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To assist nurses in making sound professional judgment about nursing tasks or procedures there are six factors that govern decision-making for determining nursing scope of practice in the state of Texas.

First, if the act is consistent with the Texas Nursing Practice Act (NPA), and whether the Board’s rules or position statements address the act.

Second, if the activity is appropriately authorized by a valid order/protocol and in accordance with established policies and procedures.

Third, if the act is supported by either research in nursing and health-related literature or in scope-of-practice statements by national nursing organizations.

Fourth, if the nurse possesses the required knowledge and, if he/she has demonstrated the competency required to carry out the activity safely.

Fifth, if a reasonable and prudent nurse would perform the activity in the specified setting and,

Sixth, if the nurse is prepared to assume accountability for the provision of safe care and the outcome of the care rendered.

Reference

Texas Nursing Practice Act 301.002 (2), 301.002 (5), BON Rules 217, 224, 225

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The importance of exercise in protecting human health cannot be underestimated, and its value to middle-aged adults is particularly evident. Regular exercise provides adults with a host of benefits, including fighting depression, heart disease, diabetes, and many different kinds of cancer: especially colon and breast cancer (Harvard Medical School, 2018).

According to Harvard Medical School (2018), regular exercise for only 30 minutes daily can prevent the onset of heart disease and reduce the chances of death for those who have already developed heart disease. In addition, regular exercise reduces the incidence of hypertension and diabetes (Harvard Medical School, 2018). For those with developed diabetes, regular exercise can manage the symptoms of the condition (Harvard Medical School, 2018). Regular exercise is an excellent remedy for depression and the protection against cognitive decline in later years (Harvard Medical School, 2018). It also strengthens the bones and prevents the loss of muscle density (Harvard Medical School, 2018).

When considering what kind of activities healthcare providers should recommend, the age, health status, and physical capability of each patient should be considered. Recommended exercises should include weight training; flexibility exercises; cardiovascular activities, such as running, brisk walking, and swimming; and biking. Patients should be encouraged to burn an additional 700 to 1000 calories during weekly exercise.

Education is the best approach to encourage patients to participate in exercise because there is a better chance of commitment when patients understand the value of exercise in protecting their health in mitigating the impact of existing health conditions. In addition to the well-documented beneficial health effects of exercise, I can personally attest to its value in fighting depression, managing stress, and creating a general sense of well-being.

References

The secret to better health. (2018). Harvard Medical School. Retrieved from https://www.health.harvard.edu/healthbeat/the-secret-to-better-health-exercise

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Studies have shown that about 80% of Americans would prefer to die in their own home, if possible. In spite of this, 60% of Americans pass away in acute care hospitals, 20% in nursing homes and only 20% at home. A smaller number of dying patients uses hospice care and even those patients are often referred to hospice only in the last 3-4 weeks of life. However, not every patient will want to die at home. Dying at home is taboo in certain cultures and some patients may wish not to die at home, out of concern that they might be a burden on the family. Still, it is clear that fewer patients are dying at home than want to do so. (Stanford school of medicine 2018)

End-of-life care is almost 30% of Medicare’s annual budget over the last year of life. Dying at home is much cheaper rather than in the Hospital or nursing home. Family caregivers have the heavy burden of caring for their loved ones which could be too much at times. Hospice care at home is helpful, but the family might not be ready for the emotional response of losing your loved one. Patient might get more sick and unable to maintain pain control forcing them into the Emergency Room for care and possibly a hospital admission. Also the caregivers might be fatigued and need a little break, to reset.

As Nurses we need to be supportive and non-judgmental. The family caregivers might be trying to overcome their guilt of not being able to live up to their loved ones last wishes. We can be understanding and offer pastoral help for the family. We as nurses can reassure the family that we will maintain their loved ones wishes with dignity.

Reference:

Brenoff, A. (2017). When Loved Ones Die At Home, Family Caregivers Pay The Price. HuffPost

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Culture Preservation is to preserve the cultural practices within all culture that promote a positive healthy behavior (GCU, 2017). For example, a Polish Catholic family would call the priest when a family member is near death to recite the last rites. This is believed to cleanse the soul. The Catholic priest may lay a hand on the sick and anoints blessed oil on the forehead of the person. This is a special oil that is blessed by the bishop (“When can Last Rites”, 2016). My family called the priest for my grandmother near her death and prayed. My grandmother believed this to be very important. The barrier would be the patient not feeling forgiven for past mistakes or worried about the after life with GOD. As a nurse we could support the positive and reassure any negative thought.

Cultural Accommodation is to accommodate different practices of religion to respect tradition and cultures as long as it is not harmful(GCU, 2017). For example, Shamans, which communicate with the spirit world and help treat illnesses or sickness (What is Shamanism?, n.d.). They believe the Shaman is in between worlds and can be healers, psychics, gurus, and magicians that are set in a trance to communicate to spirits (What is Shamanism?, n.d.). The barrier with this is if the client believes a bad spell has been cast on them. Not being able to fix the spirit world would be an issue.

Cultural Repatterning promotes patients to view and practice safe cultural traditions (GCU, 2017). For example, traditionally Mexican’s have an unhealthy diet with high fat, fried foods that can link to high blood pressure, heart disease and obesity that leads to type 2 diabetes. Changing patterns is difficult but with interventions and preventions of physical activity, nutrition with parent involvement, childhood obesity can decrease (Kaiser et, al., 2018). The barrier is the family not making any changes because of influences from family.

Cultural brokering is to support the client and to ensure they are receiving proper health care with the western health system (GCU, 2018). It is important to value all cultures and to be aware of the needs. Having the knowledge of different culture will help the nurse guide the teaching plan to better health. This will promote positive outcome for patients’.

References

Kaiser, L., Martinez, J., Horowitz, M., Lamp, C., Johns, M., Espinoza, D., & Byrnes, M. (2015, May 24). Adaptation of a Culturally Relevant Nutrition and Physical Activity Program for Low-Income, Mexican-Origin Parents With Young Children. In Centers for Disease Control and Prevention . Retrieved July 30, 2018, from https://www.cdc.gov/pcd/issues/2015/14_0591.htm

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When a disaster happens, spirituality may be the only thing that the victims might have to hang on to, spirituality is very individualized. Spirituality is not tangible but comes from the core beliefs within the person. A couple of way that someone may either question their spirituality or suddenly gain spirituality. They could be grieving and ask why GOD would ever do this to anyone, is there really a higher being, or even blame themselves saying that GOD must be punishing them. With everyone having their own ways of belief or worship ways, it may be truly challenging for the nurse to help or even recognize the spiritual beliefs.

The community health nurse, can simply ask the person of their spirituality to gain some insight of them. No matter what their response, the community health nurse should not judge and remember that they might be going through the stages of grief during this trying time. Providing the spiritual support is helpful. If pastoral care is not available it could also use other victims, if they are stable, to show that support. This could be helpful to all that is included. When the community nurse is focused on helping those impacted by the event, they must not forget that they need to remember to think of taking care of themselves, spiritually as well.

Reference:

Maurer, F., Smith, C. (2013). Community/Public Health Nursing, 5th edition. Elsevier Saunders. Missouri