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The scope of practice describes the procedures, actions, and processes that a healthcare practitioner is permitted to undertake in keeping with the terms of their professional license.

The Scope of Nursing Practice describes the “who,” “what,” “where,” “when,” and “why” of nursing practice.

When it comes to investigating a new procedure, a systematic approach should be applied. It is very critical to determine whether a given procedure is within the nursing scope of practice before deciding to adopt or implement.

Some standard steps that must always be followed are based on the Nurse Practice Act, the ANA Standards of Practice, rights of patients, and safe nursing practice. According to Anderson (2013), determining if a new procedure is within the scope of nursing practice can be accomplished in three steps.

First, defining the issue, which means clarifying what exactly is being asked and what the new procedure entails. This step also includes gathering any additional information such as conducting a competency assessment to perform a task, as well as any previous experience, current knowledge and skill. Evidence-based practice and nursing research must also support the adoption of any new procedure.

Secondly, since evidence is not the only component, the Nurse Practice Act and the policies of the workplace must also be considered. Nurses may be limited by the facility policies/standards to perform certain tasks even though the tasks are allowed by the BON (Anderson, 2013). Likewise, nurses may not be legally permitted to perform certain tasks that are commonly performed in the facility. These policies can vary within the same state and even within the same facility. For instance, ICU nurses may be permitted to perform a certain procedure that nurses on the other unit are not.

Many states also have a set of rules to follow that help to determine whether task is within the scope of practice. Hence in the process of investigating a new procedure, I would review laws and other documents and follow institutional polices or the chain of command to make inquiries, as necessary. For example, if I learn that the BON permits nurses to perform the given procedure then the next step is to determine what conditions must be met in order to comply with the Board, such as additional training or education.

The final step, according to Anderson (2013), is decision-making. For a task/procedure to be within the scope of nursing practice, it must be consistent with the Nurse Practice Act, institutional polices, and supported by research or professional organization. Most significantly, the primary concern must always be safe environment and patient care (Anderson, 2013). Before introducing and implementing the new procedure, research of evidence-based guidelines, literature from professional organizations, and other resources must be reviewed to determine whether the procedure will result in improved patient outcomes.

The competency, knowledge, and experience with the procedure must also be taken into consideration to determine if additional training may be necessary. If any training is required, then a plan must be made of what the training should entail, how long it will take, along with other details such as when and where.

When it is time to introduce the new procedure, I will have to be prepared to be a leader and an expert in the change process. (Seagraves, 2009, p.19).

To reduce the possibility of resistance it is also important to share with the staff the research findings about the procedure and receive feedback, thereby gaining support.

References

https://www.nursingworld.org/practice-policy/scope-of-practice/

Anderson, L. (2013). Understanding the different scopes of nursing practice.

Seagraves, K. (2009). How to be a catalyst for Change. Nursing2009: December 2009 – Volume 39 – Issue 12 – p. 18-19 doi: 10.1097/01. NURSE. 0000365017.08493.08

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While interviewing Ms. Li, the cultural considerations will be language barrier and cultural beliefs. Nearly 38% of Asian-Americans do not speak English fluently because about 2/3 rd of them are foreign born (Edelman, Kudzma and Mandel, 2014). I will first of all ensure that Ms. Li understands and speaks English if not an interpreter can be used preferably female because Asians are very conservatives and language barrier can interfere with receiving quality health care. Cultural beliefs about health and illness often conflict with western medicine. Asian cultures place great importance on respect. Hierarchies are much more visible in their society than in Western cultures, and their social behaviors reflects this. Ms. Li will be allowed to control the amount of eye contact that goes on during the interview because eye contact is not considered an essential to social interaction, instead it is often considered inappropriate and it is believed that subordinates shouldn’t make steady eye contact with their superiors. Asian folk medicine uses a wide variety of herbs for healing purposes, including roots, leaves, seeds, tree bark, and parts of flowers (Edelman, Kudzma & Mandle, 2014). Some aspects of Asian folk medicine have gained popularity within the professional care system. It is also important to identify and put into consideration the use of any medicinal remedies by Ms. Li that may cause complications with any prescribed medications.

The Abuse Assessment Screen (AAS) is an assessment tool designed to screen for domestic violence and abuse during pregnancy by asking by asking questions about current emotional, sexual and physical abuse before and during pregnancy (WHEC, 2018). It also assesses the frequency and severity if present.

During the assessment, if there is suspected or disclosed abuse, Ms. Li will be approached gently in a nonjudgmental and open way. I will listen and substantiate her decision to speak up about the abuse. I will inform her that this type of behavior is unacceptable and she does not deserve to be treated like that. It is also imperative to assist her, assess and ascertain that she is safe especially if the abuser is nearby. The appropriate authorities will be notified so that an investigation can take place.

References:

Edelman, C., Kudzma, E., & Mandle, C. (2014). Health Promotion Throughout the Life Span, eighth edition. St. Louis: Elsevier Mosby

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The comprehensive health assessment of the geriatric patient requires knowledge of normal aging changes, the effects of chronic diseases, genetic makeup, and lifestyle. It is multidimensional and incorporates the physical exam and assessment of mental status, functional status, social and economic status, pain and exam of the environment for safety concerns (Jarvis, 2016). Some of the special considerations the nurse must keep in mind is the presence of “geriatric syndromes” such as urinary incontinence fragile skin, confusion, eating problems or feeding problems, falls and sleep disorders. The goal of the functional assessment of the geriatric patient is to identify the geriatric patient’s strengths and limitations and to be able to come up with interventions to promote independence and prevent functional decline.

Reference:

Jarvis, C. (2016). Physical Examination and Health Assessment

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The term “at risk” for poor health is made up of a population of people that share common risk factors or are exposed to risks which poses a threat to their health. A vulnerable population consists of “a group or groups that are more likely to develop health-related problems, have more difficulty accessing health care to address those health problems, are more likely to experience a poor outcome or shorter life span because of those health conditions”(Maurer and Smith, 2013). A vulnerable population includes the poor, the homeless, very young, very old, and severely mentally ill and the disabled. Not all individuals that are at risk for poor health are vulnerable because for an individual to be vulnerable, the individual or group suffer from the factors that puts them at the greater risk for on-going poor heath than at-risk people do (Maurer and Smith, 2013). For an example, an individual is regarded as vulnerable, only if he/she suffers from a disease, income below poverty level, has no health insurance and is stressed as a result of their living conditions (Maurer and Smith, 2013). The people in this group cannot advocate for themselves as they are poor and have limited access to resources that they require. The people that are within this population are usually looked down on therefore making them afraid, ashamed and feel like they don’t deserve to be helped. It would be beneficial to advocate for these people because everyone should be able to have access to care irrespective of their level of income as everyone deserves a chance to live a healthy life. As nurses, when taking care of these group of people, we should treat them with same care and respect as other patients, rich or poor, young or old, disabled or homeless, everyone deserves the same treatment and the right to receive care. “Community health nurses can advocate on behalf of vulnerable groups by writing and calling government representatives and speaking to professional and community organizations about the problems and needs of high-risk groups” (Maurer and Smith, 2013).

Homelessness can be seen in people in both urban and rural areas. According to Maurer and Smith (2013), in rural areas, the largest group of homeless persons consist of white, single or married women and their children. In urban areas, the two largest groups of homeless persons include single men and single women with children. Depending on geographical location, racial and ethnic homeless population varies, such as 80% of the homeless population who are white or African American are found in the urban areas. In rural areas, homeless people are more likely to be white, American Indian, or migrant workers (Maurer and Smith, 2013).

Reference:

Maurer, F., Smith, C. (2013). Community/Public Health Nursing Practice, 5th Edition. Retrieved from https://pageburstls.elsevier.com/#/books/978-1-455…

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In her Diary Journal 3, the GCU student nurse reports “amputation, stump revision, horrible infections and dressing changes like can’t be explained” following the Haiti earthquake in 2010. To prevent the spread of infections and improve the situation, one primary prevention initiative done by nurses could be to educate the population and local medical staff in hospital about safe and proper sanitation practices, including hand washing and personal hygiene, sterilizing of medical instruments… Nurses could also give the basic immunizations to Haitians in order to avoid the spread of epidemics such as measles, hepatitis, rubella etc. These prevention action can be started as soon as the nurses arrive to Haiti.

Starting in phases 3 or 4, nurses can start assist the local doctors and surgeons in providing care to Haitian patients, in hospitals, clinic or even in the streets. As the GCU student remarks in her 4th video, the task is enormous, but Haitians are always grateful for the help: “As the care providers we felt tremendous appreciation and thankfulness from the throngs of people we have treated. Despite their amputations, broken limbs, massively infected wounds, filthy dressings…”

Tertiary prevention initiatives take more importance towards the end of the intervention, when the immediate emergency has declined and when more time and resources are available to plan for the future. At this point in times nurses can start implementing initiatives to help people manage their long-term health problems and injuries (chronic diseases, permanent impairments), to improve as much as possible their ability to function, their quality of life and their life expectancy. Support groups could be created so as to share strategies for living well. The GCU nursing student also remarked that many people had to be amputated after the earthquake. In partnership with the Haitian government and local authority, vocational rehabilitation programs could be developed to retrain amputated workers for new jobs fitting their disability.

One crucial need is for instance to provide teaching and educational support for the Haitian national staff, so that they can continue to cure patients and victims appropriately in the future (when international volunteers and NGOs retreat), and that they be better prepared in the event of other catastrophes. In particular, it is important that the Haitian staff follows up with treatment adherence for victims of the earthquake, and continues immunization campaigns in vulnerable populations.

For all nursing interventions, collaborations with the other medical NGOs present in Haiti would be useful, so as to best deploy available resources, make sure to treat as many people in need as possible, avoid duplication of initiatives and avoid the concentration of resources in a few areas. NGOs present in Haiti in 2010 included Doctors Without Borders, Relief International, International Medical Corps, Medshare. Collaboration with local authorities and the Haitian government is also crucial to ensure the maximal impact of initiatives taken, and coordination of relief efforts.

References:

“Diary of Medical Mission Trip” (2018). Grand Canyon University. Retrieved from: http://lc.gcumedia.com/zwebassets/courseMaterialPa…