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There are many factors that determine what skills fall into a nursing scope of practice. From my research in our textbooks and readings as well as my own experience I have pinpointed some aspects that shape what we call our “scope of practice” as nurses. State boards of nursing determine what we can legally do as nurses, they set standards of what should be included in nursing practice. The state boards then collaborate with nursing schools to make sure there are standards of nursing skills and education that will shape nurses to deliver safe care to the public. State boards throughout the nation ensure the state regulations that are set for nursing scope of practice are appropriate. Laws are also created and discussed each year that will affect nursing practice and this is constantly changing, due to the evolving world of nursing. (Grand Canyon University ,2011)

Another factor that determines scope of practice for nursing is the degree of an individual nurse and educational preparation. A bachelor’s educated nurse’s scope of practice is much broader than an LVN. There are many more skills and assessments that these nurses are legally allowed to provide for their patients. (Creasia and Friberg ,2016)

Also, a nurse can earn a certification or work on a specialty unit. For example, nurses who work on a cardiac/telemetry unit have a scope of practice that include initiating and maintaining cardiac drips. Most medical surgical nurses are not qualified or trained to do this. Even ICU nurses are licensed to initiate certain drips and practice certain skills that other nurses have not had the training for. The environment of where you work as a nurse also determines your nursing scope of practice. For example, each hospital has its own policies and procedures that determine how their nurses practice. (Creasia and Friberg ,2016) Having a scope of practice ensures that nurses are only providing care for which they are qualified to provide, this ultimately improves patient’s safety and outcome.

Reference:

Creasia,Joan L. and Friberg, Elizabeth E. (2016) Chapters 1-5..Conceptual Foundations:T

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Three health disparities that can be prevented or managed with regular physical exercise are: Hypertension (HTN), Coronary Artery Disease (CAD), and Obesity. According to statistics found in Medical Surgical Nursing, in the United States, one in three adults have HTN (p.738), about 610,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths (Heart Disease Facts, 2017) and over one third of Americans are obese; however, this statistic jumps to 66% when considering how many are overweight in addition to obese (p.946).

As a nurse many factors need to be considered when incorporating health promotion measures such as exercise and physical activity into our clients’ lives. The Health belief model (HBM) is a theory used to predict and explain a patient’s health behavior. It is based on three assumptions: the patient’s readiness to change, their perceived need to change, and the client’s perceived benefits of the health change (Edelman, Kudzma, & Mandle, 2014 p.219) A program can be designed to meet the patient’s motivation level or their ability to perform certain exercises or activities. One thing I would impress upon all the patients is try to walk, bike or take the stairs whenever possible; for some, this maybe a big change. Another strategy I would try, is find out what outdoor activities they like to do or have them try a new sport. By becoming interested in a new hobby or activity they are becoming more active and don’t really think of it as “work.”

The current guidelines recommended by the American College of Cardiology/AHA is at least 30 minutes of moderate activity on most days of the week. Examples provided of moderate activity include: brisk walking, hiking, biking, and swimming. Regular physical activity contributes to weight reduction (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2011 p.767, 768).

References:

Edelman, C. L., Kudzma, E., & Mandle, C. L. (2014). Health Promotion Throughout the Life Span (8th ed., pp. 214-228). St.Louis, MO: Elsevier.

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I see this first hand from working in hospice where patients have been relocated into their children’s homes because they can no longer take care of themselves or bel eft alone for that matter. Prior to them moving into their children’s homes, there were already pending medical issues that prompted the final move in such as reoccurring falls, fractures, forgetfulness/cognitive decline, poor vision, constant hospitalizations, failure to thrive and failed cancer treatments/interventions. I even see this on admission with elderly patients and not just my hospice patients. So sometimes the child has to basically be the more responsible one when it comes to the safety and health of the elderly parent since sometimes the parent can be in denial of need or unaware of how severe their condition is.

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To adequately meet the needs of patients with diverse backgrounds, nurses much use methods that are culturally competent. In 1991, Madeleine Leininger published the The Transcultural Nursing Theory, establishing approaches such as cultural preservation, cultural accommodation, cultural repatterning, and cultural brokering (Andrews & Boyle, 2008, p. 62).

Cultural preservation entails a situation where the nurse supports the use of scientifically sound cultural practices of care by their patients (Stanhope & Lancaster, 2014, p. 78). An example would include agreeing to the use of acupuncture by a Chinese patient as an adjunct to pain management using conventional medicines such as opioid analgesics (Huber, 2009).
Cultural accommodation entails a situation where the nurse supports the use of cultural practices that have been shown as not harmful (Stanhope & Lancaster, 2014, p. 78). For example, placing a table knife under the bed of a laboring woman to symbolically cut the pain (Smith, 2013). For African Americans in the Delta, alcohol or Vaseline rubs to the chest are utilized for comfort measures (Gunn & Davis, 2011). Within cultural accommodation, these acts would be supported if not contraindicated in the patient’s care.
Cultural repatterning entails a nurse working in collaboration with a patient towards helping them change cultural practices that are considered harmful (Stanhope & Lancaster, 2014, p. 78).
In case, when a pregnant Muslim patient intends to fast during the month of Ramadan, but is unaware of the negative impact that it would have upon her and her pregnancy (Wintz & Cooper, 2009, p. 28).

Cultural brokering utilizes negotiating between the patient’s culture and biomedical healthcare to ensure that the care is used together as culturally competent (Stanhope & Lancaster, 2014, p. 79).
Community health nurses need to utilize various cultural competence strategies in ensuring that they effectively deliver health care services that are able to meet the individual needs of their patients. Such strategies help community nursing in improving the health outcomes and quality of care provided by the nurse (Betancourt, et.al, 2016). Theses methods also help in the elimination of racial and ethnic health disparities and boundaries that may hinder effective delivery of care. Consequently, the nurse is able to develop and cultivate patient trust, understanding and respect that help significantly in ensuring the realization of the best health outcomes. In achieving the above, community nurses can use a number of approaches such as cultural preservation, cultural accommodation, cultural repatterning, and cultural brokering. Possible barriers in the utilization of the above strategies would be attributed to conflicts arising from different cultures, languages, and beliefs. For example, in the instance of persuading a patient to stop taking a herb that has been used for many years by their native community would be seen as insensitive and rude by the patient.

Andrews, M. M., & Boyle, J. S. (2008). Transcultural concepts in nursing care (5th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins Health.

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Individual’s reaction to disaster is different. Some can have traumatic stress and others overwhelmed by issues that distress their spiritual lives. The occurrence of a disaster makes many people feel alive and connected to the divine than even before. There are several issues that can arise to the individuals, communities, and health care providers during that event. They can blame the disaster when it occurs even afterwards directly to God as they take Him to be the motive behind it. This blame may be brought forth through questions and proclamations made and those going through their heads. Spiritual care is a significant measurement of total health, and should be recognized and resolved for the spiritual requirements of disaster sufferers; this is an essential role of health care providers. Calamity managing is a group effort and as a result requires that health care providers lean on the knowledge and support of other team members; facilitating efforts with local religious, social governmental organizations, and non-governmental organizations, to handle the elusive effects of the cultural and spiritual shock of a disaster and to avert further disheartenment of the affected the people is crucial. Tragedies take place, and the only thing that can revolutionize in their destructive effects is to advance catastrophe preparedness and act in response jointly and bravely to every catastrophic event.

As community health nurses, we can assist in the spiritual care of those in need by using our language of compassion and empathy. This is our fundamental responsibility. Empathy and Compassion cannot be operationalized unless we demonstrate culturally ability, ethically true, and spiritually considerate behavior. We must be tolerant of cultures other than our own; we must read information and gain an understanding with the primary cultures of the affected populace.

References:

Minority nurse (2013). Caring for Communities After Disaster. Retrieved from https://minoritynurse.com/caring-for-communities-a…