Nursing Practice Standards
Standard 1: Assessment
As a registered nurse on a burn unit, I perform initial head-to-toe assessments on my adult and pediatric patients, as well as follow up assessments based on the patient’s level of acuity (critical, progressive, or general level of care).
Standard 2: Diagnosis
Once I have collected my assessment data, I use this data to identify actual or potential risks to the patient’s health, and formulate appropriate nursing diagnoses that fit the overall picture. I use these nursing diagnoses as a starting point to guide my development of a plan of care for the patient. Many patients in the burn unit have a primary nursing diagnosis of impaired skin integrity related to burn injury as evidenced by open wound beds, erythema, and the presence of biofilm.
Standard 3: Outcomes Identification
After determining the appropriate nursing diagnoses, I collaborate with the patient, health care provider, and other health professionals to determine expected outcomes. I formulate outcomes that are specific, measurable, attainable, realistic, and timely. For example, I might formulate an outcome that says the patient with a impaired skin integrity will walk to the shower, clean his wounds and undergo a burn dressing change by the end of the shift.
Standard 4: Planning
Next I collaborate with the patient, health care provider, and other health professionals to come up with a plan to help the patient meet the established outcomes. The plan is evidence-based and individualized to the patient’s specific goals, preferences, and needs. In the example of working with a patient to get the dressing change and shower completed, I would ask the patient what time they would like to shower. Then, I would plan to administer PO pain medication 30-45 minutes prior to the patient getting in the shower to help decrease their pain. I would also coordinate with the health care provider to ensure the doctor will be available to visualize the wounds once the patient is done showering. I would also plan to have all of the wound care supplies ready, and the shower set up with anything the patient needs, prior to the selected time.
Standard 5: Implementation; Standard 5A: Coordination of Care; Standard 5B: Health Teaching & Health Promotion
With a plan in place, I work with the patient and the entire health care team to carry out the plan while delivering culturally congruent, therapeutic care. I incorporate health teaching and health promotion strategies throughout the plan implementation, and assist with coordinating different facets of care related to the care plan. To continue with the above example, I would educate the patient about how to remove bandages, clean the wounds, remove biofilm from the wound bed, and apply clean bandages. If the patient’s family members were going to help the patient upon discharge, I would coordinate their presence during wound care, and help educate them about the steps for wound care. I would promote independence by allowing the patient and family to be hands on during care. I would also engage in health promotion strategies by ensuring the patient has access to distilled water for wound care at home and that they understand PRN pain medication safety.
Standard 6: Evaluation
When the plan has been executed, I talk to the patient and analyze the assessment data to evaluate the patient’s progress towards completing their outcomes. If necessary, I modify the outcomes and plan to fit the needs of the patient. I communicate my evaluation to the health care team. In the above example, if the patient was having significant pain during the shower process, I would evaluate that the outcome had not been met, because the patient was not able to fully clean the wounds due to pain. I would then communicate this with the patient and provider, and change the outcomes and plan. The new outcome could be that the patient will have only moderate to mild pain during the shower for next shift, and the new plan could involve the doctor ordering a different type of PRN pain medication.
Professional Performance Standards
Standard 7: Ethics
The academic framework for my ethical practice is rooted in learning from nursing school as well as additional college coursework. NURS 307, Foundations of Professional Nursing I at VCU, included a module about ethics in nursing, as well as many readings about ethics. NSG 230, Advanced Professional Nursing Concepts at Reynolds Community College, also included modules about ethics. Beyond nursing school, I’ve also taken a course called RELG 260, Theology, Ethics, and Medicine at UVA which was a full semester about ethics in health care, and how various religious beliefs influence those ethical ideals. I incorporate the ANA Code of Ethics into my daily practice. I strive to balance the ethical principles of beneficence, patient autonomy, nonmaleficence, and justice into my practice each day. I ensure my patients’ privacy and confidentiality are maintained at all times. I approach my practice with compassion and a nonjudgmental attitude which allows me to maintain therapeutic relationships with my patients and colleagues.
Standard 8: Culturally Congruent Practice
To help me expand my understanding of practicing nursing in a way that is culturally congruent, I attended a webinar called Cultivating Cultural Competence and Inclusion through VCU Health. This course promoted cultural humility and helped me reflect on my implicit biases to help me better care for my patients regardless of gender, race, or age. In my practice I care for patient of all ages, races and ethnicities, gender identities, sexuality, and religious affiliations. I strive to care deeply for my patients like I would my own family member, and be open and respectful to cultural backgrounds which are different from my own. Some of my clinical experiences from nursing school have also helped me develop my culturally congruent practice. For example, as a part of NSG 200, Health Promotion and Assessment at Reynolds Community College, I worked with a group to teach STI prevention and sex education to the LGBT community.
Standard 9: Communication
In nursing school, I learned about different strategies one can use to communicate therapeutically. NSG 211, Clinical Concepts II at Reynolds Community College, specifically dialed into therapeutic communication skills. I use those skills each day as a part of my nursing practice, not only when communicating with my patients and their families, but also when talking to my colleagues and the medical team. I also utilize resources to ensure effective communication is taking place. When a patient does not speak English or is uncomfortable using English to discuss the care plan, I use a Cyracom translator or Marti video translator to respectfully communicate with the patient.
Standard 10: Collaboration
Collaboration is an essential part of my nursing practice. I collaborate with the patient and the care team to ensure the plan of care is appropriate for the patient and is carried out effectively. For my ICU patients, I participate in morning round with the ICU team of doctors to help the providers better understand the patient’s current condition, communicate nursing and patient needs, ask questions, and establish goals for the day. For progressive and general level of care patients, I also participate in daily rounds with the physical therapist, occupational therapist, social worker, care coordinator, and clinical coordinator to assess the patient’s needs and barrier to discharge, and strategize together to come up with an appropriate plan.
Standard 11: Leadership
In my practice I work with assistive personnel daily, and I work with these team members to ensure their workload is manageable and appropriate when considering which tasks to delegate to them. I communicate respectfully and openly, and maintain responsibility for any tasks I’ve delegated. I also use therapeutic communication strategies to handle any conflict that arises at work, whether it involve the patient, a family member, or a colleague. I am also a member of the American Association of Critical Care Nurses (AACN).
Standard 12: Education
I am currently advancing my education by pursuing a Bachelor of Science in Nursing through VCU School of Nursing. Additionally, I am completing a 90 critical care competencies course through the AACN. This RamPages website serves as a portfolio which provides evidence of my continuous journey towards furthering my nursing education.
Standard 13: Evidence-based Practice & Research
NURS 301, Nursing Informatics, and NURS 307, Foundations of Professional Nursing I at VCU, have both transformed my understanding of evidence-based practice (EBP) and my research skills. NURS 301 honed in on my database searching skills, which are foundational to EBP and research. NURS 307 taught me how to formulate a PICO question, write a literature review, and appraise the quality of sources found during a database search. In my practice, I am currently participating in an EBP project on my unit as a part of the Nurse Residency Program, which is focused on determining the best way for nurses to assess anxiety for burned patients.
Standard 14: Quality of Practice
I engage in formal peer review processes as a part of my practice. Additionally, I document my assessment data, interventions, and other nursing data in a consistent way to support quality improvement initiatives and audits.
Standard 15: Professional Practice Evaluation
As a new nurse, I participated in a 16 week preceptorship program which involved daily evaluation of my practice and my progress over time. I am currently completing a formal self-evaluation process that involves writing detailed exemplars to explain how my nursing practice meets organizational and professional standards. After completing the self-evaluation portion, I will be reviewed by my peers and supervisors in another formal evaluation process. During this evaluation process, I will set goals with management that are consistent with the practice and professional standards of nursing.
Standard 16: Resource Utilization
I work with the patient and the patient’s family to identify the patient’s needs as a part of the discharge process. I help pinpoint areas that could negatively affect their ongoing care, and then help the patient find resources in the community that can help address that need. I ensure that patients have adequate wound care supplies when I am discharging them, and work with the social worker and care coordinator to make sure additional supplies will be delivered to them. If the patient needs assistance at home, I help coordinate that as well. I incorporate telehealth into my practice when patient’s family members cannot come into the hospital, especially with the restricted visitor policy associated with Covid-19. I use video calls to help the family learn and participate in wound care. I also provide the patient with information about supportive community resources, such as setting pediatric patients up to attend Central Virginia Burn Camp, or providing information about the Phoenix Society support group for burn survivors.
Standard 17: Environmental Health
I promote a clean and safe environment at my workplace each day, by tidying the patients room and cleaning equipment according to best practices. I utilize appropriate personal protective equipment based on the patient’s condition, and wear a hand hygiene badge to ensure that I am washing my hands before entering a patient’s room, and after leaving the room.