipitating factors should be noted in liver health management since they are predictors of mortality (Gawande et al., 2019).

The study results are useful for improving care outcomes for persons diagnosed with ACLF or at risk of developing liver disease. The findings offer statistical evidence to link the identified predictive factors ACLF occurrence and mortality. Using the study results nursing practice can present liver management protocols that offer the high risk factors to be noted to improve care outcomes. Of particular concern would be alcohol that is noted to significantly increase the risk of mortality for persons with ACLF (Gawande et al., 2019) Research Critiques and PICOT Statement Final Draft.

Ethical considerations

Gawande et al. (2019) mentions that the study was approved by an institutional review board (IRB) to imply that the study did not pose a threat to the participants with appropriate measures applied to adequately protect them. In addition, informed consent was sought from the participants. The measures applied in the study address concerns about beneficence (do no harm) and informed consent (Gawande et al., 2019). Babbie (2016) adds to the discussion by mentioning that in addition to beneficence and informed consent, the study should address confidentiality, respect for anonymity, and respect for privacy. It mentions that even as medical research focuses on advocacy, protecting dignity, preventing harm and caring, it should not forget to defend the rights of the research participants as an incongruent aspect of ethics. As such, there study should detail how it addressed ethical concerns about respect for privacy, confidentiality and anonymity. Still, IRB approval is an indication that these ethical concerns were addressed, although not mentioned in the literature (Babbie, 2016) Research Critiques and PICOT Statement Final Draft Assignment.

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Conclusion

The research assesses the etiologies, course, and outcome in patients with ACLF. Towards this end, that study applied a quantitative methodology that recruited 208 participants with ACLF. Ethical approval was sought from an IRB to ensure that the participants’ rights were protected. The study results reported that the most common etiology for ACLF are alcohol (63.94%), viral hepatitis (15.4%), cryptogenic cirrhosis (13.94%), autoimmunity (4.3%), nonalcoholic steatohepatitis (1.4%), and Wilson disease (1%). Mortality for inpatients was reported at 37.5% (p<0.05). Based on these results, it is possible to improve ACLF care outcomes by reducing the risk factors.

 

References

Babbie, E. (2016). The basics of social research (7^th ed.). Boston, MA: Cengage Learning.

Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review. Therapeutics and Clinical Risk Management, 15, 579-588. doi: 10.2147/tcrm.s189833

Gawande, A., Gupta, G. K., Gupta, A., Wanjari, S. J., Goel, V., Rathore, V., . . . Nijhawan, S. (2019). Acute-on-Chronic Liver Failure: Etiology of Chronic and Acute Precipitating Factors and Their Effect on Mortality. Journal of Clinical and Experimental Hepatology, In Press. doi: 10.1016/j.jceh.2019.04.050 Research Critiques and PICOT Statement Final Draft

Sarkar, S. & Seshadri, D. (2014). Conducting record review studies in clinical practice. Journal of Clinical & Diagnostic Research, 8(9), JG01-JG04. doi: 10.7860/JCDR/2014/8301.4806 Research Critiques and PICOT Statement Final Draft Assignment

Nursing’s Social Policy Statement: An Overview

“Nursing is the pivotal health care profession, highly valued for its specialized knowledge, skill, and caring in improving the health status of the public and ensuring safe, effective, quality care.”

–(ANA, 2003)

This revision of Nursing’s Social Policy Statement is the culmination of an extensive review process that also included a long public comment period. It builds on previous editions, especially the original 1980 document. The work describes the essence of the profession by discussing nursing as a profession that is both valued within a society and uniquely accountable to that society. The definition of nursing follows and describes contemporary nursing practice. A more detailed discussion of practice is presented in the sections about the scope and standards of practice and professional performance. A brief commentary about regulation provides an overview of professional, legal, and self-regulation expectations. This foundational ANA publication remains a key resource for nurses both to conceptualize the framework of nursing practice and to provide direction to nursing educators, administrators, and researchers. This publication also can inform other health professionals, legislators and other regulators, those who work in funding bodies, and members of the general public. Nursing’s Social Policy Statement: An Overview

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Social Context of Nursing

 

“Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.”

–(ANA, 2002)

Nursing, like other professions, is an essential part of the society out of which it grew and within which it continues to evolve. Nursing is responsible to society in the sense that nursing’s professional interest must be perceived as serving the interests of society. The mutually beneficial relationship between society and the nursing profession has been expressed as follows:

Professions acquire recognition and relevance primarily in terms of needs, conditions, and traditions of particular societies and their members. It is societies (and often vested interests within them) that determine, in accord with their different technological and economic levels of development and their socioeconomic, political, and cultural conditions and values, what professional skills and knowledge they most need and desire. By various financial means, institutions will then emerge to train [educate] interested individuals to supply those needs.

Logically, then, the professions open to individuals of any particular society are the property not of the individual, but of the society. What Nursing’s Social Policy Statement: An Overview

P.4

 

individuals acquire through training [education] is professional knowledge and skill, not a profession or even part ownership of one. (Page, 1975, p. 7)

The Social Concerns in Health Care and Nursing

Health care continues to be a major focus of attention in the United States and worldwide. Many other societal concerns garner extensive attention and subsequent action by the nursing profession and its nurse constituency. Nursing has an active and enduring leadership role in public and political determinations about the following six key areas of health care:

Organization, delivery, and financing of quality health care

Quality health care is a human right for all (ANA, 2008b). To improve the quality of care, healthcare professionals must address these complex issues: increasing costs of care; health disparities; and the lack of safe, accessible, and available healthcare services and resources.

Provision for the public’s health

Increasing responsibility for basic self-help measures by the individual, family, group, community, or population complements the use of health promotion, disease prevention, and environmental measures.

Expansion of nursing and healthcare knowledge and appropriate application of technology

Incorporation of research and evidence into practice helps inform the selection, implementation, and evaluation processes associated with the generation and application of knowledge and technology to healthcare outcomes.

Expansion of healthcare resources and health policy

Expanded facilities and workforce capacity for personal care and community health services are needed to support and enhance the capacity for self-help and self-care of individuals, families, groups, communities, and populations.

Definitive planning for health policy and regulation

Collaborative planning is responsive to consumer needs and provides for best resource use in the provision of health care for all. Nursing’s Social Policy Statement: An Overview

P.5

 

Duties under extreme conditions

Health professionals will weigh their duty to provide care with obligations to their own health and that of their families during disasters, pandemics, and other extreme emergencies.

Of increasing importance, healthcare regulatory bodies set institutional standards for mandated quality of care, and other healthcare entities provide guidelines and protocols to attain quality care and better outcomes. The goals to provide quality while addressing the costs and quantity of available healthcare services will continue to be social and political priorities for nursing action.

The Authority for Nursing Practice for Nurses

The authority for nursing, as for other professions, is based on social responsibility, which in turn derives from a complex social base and a social contract.

There is a social contract between society and the profession. Under its terms, society grants the professions authority over functions vital to itself and permits them considerable autonomy in the conduct of their own affairs. In return, the professions are expected to act responsibly, always mindful of the public trust. Self-regulation to assure quality and performance is at the heart of this relationship. It is the authentic hallmark of the mature profession. (Donabedian, 1976)

Nursing’s social contract reflects the profession’s long-standing core values and ethics, which provide grounding for health care in society. It is easy to overlook this social contract underlying the nursing profession when faced with certain facets of contemporary society, including depersonalization, apathy, disconnectedness, and growing globalization. But upon closer examination, we see that society validates the existence of the profession through licensure, public affirmation, and legal and legislative parameters. Nursing’s response is to provide care to all who are in need, regardless of their cultural, social, or economic standing.

The nursing profession fulfills society’s need for qualified and appropriately prepared individuals who embrace, and act according to, a strong code of ethics, especially when entrusted with the health care of individuals, families, groups, communities, and populations. The public ranks nurses among the top-few most trusted professionals. In turn, the nursing profession’s trusted position in society imposes a responsibility to provide the very best health Nursing’s Social Policy Statement: An Overview

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care. The provision of such health care relies on well-educated and clinically astute nurses and a professional association, comprising these same nurses, that establishes a code of ethics, standards of care and practice, educational and practice requirements, and policies that govern the profession.

The American Nurses Association (ANA) is the professional organization that performs an essential function in articulating, maintaining, and strengthening the social contract that exists between nursing and society, upon which the authority to practice nursing is based. That social contract is evident in ANA’s most enduring and influential work, which is derived from the collective expertise of its constituent member associations, individual members, and affiliate member organizations. Such work includes:

Developing and maintaining nursing’s code of ethics;

Developing and maintaining the scope and standards of nursing practice;

Supporting the development of nursing theory and research to explain observations and guide nursing practice;

Establishing the educational requirements of professional practice;

Defining professional role competence; and

Developing programs and resources to establish and articulate nursing’s accountability to society, including practice policy work and governmental advocacy.

The Elements of Nursing’s Social Contract

The following statements undergird professional nursing’s social contract with society:

Humans manifest an essential unity of mind, body, and spirit.

Human experience is contextually and culturally defined.

Health and illness are human experiences. The presence of illness does not preclude health, nor does optimal health preclude illness.

The relationship between the nurse and patient occurs within the context of the values and beliefs of the patient and nurse. Nursing’s Social Policy Statement: An Overview

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Public policy and the healthcare delivery system influence the health and well-being of society and professional nursing.

Individual responsibility and interprofessional involvement are essential.

These values and assumptions apply whether the recipient of professional nursing care is an individual, family, group, community, or population.

Professional Collaboration in Health Care

The nursing profession is particularly focused on establishing effective working relationships and collaborative efforts essential to accomplish its health-oriented mission. Multiple factors combine to intensify the importance of direct human interactions, communication, and professional collaboration: the complexity, size, and culture of the healthcare system and its transitional and dynamic state; increasing public involvement in health policy; and a national focus on health.

Collaboration means true partnership, valuing expertise, power, and respect on all sides and recognizing and accepting separate and combined spheres of activity and responsibility. Collaboration includes mutual safeguarding of the legitimate interests of each party and a commonality of goals that is recognized by all parties. The parties base their relationship upon trust and the recognition that each one’s contribution is richer and more truly real because of the strength and uniqueness of the others.

Successful collaboration requires that nursing and its members respond to diversity by recognizing, assessing, and adapting the nature of working relationships with individuals, populations, and other health professionals and health workers. These efforts also extend to relationships within nursing and between nursing and representatives of the public in all environments where nursing practice may occur.

Definition of Nursing

 

Definitions of nursing have evolved to reflect the essential features of professional nursing:

Provision of a caring relationship that facilitates health and healing

Attention to the range of human experiences and responses to health and illness within the physical and social environments

Integration of assessment data with knowledge gained from an appreciation of the patient or the group

Application of scientific knowledge to the processes of diagnosis and treatment through the use of judgment and critical thinking

Advancement of professional nursing knowledge through scholarly inquiry

Influence on social and public policy to promote social justice

Assurance of safe, quality, and evidence-based practice

In her Notes on Nursing: What It Is and What It Is Not, published in 1859, Florence Nightingale defined nursing as having “charge of the personal health of somebody…, and what nursing has to do … is to put the patient in the best condition for nature to act upon him.” Nursing’s Social Policy Statement: An Overview

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A century later, Virginia Henderson (1961) defined the purpose of nursing as “to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible.”

In the original Nursing: A Social Policy Statement (ANA, 1980), nursing was defined as “the diagnosis and treatment of human responses to actual or potential health problems.”

In 2001, ANA’s Code of Ethics With Interpretive Statements stated that “nursing encompassed the prevention of illness, the alleviation of suffering, and the protection, promotion and restoration of health in the care of individuals, families, groups, and communities.”

The definition for nursing remains unchanged from the 2003 edition of Nursing’s Social Policy Statement:

Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.

This definition encompasses four essential characteristics of nursing: human responses or phenomena, theory application, nursing actions or interventions, and outcomes. Nursing’s Social Policy Statement: An Overview

Human Responses

These are the responses of individuals to actual or potential health problems, and which are the phenomena of concern to nurses. Human responses include any observable need, concern, condition, event, or fact of interest to nurses that may be the target of evidence-based nursing practice.

Theory Application

In nursing, theory is a set of interrelated concepts, definitions, or propositions used to systematically describe, explain, predict, or control human responses or phenomena of interest to nurses. Understanding theories of nursing and other disciplines precedes, and serves as a basis for, theory application through evidence-based nursing actions.

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Nursing Actions

The aims of nursing actions (also nursing interventions) are to protect, promote, and optimize health; to prevent illness and injury; to alleviate suffering; and to advocate for individuals, families, communities, and populations. Nursing actions are theoretically derived, evidence-based, and require welldeveloped intellectual competencies.

Outcomes

The purpose of nursing actions is to produce beneficial outcomes in relation to identified human responses. Evaluation of outcomes of nursing actions determines whether the actions have been effective. Findings from nursing research provide rigorous scientific evidence of beneficial outcomes of specific nursing actions.

Figure 1 depicts the intertwined relationships of human responses, theory application, nursing actions, and outcomes. Nursing’s Social Policy Statement: An Overview

 

View Figure

 

Knowledge Base for Nursing Practice

 

Nursing is a profession and is both a science and an art. The knowledge base for professional nursing practice includes nursing science, philosophy, and ethics; biology and psychology; and the social, physical, economic, organizational, and technological sciences. To refine and expand nursing’s knowledge base, nurses use theories that fit with professional nursing’s values of health and health care and that are relevant to professional nursing practice. Nurses apply research findings and implement the best evidence into their practice based on applicability to the individual, family, group, community, population, or system of care. These efforts generate knowledge and advance nursing science.

Nurses are concerned with human experiences and responses across the life span. Nurses partner with individuals, families, communities, and populations to address issues such as the following: Nursing’s Social Policy Statement: An Overview

Promotion of health and wellness

Promotion of safety and quality of care

Care, self-care processes, and care coordination

Physical, emotional, and spiritual comfort, discomfort, and pain

Adaptation to physiological and pathophysiological processes

Emotions related to the experience of birth, growth and development, health, illness, disease, and death

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Meanings ascribed to health, illness, and other concepts

Linguistic and cultural sensitivity

Health literacy

Decision making and the ability to make choices

Relationships, role performance, and change processes within relationships

Social policies and their effects on health

Healthcare systems and their relationships to access, cost, and quality of health care

The environment and the prevention of disease and injury

Nurses use their theoretical and evidence-based knowledge of these human experiences and responses to collaborate with patients and others to assess, diagnose, plan, implement, evaluate care, and identify outcomes. Nursing interventions aim to produce beneficial effects, contribute to quality outcomes, and—above all—do no harm. Nurses use the process that is evidence-based practice as a foundation of quality patient care to evaluate the effectiveness of care in relationship to identified outcomes. Nursing’s Social Policy Statement: An Overview

 

Scope of Nursing Practice

 

Professional nursing has a single scope of practice that encompasses the range of activities from those of the beginning registered nurse through those of the most advanced level of nursing practice. The scope of practice statement (ANA, 2010) describes the who, what, where, when, why, and how of nursing practice. Although a single scope of professional nursing practice exists, the depth and breadth to which individual nurses engage in the total scope of professional nursing practice are dependent on their educational preparation and self-development, their experience, their role, the setting, and the nature of the populations they serve.

Further, all nurses are responsible for practicing in accordance with recognized standards of professional nursing practice and the recognized professional code of ethics. Note that the lower level and foundation of the pyramid in Figure 2 (see next page) includes the scope of professional practice, standards of practice, and the code of ethics.

Each nurse remains accountable for the quality of care within his or her scope of nursing practice. The level of application of standards varies with the education, experience, and skills of the individual nurse, who must rely on self-determination and self-regulation as the final level of professional accountability.

Professional nursing’s scope of practice is dynamic and continually evolving, characterized by a flexible boundary responsive to the changing needs of society and the expanding knowledge base of applicable theoretical and

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scientific domains. This scope of practice thus overlaps those of other professions involved in health care, whose boundaries are also constantly evolving. Members of any profession collaborate in various ways, such as: Nursing’s Social Policy Statement: An Overview

 

View Figure

FIGURE 2. MODEL OF PROFESSIONAL NURSING PRACTICE

 

Sharing knowledge, techniques, and ideas about how to deliver and evaluate quality and outcomes in health care

Sharing some functions and a common focus on the same overall mission

Recognizing the expertise of others within and outside the profession, referring patients to other providers when appropriate

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Nursing practice necessitates using such critical-thinking processes as the nursing process to apply the best available evidence to caregiving and promoting human functions and responses. Such caregiving includes, but is not limited to, initiating and maintaining comfort measures, establishing an environment conducive to well-being, providing health counseling, and teaching. Nurses not only independently establish plans of care but also carry out interventions prescribed by other authorized healthcare providers. Therefore, advocacy, communication, collaboration, and coordination are notable characteristics of nursing practice. Nurses base their practice on understanding the human condition across the life span and the relationship of the individual, family, group, community, or population within their own setting and environment.

Registered nurses and nurses with advanced graduate education and preparation provide and direct nursing care. All registered nurses are educated in the art and science of nursing, with the goal of helping individuals, families, groups, communities, and populations to promote, attain, maintain, and restore health or to experience dignified death. Nurses may also develop expertise in a particular specialty. The increasing complexity of care reinforces ANA’s consistent advocacy (since 1965) of the baccalaureate degree in nursing as the preferred educational requirement for entry into professional nursing practice. Nursing’s Social Policy Statement: An Overview

Specialization in Nursing Practice

Specialization involves focusing on nursing practice in a specific area, identified from within the whole field of professional nursing. ANA and specialty nursing organizations delineate the components of professional nursing practice that are essential for any particular specialty. The following characteristics must be met for ANA recognition of a nursing specialty. A nursing specialty (ANA, 2008d):

Defines itself as nursing;

Adheres to the overall licensure requirements of the profession;

Subscribes to the overall purposes and functions of nursing;

Is clearly defined;

Can identify a need and demand for itself;

Has a well-derived knowledge base particular to the practice of the nursing specialty;

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Is concerned with phenomena of the discipline of nursing;

Defines competencies for the area of specialty nursing practice;

Has existing mechanisms for supporting, reviewing, and disseminating research to support its knowledge base;

Has defined educational criteria for specialty preparation or graduate degree;

Has continuing education programs or continuing competence mechanisms for nurses in the specialty;

Is organized and represented by a national or international specialty association or branch of a parent organization;

Is practiced nationally or internationally; and

Includes a substantial number of registered nurses who devote most of their practice to the specialty.

Registered nurses may seek certification in a variety of specialized areas of nursing practice as a demonstration of competence (ANA, 2008c). Nursing’s Social Policy Statement: An Overview

Advanced Nursing Practice

Advanced nursing practice builds on the competencies of the registered nurse and is characterized by the integration and application of a broad range of theoretical and evidence-based knowledge that occurs as part of graduate nursing education.

Advanced Practice Registered Nurses

Advanced practice registered nurses (APRNs) hold master’s or doctoral degrees in nursing, are certified in their designated specialty practice areas, and are recognized and approved to practice in their roles by state boards of nursing or other regulatory oversight bodies, often through special professional licensing processes.

APRNs are educationally prepared in one of the four APRN roles (certified nurse practitioners, certified registered nurse anesthetists, certified nurse-midwives, and clinical nurse specialists) and in at least one of six possible population foci: family/individual across the life span; adult/gerontology; neonatal;

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pediatrics; women’s health/gender-related health; psychiatric/mental health). Education, certification, and licensure of these individuals should be congruent with role and population foci (APRN Consensus, 2008). APRN specialty practice may focus on specific populations beyond those identified or focus on healthcare needs (such as oncology, palliative care, substance abuse, nephrology) that meet criteria for specialization as identified in the APRN Consensus Model. (See Appendix A for the full text of the APRN Consensus Model.)

Additional Specialized Advanced Nursing Positions

The profession of nursing is also dependent on continued expansion of nursing knowledge, education of nurses, appropriate organization and administration of nursing services, and development and adoption of policies consistent with values and assumptions that underlie the scope of professional nursing practice. Registered nurses may practice in such advanced positions as nurse educator, nurse administrator, nurse researcher, nurse policy analyst, advanced public health nurse, and informatics nurse specialist. These advanced roles require specific additional knowledge and skills gained through graduate-level education, holding master’s or doctoral degrees.

Further details on the scope of professional nursing practice and the specifics that describe the who, what, where, when, why, and how of nursing practice for all registered nurses appear in the current version of Nursing: Scope and Standards of Practice (ANA, 2010). Nursing’s Social Policy Statement: An Overview

 

Standards of Professional Nursing Practice

 

To guide professional practice, nursing has established standards of professional nursing practice, which are further categorized into standards of practice and standards of professional performance.

Definition and Function of Standards

Standards are authoritative statements by which the nursing profession describes the responsibilities for which its practitioners are accountable. Standards reflect the values and priorities of the profession and provide direction for professional nursing practice and a framework for the evaluation of this practice. They also define the nursing profession’s accountability to the public and the outcomes for which registered nurses are responsible (ANA, 2010).

Development of Standards

A professional nursing organization has a responsibility to its members and to the public it serves to develop standards of practice and standards of professional performance that may pertain to general or specialty practice. The American Nurses Association, as the professional organization for all registered nurses, has assumed the responsibility for developing generic standards that apply to the practice of all professional nurses. However, standards belong to the profession and thus require broad input into their development and

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revision. The scope and standards of practice developed by ANA describe a competent level of nursing practice and professional performance common to all registered nurses (ANA, 2010).

Standards of Professional Nursing Practice

The Standards of Professional Nursing Practice are comprised of the Standards of Practice and the Standards of Professional Performance.

Standards of Practice

The Standards of Practice describe a competent level of nursing care, as demonstrated by the critical thinking model known as the nursing process, which includes the components of assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. These standards encompass significant actions taken by registered nurses and form the foundation of the nurse’s decision making.

Standards of Professional Performance

The Standards of Professional Performance describe a competent level of behavior in the professional role, including activities related to quality of practice, education, professional practice evaluation, collegiality, collaboration, ethics, research, resource utilization, and leadership. Registered nurses are accountable for their professional actions to themselves, their patients, their peers, and ultimately to society.

The nursing process is usually conceptualized and presented as the integration of singular, concurrent actions of assessment, diagnosis, identification of outcomes, planning, implementation, and, finally, evaluation. Most often the nursing process is introduced to nursing students as a linear process with a feedback loop from evaluation to assessment, as reflected in Figure 3.

Figure 4 reflects how the nursing process in practice is not linear, but relies heavily on the bidirectional feedback loops from and to each component. The standards of practice are co-located near the steps of the nursing process to represent the directive nature of the standards as the professional nurse completes each component of the nursing process. Similarly, the standards of professional performance relate to how the professional nurse adheres to the standards of practice, completes the nursing process, and addresses other nursing practice issues and concerns. Nursing’s Social Policy Statement: An Overview

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FIGURE 3. THE NURSING PROCESS

 

 

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FIGURE 4. THE NURSING PROCESS AND THE STANDARDS OF PROFESSIONAL NURSING PRACTICE

 

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Application of Scope and Standards

Content within the current edition of Nursing: Scope and Standards of Practice should serve as the basis for the following:

Policies, procedures, and protocols

Position descriptions and performance appraisals

Certification activities

Educational programs and offerings

Development and evaluation of nursing service delivery systems and organizational structures, including the application of technologies

Specialty nursing scope and standards of practice

Quality improvement systems

Databases

Regulatory systems

Healthcare reimbursement and financing methodologies

Establishing the legal standard of care

Code of Ethics for Nurses

The current code of ethics for the profession, Code of Ethics for Nurses With Interpretive Statements (ANA, 2001) “functions as a general guide for the profession’s members and as a social contract with the public that it serves” (Fowler, 2008, p. xi). It is the profession’s expression of the values, duties, and commitments to that public. Its nine provisions give voice to professional nurses and delineate what the nurse owes not only to others but also to him- or herself. This includes, but is not limited to, personal and professional growth, preserving integrity, and safety (Fowler, 2008).

Although the Code of Ethics for Nurses is intended to be a living document for nurses, and health care is becoming more complex, the basic tenets found within this particular code of ethics remain unchanged. For example, Guide to the Code of Ethics for Nurses: Interpretation and Application (Fowler, 2008) provides interpretation and examples of the application of the nine ethical provisions. Nursing’s Social Policy Statement: An Overview

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Autonomy and Competent Practice

Autonomy is the capacity of a nurse to determine his or her own actions through independent choice within the full scope of nursing practice (Ballou, 1998). Competence is foundational to autonomy: the public has a right to expect nurses to demonstrate professional competence. The nursing profession and professional associations must shape and guide any practice, assuring nursing competence.

The key indicators of competent practice are identified with each standard of practice and professional performance. For a standard to be met, all the listed competencies must be met. An individual who demonstrates competence is performing successfully at an expected level. A competency is an expected level of performance that integrates knowledge, skills, abilities, and judgment. Standards should remain stable over time because they reflect the philosophical values of the profession. Competency statements, however, may be revised more frequently to incorporate advances in scientific knowledge and expectations for nursing practice.

Assurance of competence is the shared responsibility of the profession, individual nurses, professional organizations, credentialing and certification entities, regulatory agencies, employers, and other key stakeholders (ANA, 2008c). Nursing’s Social Policy Statement: An Overview

 

Regulation of Professional Nursing

 

Figure 5 (see next page) depicts the roles and relationships associated with the regulation of nursing practice. The model recognizes the contributions of professional and specialty nursing organizations, educational institutions, credentialing and accrediting organizations, and regulatory agencies; explains the role of workplace policies and procedures; and confirms the individual nurse’s ultimate responsibility and accountability for defining nursing practice (Styles, Schumann, Bickford, & White, 2008).

The Scope of Nursing Practice, the Standards of Professional Nursing Practice, and the Code of Ethics for Nurses serve as the foundation for legislation and regulatory policies to assure protection of the public’s safety (Styles, Schumann, Bickford, & White, 2008).

Under the terms of a social contract between society and the profession, society grants authority over functions vital to the profession and permits considerable autonomy in the conduct of its own affairs. Professional nursing, like other professions, is accountable for ensuring that its members act in the public interest while providing the unique service that society has entrusted to them. The processes by which the profession does this include professional regulation, legal regulation, and self-regulation. The Scope of Nursing Practice, the Standards of Professional Nursing Practice, the Code of Ethics for Nurses, and the current social policy statement are components of professional regulation and serve as the foundation for legislation, regulatory policy making, and nursing practice that may be set in place to help assure protection of the public’s safety. Nursing’s Social Policy Statement: An Overview

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View Figure

FIGURE 5. MODEL OF PROFESSIONAL NURSING PRACTICE REGULATION

 

Professional Regulation

Professional regulation is a profession’s oversight, monitoring, and control of its members based on principles, guidelines, and rules deemed important. Professional regulation of nursing practice begins with the professional definition of nursing and the delineation of the scope of professional nursing practice. Professional standards are derived from the scope of nursing practice.

The social contract for nursing has been made specific through the professional society’s work, derived from the collective expertise of the American Nurses Association, in collaboration with members of its constituent member associations and members of other nursing organizations. These responsibilities include the following:

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Establishing and maintaining a professional code of ethics

Determining standards of practice

Fostering the development of nursing theory, derived from nursing research

Establishing nursing practice built on a base of best evidence

Establishing the specifications for the educational requirements for entry into professional practice at basic and advanced levels

Developing certification processes as measures of professional competence

Certification is a judgment of competence made by nurses who are themselves practicing within the area of specialization. Certification is the formal recognition of the knowledge, skills, abilities, judgment, and experience demonstrated by the achievement of formal criteria identified by the profession. Credentialing boards develop and implement certification examinations and procedures for nurses who wish to have their specialty-practice knowledge recognized by the profession and the public. One component of the required evidence is successful completion of an examination that tests the knowledge base for the selected area of practice. Other requirements relate to the requisite content of course work and the amount of practice hours. Credentialing bodies may elect to use professional portfolios as psychometrically and legally defensible alternatives for certification examinations. Professional portfolios provide a comprehensive and reflective representation of professional abilities, achievements, and efforts.

Contemporary specialty nursing practice is in transition in response to the increasing complexity of care and exponential explosion of data, information, and knowledge. Specialization is a mark of the advancement of the nursing profession and assists in clarifying, revising, and strengthening existing practice. Specialization not only expedites the production of new knowledge and its application in practice, but also provides preparation for teaching and research related to any defined area of nursing. The specialist in nursing practice is evolving to be a nurse who has become expert in a defined area of knowledge and nursing practice through study and supervised practice at the graduate (master’s or doctoral) level. Nursing’s Social Policy Statement: An Overview

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Legal Regulation

Legal regulation is the oversight, monitoring, and control of designated professionals, based on applicable statutes and regulations, accompanied by the interpretation of these laws. All nurses are legally accountable for actions taken in the course of professional nursing practice, as well as for actions delegated by the nurse to others assisting in provision of nursing care. Such accountability is accomplished through legal regulatory mechanisms of licensure; granting of authority to practice, such as nurse practice acts; and criminal and civil laws.

The legal contract between society and the professions is defined by statute and by associated rules and regulations. State nurse practice acts and related legislation and regulations serve as the explicit codification of the profession’s obligation to act in the best interests of society. Nurse practice acts grant nurses the authority to practice and grant society the authority to sanction nurses who violate the norms of the profession or act in a manner that threatens the safety of the public.

Statutory definitions of nursing should be compatible with, and build upon, the profession’s definition of its practice base. They must be general enough to provide for the dynamic nature of an evolving scope of nursing practice. Society is best served when consistent definitions of the scope of nursing and of advanced practice nursing are used by each state’s board of nursing and other regulatory bodies. This allows residents of all states to access the full range of nursing services. Multiple stakeholders have established a collaborative effort to garner consensus in this arena.

Institutional Policies and Procedures

Nursing practice occurs within societal institutions, organizations, and settings that have accompanying policies, procedures, rules, and regulations. The scope and standards of practice for nursing and nursing specialties should help guide development of institutional policies and procedures to create a more detailed representation of what constitutes safe, quality, and evidence-based nursing practice.

Self-Regulation

Self-regulation, which requires personal accountability for the knowledge base for professional practice, is an individual’s demonstrated personal control based on principles, guidelines, and rules deemed important. Nurses develop

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and maintain current knowledge, skills, and abilities through formal academic programs and continuing education professional development programs. When available, nurses pursue certification in their area of practice to demonstrate this competence.

 

View Figure

FIGURE 6. SELF-DETERMINATION IN THE MODEL OF PROFESSIONAL NURSING PRACTICE REGULATION

 

Nurses exercise autonomy and freedom within their scope of practice. Autonomy is defined as the capacity of a nurse to determine his or her own actions through independent choice within the full scope of nursing practice (Ballou, 1998). Autonomy and freedom are based on the nurse’s commitment to self-regulation and accountability for practice. In Figure 6, the apex of the pyramid, labeled Self-Determination, represents autonomy, self-regulation, and accountability for practice.

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Competence is foundational to autonomy. Nursing competency is an expected level of performance that integrates knowledge, skills, abilities, and judgment (ANA, 2008d). Greater autonomy and freedom in nursing practice are based on broader authority rooted in expert or advanced knowledge in selected areas of nursing. This expert knowledge is associated with greater self-discipline and responsibility for direct care practice and for advancement of the nursing profession. A greater degree of autonomy not only imposes a greater duty to act and to do so competently but also increases accountability.

Nurses also regulate their own practice by participating in peer review. Continuous performance improvement fosters the refinement of knowledge, skills, and clinical decision-making processes at all levels and in all areas of professional nursing practice. As expressed in the profession’s code of ethics, peer review is one mechanism by which nurses are held accountable for practice. As noted in Provision 3.4 (Standards and Review Mechanism) in Code of Ethics for Nurses with Interpretive Statements, nurses should also be active participants in the development of policies and review mechanisms designed to promote patient safety, reduce the likelihood of errors, and address both environmental system factors and human factors that present increased risk to patients. In addition, when errors do occur, nurses are expected to follow established guidelines in reporting committed or observed errors. The focus should be directed to improving systems, rather than projecting blame.

 

Application of Nursing’s Social Policy Statement

 

Registered nurses should find the content within Nursing’s Social Policy Statement: The Essence of the Profession pertinent to everyday practice. The description of nursing as a profession valued within society, definition of nursing, presentation of the nursing process, and discussion of regulation set the stage for practice by promoting understanding. Nursing’s Social Policy Statement: An Overview

Nursing faculty should find content within this edition of Nursing’s Social Policy Statement that is critical for inclusion in curricula and course materials in undergraduate-, graduate-, and doctoral-level education. Similarly, nurses in professional development roles reinforce the concepts presented in this resource in the practice setting, especially those related to autonomy, competence, scope and standards of nursing practice, and the nursing process.

Students will benefit from reading this statement on nursing’s social policy as they learn about the evolution of their profession through its key attributes: the definition of nursing, the profession’s delineation of the characteristics of a nursing specialty, and the delineation of its scope of practice and accompanying standards and competency statements. The models depicting the nursing process, with its feedback loops and the relationship of the standards of practice and professional performance to the nursing process, will be invaluable in generating improved understanding of the complexity of nursing practice.

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Similarly, clear delineation of the six social concerns in health care, and other statements that undergird nursing’s social contract with society, reaffirm the importance of collaboration within nursing and interprofessional healthcare teams. Registered nurses will experience even greater relevance of this content in every practice setting.

Nurse administrators should use this nursing social policy statement as a resource for strategic planning activities, public explanations about nursing and its registered nurses, and the development of vision and mission statements. Members of legal and regulatory bodies and organizations should review this document to understand better how professional, self-, and legal regulation can complement—rather than conflict with—each other. Healthcare consumers may wish to use the social policy statement to understand better the foundation upon which the nursing profession and its registered nurses base their practice. Nursing’s Social Policy Statement: An Overview

 

Conclusion

 

This social policy statement describes the pivotal nature and role of professional nursing in society and health care. The definition of nursing, introduction of the scope and accompanying standards of professional nursing practice, and discussion of specialization and regulation within the social context in which nurses practice provide an overview of the essence of nursing. Registered nurses focus their specialized knowledge, skills, and caring on improving the health status of the public and ensuring safe, effective, quality care. This statement serves as a resource to assist nurses in conceptualizing their professional practice and provides direction to educators, administrators, and researchers within nursing. This statement also informs other health professionals, legislators and other regulators, funding bodies, and the public about nursing’s social responsibility, accountability, and contribution to health care.

 

References

All web-based references were retrieved May 31, 2010.

American Nurses Association. (1980). Nursing: A social policy statement. Kansas City, MO: American Nurses Publishing.

American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Nursesbooks.org.

American Nurses Association. (2002). Nursing’s agenda for the future: A call to the nation. http://nursingworld.org/MainMenuCategories/HealthcareandPolicyIssues/Reports.aspx

American Nurses Association. (2003). Nursing’s social policy statement (2nd ed.). Silver Spring, MD: Nursesbooks.org.

American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Nursesbooks.org.

American Nurses Association. (2008a). Adapting standards of care under extreme conditions: Guidance for professionals during disasters, pandemics, and other extreme emergencies. Silver Spring, MD: Author.

American Nurses Association. (2008b). ANA’s health system reform agenda. www.nursingworld.org/healthreformagenda Nursing’s Social Policy Statement: An Overview

Guide Describing Electronic Data Interchange

I have uploaded an example. Please use the example provided as a reference only

Imagine you are the office manager at a small doctor’s office. As the office manager, you are in charge of educating new hires.

Write a 700- to 1,050-word reference guide describing electronic data interchange (EDI). Guide Describing Electronic Data Interchange

Include the following in your summary:

ORDER A PLAGIARISM – FREE PAPER NOW

• Define EDI.
• Explain how using EDI facilitates electronic transactions.
• Explain how HIPAA has changed how health care information is transmitted in EDI.
• Describe the relationship between Electronic Health Records, reimbursement, HIPAA, and EDI transactions. Guide Describing Electronic Data Interchange

Cite a minimum of two outside sources. For additional information on how to properly cite your sources, log on to the Reference and Citation Generator in the Center for Writing Excellence.

Format your assignment according to APA guidelines. Guide Describing Electronic Data Interchange

Medication ISBAR Worksheet

1}Patient Introduction

Jackson Weber is a 5-year-old Caucasian male. He was diagnosed with generalized tonic-clonic seizures 2 years ago. Upon diagnosis, Jackson’s neurologist started him on oral phenobarbital. Jackson has been seizure-free until last night, when his mother brought him to the emergency department following a 3-minute tonic-clonic seizure. She is a single mother and the sole source of financial support.

Jackson has not seen his neurologist in 15 months due to his mother’s work schedule. Jackson was seen by his health care provider this morning and currently has an intravenous infusion in his left arm running D5 NS + 20 mEq KCl/L at 58 mL/hr.

He has been eating well, has urine output, and vital signs are stable. His pupils are equal and reactive to light. He is able to move all extremities equally. He is awake and alert and is watching cartoons. His mother is at the bedside. Medication ISBAR Worksheet

ORDER A PLAGIARISM – FREE PAPER NOW

Medication: Phenobarbital

2) Patient Introduction

Sabina Vasquez is a 5-year-old Hispanic girl admitted today from the emergency room with a diagnosis of pneumonia. She has a history of asthma and has had several episodes requiring use of an albuterol inhaler at home.

Sabina has had an upper airway infection for the past few days. Earlier today she developed a fever of 39°C (102.2°F), so her mother brought her to the emergency room. She was placed on oxygen via nasal cannula at 2 L/min. She received a 380-mL bolus of normal saline and an albuterol nebulizer treatment at 5:00 PM. This improved her oxygen saturation to 94%. The chest x-ray revealed right lower lobe pneumonia with effusion. An intravenous infusion of D5 ½NS is infusing at 61 mL/hr. Sabina just got settled in bed, and her mother is at the bedside Medication ISBAR Worksheet.

Medication: Azithromycin

 

3) Patient Introduction

Eva Madison is a 5-year-old female who just arrived to the pediatric floor from the emergency department, where she arrived at 7:00 AM with a 3-day history of vomiting and diarrhea, inability to keep fluids down, and no urination since 8:00 PM yesterday.

At her last check-up a few months ago, her weight was 21.2 kg, and today her weight is 20.5 kg. She is pale and listless, and her mucous membranes are dry. An intravenous saline bolus of 400 mL was started in the emergency department and has just finished. Maintenance fluids are to follow.

 

Medication: Sodium chloride

4) Patient Introduction

Brittany Long is a 5-year-old African American female with a history of sickle cell disease, diagnosed at 6 months old, and has been prescribed regular folic acid supplement.

She was brought into the emergency department during the night by her mother, who stated that the patient has been complaining of right lower leg pain over the last 2 days. Brittany rated her pain as a 5 on the FACES Scale and did not want anyone to touch her leg during assessment. She has not had an appetite in the last 24 hours but has taken small amounts of oral fluids.

She has had pain crises before, mostly managed at home with acetaminophen and ibuprofen. She has been hospitalized twice, once at age 4 years for a vaso-occlusive crisis episode and once at age 3 years for a fever.

Brittany was given oral pain medication in the emergency department at 6:00 AM. She is asleep but is responsive when awakened. She has been taking small amounts of oral fluids and continues to receive intravenous maintenance fluids at 52 mL/hr. When examined this morning, her blood pressure was 101/70 and her temperature was 37.4°C (99°F). She now rates her pain as a 3. New orders have been given Medication ISBAR Worksheet.

Medication: Morphine

 

5) Patient Introduction

Charlie Snow is a 6-year-old Caucasian male staying with his aunt and uncle while his parents are serving overseas in the military. Charlie presents in the emergency department with tachycardia and dyspnea with mild stridor. His aunt and uncle report that he accidentally ate a cookie containing peanuts, and he has peanut allergies. When Charlie began having difficulty breathing, they rushed him to the emergency department.

He is currently able to talk through the dyspnea and is on a nasal cannula at 2 liters. A saline lock has been placed in his left arm. He has been connected to a cardiac/apnea monitor with a SpO2 probe in place. Charlie is in bed, and the health care provider has been notified of Charlie’s arrival Medication ISBAR Worksheet.

Medication: Ranitidine hydrochloride

Assignment Nursing Roles Graphic Organizer

Use the “Nursing Roles Graphic Organizer Template” to differentiate how advanced registered nurse roles relate to and collaborate with different areas of nursing practice. Compare your future role with one of the following: nurse educator; nurse leader; family nurse practitioner; acute care nurse practitioner; graduate nurse with an emphasis/specialty in public health, health care administration, business, or informatics; clinical nurse specialist; doctor of nursing practice. Indicate in the appropriate columns on the template which roles you are comparing.  Assignment Nursing Roles Graphic Organizer

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Advanced registered nurses work in highly collaborative environments and must collaborate with interdisciplinary teams in order to provide excellent patient care. Besides knowing the role and scope of one’s own practice, it is essential to understand the role and scope of other nurse specialties to ensure effective collaboration among nurses, the organization, and other professionals with whom advanced registered nurses regularly interact. Assignment Nursing Roles Graphic Organizer

Use the “Nursing Roles Graphic Organizer Template” to differentiate how advanced registered nurse roles relate to and collaborate with different areas of nursing practice. Compare your future role with one of the following: nurse educator; nurse leader; family nurse practitioner; acute care nurse practitioner; graduate nurse with an emphasis/specialty in public health, health care administration, business, or informatics; clinical nurse specialist; doctor of nursing practice. Indicate in the appropriate columns on the template which roles you are comparing. Assignment Nursing Roles Graphic Organizer

Make sure to compare the following areas of practice in your graphic organizer:

1. Ethics
2. Education
3. Leadership
4. Public Health
5. Health Care Administration
6. Informatics
7. Business/Finance
8. Specialty (e.g., Family, Acute Care)

Include any regulatory bodies or certification agencies that provide guidance or parameters on how these roles incorporate concepts into practice.

You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content. Assignment Nursing Roles Graphic Organizer

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite. Assignment Nursing Roles Graphic Organizer