chapter 4

Question 1

Scopes and Standards of Practice

Answer 1

Describe a competent level of nursing care
The levels of care are demonstrated through the nursing process
The nursing process is the foundation of clinical decision making and includes all significant actions taken by nurses in providing care to clients
Within these are the nursing responsibilities for diversity, safety, education, health promotion, treatment, self care, and planning for the continuity of care

Question 2

Standards of Care

Answer 2

Standards of care are important if a legal dispute arises over whether a nurse practiced appropriately in a particular case
Nursing standards of care pertain to professional nursing activities that are demonstrated by the nurse through the nursing process
These involve assessment, diagnosis, outcome identification, planning implementation, and evaluation.
The nursing process is the foundation of clinical decision making and encompasses all significant action taken by nurses in providing care to all consumers

Question 3

1. assessment

Answer 3

The nurse collects comprehensive data pertinent to the patient’s health or situation

Question 4

assessment-measurement criteria

Answer 4

Collects data in a systematic and ongoing process
Data collection involves the patient, significant others, and health care providers, as appropriate
Prioritizes data collection activities based on the patient’s immediate condition or needs
Collects and documents pertinent data using appropriate assessment techniques

Question 5

2. Nursing Diagnosis

Answer 5

The nurse analyzes the assessment data to determine the diagnoses or health issues

Question 6

nursing diagnosis-measurement criteria

Answer 6

Derives nursing diagnoses from the assessment data
Validates the diagnoses with patient, significant others, and health care providers, when possible
Documents diagnoses in a manner that facilitates the determination of expected outcomes and plan of care

Question 7

3. Outcomes Identification

Answer 7

The nurse identifies expected outcomes for a plan individualized to the patient or the situation

Question 8

outcomes id-measurement criteria

Answer 8

Derives outcomes from the nursing diagnosis
Formulates outcomes mutually with the patient and other health care providers, when possible
Outcomes are culturally appropriate and realistic in relation to the patient’s present and potential capabilities
Defines expected outcomes in terms of the patient, patient values, ethical considerations, environment, or situation with such considerations as associated risks, benefits, costs, current scientific evidence, and clinical expertise when formulating expected outcomes
Outcomes are attainable in relation to resources available to the person
Outcomes include a time estimate for attainment for expected outcome
Outcomes provide direction for continuity of care
Modifies expected outcomes based on changes in the status of the patient or evaluation of the situation
Documents outcomes as measureable goals

Question 9

4. planning

Answer 9

The nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes

Question 10

planning-measurement criteria

Answer 10

Measurement Criteria
The plan is individualized to the patient and patient’s condition or needs
Plan is developed with the patient, significant others, and health care providers, when appropriate
Includes strategies within the plan that address each of the identified diagnosis or issues, which may include strategies for promotion and restoration of health and prevention of illness, injury , and disease
Provides for continuity within the plan
Incorporates an implementation pathway or timeline within the plan
Utilizes the plan to provide direction to other members of the health care team
Defines the plan to reflect current status, rules, and regulations and standards
Integrates current trends and research affecting care in the planning process
Considers the economic impact of the plan
Uses standardized language or recognized terminology to document the plan

Question 11

5. implementation

Answer 11

The nurse implements the identified plan of care

Question 12

implementation-measurement criteria

Answer 12

Interventions are consistent with the established plan of care
Implements interventions in a safe and appropriate manner, documents interventions
Utilizes evidence based interventions and treatments specific to the diagnosis or problem
Collaborates with nurse colleagues to implement the plan
Utilizes community resources and systems to implement the plan

Question 13

5a. coordination of care

Answer 13

The registered nurse coordinates care

delivery

Question 14

5B. Health teaching and health promotion

Answer 14

nothing

Question 15

5C. Consultation

Answer 15

The advanced practice registered nurse and the nursing role specialist provide consultation to influence the identified plan, enhance the abilities of others and effect change

Question 16

5D. Prescriptive Authority and Treatment

Answer 16

The advanced practice registered nurse uses prescriptive authority, procedures, referrals, treatments, and therapies in accordance with the state and federal laws and regulations

Question 17

6. Evaluation

Answer 17

The nurse evaluates progress towards attainment of outcomes

Question 18

evaluation-measurement criteria

Answer 18

Evaluation is systematic, ongoing and criterion based
Involves the patient, significant others, and the health care providers in the evaluation process, when appropriate
Uses ongoing assessment data to revise diagnoses, outcomes and plan of care as needed
Documents revisions in diagnoses, outcomes, and the plan of care
Evaluates the effectiveness of interventions in relation to outcomes
Documents the patient’s response to interventions

Question 19

Nursing Standards: An Asset

Answer 19

To ensure quality of care, the nursing care needs standards
Standards are a degree of excellence
The aim of standard nursing care is to support and contribute to excellent practices
The role of the nurse is constantly changing to meet the growing needs of health services

Question 20

Objectives of Nursing Standards of Care

Answer 20

Plan
Holistic approach
Appropriate nursing diagnosis
Realistic goals
Quality care rather than quantity of care
Economic use of time, materials, and energy

Question 21

Types of Standard Care

Answer 21

Structure: Things we use

Process: Things we do

Outcome: Results of what we do

Question 22

Characteristics of Standards of Care

Answer 22

Dynamic

Reflective of Change

Non Static

Question 23

Summary1

Answer 23

Standard: Nursing practice requires that a conceptual model for nursing be the basis for the independent part of that practice.
Elements: Nurses are required to have a clear idea of the distinct goal of nursing, the patient, the health needs of the society, the source of client difficulty, the focus, and the models of nursing interventions and the expected consequences of nursing activities

Question 24

Summary2

Answer 24

Standard: Nursing practice requires the effective use of the nursing process
Elements: Nurses are required to collect data in accordance with their conception of the goal of nursing, client, the source of client difficulty based on conceptual models for nursing

Question 25

Summary3

Answer 25

Standard: Nursing practice requires that the helping relationship be the nature of the client-nurse relationship Elements: Nurses are required to increase the likelihood that the client will perceive the health service experiences as understandable, manageable, and meaningful at the onset. Nurses are required to ensure a successful termination of the helping relationship

Question 26

Summary4

Answer 26

Standard: Nursing practice requires nurses to fulfill professional responsibilities Elements: Nurses are required to respect status and policies relevant to the profession and the practice setting. Nurses are required to comply with the Nursing Code of Ethics to their profession. Nurses are required to function as members of a health care team

Question 27

ANA Standards of Practice Conclusion

Answer 27

Nursing Standards of Care pertain to professional nursing activities that are demonstrated by the nurse through the nursing process. The process involves assessment, diagnosis, outcome identification, planning, implementation, and evaluation The nursing process is the foundation of clinical decision making and encompasses all significant nursing action taken by nurses in providing care to all consumers.

Question 28

Nursing Standards of Professional Performance

Answer 28

Nursing Standards of Professional Performance describes a competent level of nursing behavior in the professional role, including activities related to the quality of care, performance appraisal, education, collegiality, use of theory and ethnics, collaboration, research, and resource utilization.

Question 29

Nursing Standards of Professional Performance2

Answer 29

While Nursing Standards of Professional Performance describes the roles of all professional nurses, there are many other responsibilities that are hallmarks of professional nursing. Nurses need to be self directed and purposeful in seeking necessary knowledge and skills to enhance career goals. Membership in professional organizations, certification in specialty, or advanced practice, and continuing education are desirable methods of enhancing nursing professionalism. Accountability for one’s practice as a professional nurse rests with the individual nurse.

Question 30

Standards of Professional Performance3

Answer 30

The ANA Standards of Professional Performance describes a competent level of behavior in the professional role, including activities related to quality of care, performance appraisal, education, collegiality, ethics, collaboration, research, and resource utilization. It serves as objective guidelines for nurses to be accountable for their actions, their patients, and their peers. It provides a method to assure clients are receiving high quality care and assists the nurse in knowing exactly what is necessary to provide nursing care.

Question 31

1. quality of practice

Answer 31

The Registered nurse systematically enhances the quality and effectiveness of nursing practice.

Question 32

quality of practice-measurement criteria

Answer 32

Demonstrates quality by documenting the application of the nursing process in a responsible, accountable, and ethical manner Uses quality improvement activities to initiate changes in nursing practice and health care delivery system Uses creativity and innovation to improve nursing care delivery Incorporates new knowledge to initiate changes in nursing practice if desired outcomes are not achieved Participates in quality improvement activity

Question 33

2. education

Answer 33

The nurse attains knowledge and competency | that reflects current nursing practice

Question 34

education-Measurement Criteria

Answer 34

Participates in ongoing educational activities related to clinical knowledge and professional issues Demonstrates commitment to life long learning Seeks experiences to maintain clinical skills Seeks knowledge and skills appropriate to the practice setting Maintains professional records that provide evidence of competency

Question 35

3. professional practice evaluation

Answer 35

The nurse evaluates one’s own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations, and lifelong learning

Question 36

professional practice evaluation-measurement criteria

Answer 36

Engage in self evaluation on a regular basis Seeks constructive feedback regarding one’s own practice Takes action to achieve goals identified during the evaluation process Participates in systematic peer review as appropriate Practice reflects knowledge of current practice standards, laws, and regulations Provides age appropriate care in culturally and ethnically sensitive manner

Question 37

4. collegiality

Answer 37

The nurse interacts with and contributes to the professional development of peers and other health care providers as colleagues.

Question 38

collegiality-measurement criteria

Answer 38

Shares knowledge and skills with peers and colleagues Provides peers with feedback regarding their practice Interacts with peers and colleagues To enhance one’s own professional nursing practice Maintains compassionate and caring relationships with peers and colleagues Contributes to an environment that is conducive to clinical education with nursing students, as appropriate Contributes to a supportive and healthy work environment

Question 39

5. collaboration

Answer 39

The nurse collaborates with patient, family, and others in the conduct of nursing practice

Question 40

collaboration-measurement criteria

Answer 40

Communicates with the patient, significant others, and health care providers regarding patient care and nursing's role in the provision of care Collaborates with the patient, family, and other health care providers in the formulation of overall goals, and plan of care in the decisions related to care and delivery of services Partners with others to effect change and generate positive outcomes Document referrals, including provisions for continuity of care, as needed

Question 41

6. ethics

Answer 41

The nurse integrates ethical provision in all areas of practice

Question 42

ethics-measurement criteria

Answer 42

Practice guided by Code of Ethics for nurses with interpretive statement Maintains therapeutic and professional patient-nurse relationship Delivers care in the manner that preserves patient autonomy, dignity, and rights Seeks available resources in formulating ethical decisions Reports illegal, incompetent, or impaired practice Maintains patient confidentiality within legal and regulatory parameters

Question 43

7. research

Answer 43

The nurse integrates research findings in practice

Question 44

research-measurement criteria

Answer 44

Utilize best available evidence including research findings to guide practice decisions Participates in research activities as appropriate to the nurse’s education and position Identifies clinical problems suitable for nursing research Participates in data collection, unit organization, or community research committees. Shares research activities with others, critiques research for application to practice, and uses research findings in the development of policies, procedures, and practice guidelines for patient care.

Question 45

8. resource utilization

Answer 45

The nurse considers factors related to safety, effectiveness, cost, and impact on practice in the planning and delivery of nursing services.

Question 46

resource utilization-measurement criteria

Answer 46

Evaluates factors related to safety, effectiveness, availability, and cost when practice options would result in the same expected patient outcome Assists the patient and family in identifying and securing appropriate and available services to address health related needs Assigns or delegates tasks as defined by the state nurse practice acts and according to the knowledge and skills of the designated care giver Assigns or delegates tasks based on the needs and condition of the patient, the potential for harm, the stability of the patient's condition, and complexity of the task and the predictability of the outcome Assists the patient and family in becoming informed consumers about the costs, risks, and benefits of treatment and care

Question 47

9. leadership

Answer 47

The nurse provides leadership in the professional practice setting and the profession

Question 48

leadership-measurement criteria

Answer 48

Engages in team work Works to create and maintain a healthy work environment Teach others to succeed through mentoring Exhibits creativity and flexibility during changes Directs coordination of care across settings and care givers Serves in key roles in the work settings by participating on committees, councils, and administrative duties Promotes advancement of the profession Displays the ability to define a clear vision, the associated goals, and a plan to implement and measure progress Demonstrates energy, excitement, and a passion for quality work Willingly accepts mistakes by self and others, thereby creating a culture in which risk taking is not only safe, but expected

Question 49

nursing code of ethics

Answer 49

Nursing has a code of ethics that defines the principles by which nurses provide care to their clients. Nurses must incorporate their own values into their practice. The code of ethics for nurses with interpretive statements provides a guide for carrying out nursing responsibilities that provide quality nursing care and provides for the ethical obligations of the profession