The decision-making framework provides a guide for nurses to follow to ensure that they continue to act within the scope of practice. The models contribute towards the regulation of the nursing practice. Some components of the model include the:
- Nursing’s Professional Scope of practice, the standard of practice, code of ethics, and specialty certification.
- Nurse Practice Act rules and regulations.
- Institutional Policies and Procedure
I worked as a wound care nurse in a hospital-owned wound care center. The team members worked within their scope of practice. For example, If I assessed a wound and the wound bed needs some debridement, I usually call the surgeon since surgical debridement is not within my scope of practice. Ethical responsibilities were seen as each staff carried out their role. “The ethical tradition is self-reflective, enduring and distinctive” (ANA, 2015). Ethics is very important as nurses work within their scope of practice and follow their standard of practice. For example, it was my responsibility to inform the right person first (surgeon) about a wound that needed debridement and also ensure that a follow-up appointment is scheduled. This helps with the continuity of quality care. When wound healing is not progressing, early detection can also help prevent it from becoming worse. In addition, we had weekly meetings where team members collaborate on difficult cases. The members include nurses, certified wound care nurses, a surgeon, a podiatrist, and a CHRN (Certified Hyperbaric RN). The aim was to ensure optimum patient outcomes. A lot of evidence-based practices are seen in the wound care setting. These practices enhance the quality outcome of patients such as the use of silver products to dress a wound or the use of synthetic skin grafts for diabetic ulcers. Special specific certifications and training are required to ensure that nurses are competent and able to provide safe care to patients. An example was when I was trained specifically on wound vac application. Whenever a wound vac is needed and ordered for a specific duration, I will apply it in line with the order. This example answers the “why”, “where” and “how” of nursing (Scope of Practice, Standard of practice, Specialty Certification).
The Nurse Practice Act (NPA), encourages a safe quality nursing practice for the benefit of the public. Delegations made were in line with the NPA requirement and the criteria for delegation were met. For example, the qualification of nurses, the safety of patients and the five rights of delegation were considered during delegation. For example, I have been delegated by my manager to set up an ultrasonic debrider for the doctor, but I have never been delegated to use it because it is not within my scope of practice and I am not qualified to use it (Nurse Practice Act & Rules).
For proper protection, the organizational policy there was to treat all wounds as if they were infectious and could get infected. Standard precautions were always followed including gowns and shields in cases that could involve splashes. All non-disposable equipment used was sterilized after each use. These protocols were to protect the staff and patients from any infection that could arise. Also, we followed a protocol that involved a wound culture for every new patient. This helped a lot because it helped with early detection of infection and early treatment since infection is a major cause that can inhibit wound healing. (Institutional Policies and Procedures).
When all team members embark on their respective roles in line with their various scope of practice, there was progress towards achieving a set goal. I was also determined to do my part in ensuring quality care. I was able to advocate for patients and achieved the maximum outcome for the clients within my scope of practice. It encouraged me and gave me job satisfaction to see that critical wounds and traumatic wounds eventually healed after a joint team effort. As I progress in nursing, I am determined to practice professionally within my scope of practice and contribute towards a safe and positive patient outcome (Self Determination).
American Nurses Association. (2015). Nursing : Scope and Standards of Practice: Vol. 3rd edition. American Nurses Association.