My Professional Practice

My professional nursing practice is the result of many different influences. The basis of my practice, like most nurses, is a general desire to help people. My experiences in life, both personal and professional, also contribute to my practice. The relationship between the American Nurses Association’s (ANA) scope of practice and how I practice will be explained. In order to legally practice in the state of Pennsylvania (PA), I must follow the established board regulations which affect my practice. An explanation of how Provisions seven, eight and nine can be used to develop my professional nursing practice will be given. The manner in which values, philosophical forces, ethical principles, and theories influence my practice will also be discussed.

ANA’s scope of practice is very board and constantly expanding. Nursing is becoming more specialized the number of advanced practice nurses is increasing. But it all begins with a relationship built on caring, which assists health and healing. I have the desire to help because I genuinely care about people. I am able to assist with health and healing because I learned the tools necessary in nursing school. This is a profession that requires lifelong learning. I continue to learn new things to improve my personal practice daily. As nurses, we note physical and emotional responses to diseases, illness, and health. Assessing becomes a natural response as your practice progresses. I use objective and subjective data, along with my scientific knowledge, judgment and critical thinking to diagnosis and treat patients. I advance my nursing practice by seeking knowledge. I believe I practice according to ANA’s scope of practice (ANA, 2010). Pennsylvania State Board of Nursing influences my practice in many aspects. The purpose of the Board is to “insure safe nursing services for the citizens of this Commonwealth” (Pennsylvania State Board of Nursing, Chapter 49 PA Code 21.3).

In order to fulfill its purpose, the Board establishes safe standards for the preparation of registered nurses. They determine a list of approved nursing schools. Schools can be removed from the list if specific guidelines are not followed. I graduated from an approved program. My curriculum met the guidelines and the school I attended was on the approved list. Basically, the foundation of my nursing education was developed in part by the board. The state code goes on to state the general functions of a registered nurse. It relates to me because these are the functions I perform. I assess patients and develop plans of care. I evaluate the quality of care I provide. I gather data and use that information to determine patients’ needs. I only work within the scope of practice of which I have the knowledge and skill to perform. The items listed in state code are a summation of the basic nursing job description. The code of nursing does not specifically list standards of practice but recognizes the standards of practice of nursing associations.

It does however, address standards of nursing conduct. These standards include respecting patients’ rights to privacy and confidentiality. I treat all of my patients and their private information with respect. I document accurately. I give a full report before leaving an assignment. I do not engage in inappropriate relationships with patients. I meet all of the standards of nursing (PA State Board of Nursing, Chapter 49 PA Code 21). The code of ethics for nurses Provision Seven “challenges the nurse to participate in the profession’s contribution to society by being actively engaged with its progress and development,” (Fowler, 2008, p.91). There are four facets of development for this provision. Education and practice are the facets I am currently working on by taking classes towards my bachelor degree. I hope to one day obtain my master’s degree. As I continue advancing my personal practice through education, I believe that I am contributing to the advancement of the profession as a whole. The information I am learning is incorporated into my daily practice. Administration and knowledge development are areas where I am lacking. I am not on any boards that help to create policies.

Unfortunately, I am not currently active in research development. I plan on rectifying this. I understand the importance of nurses’ involvement in developing and implementing standards of our practice. Quality of care can increase when using evidence-based practice. I adopt evidence-based practice into my personal practice. I hope to one day contribute to advancement through research and administration (Fowler, 2010). Provision Eight of the code of ethics addresses ethical tenets including; feminism, communitarianism, and social ethics. Feminism is not limited to addressing equal treatment of women but all obstacles that prevent people from living freer, fuller lives. Situations such as poverty, world hunger, and lack of access to health care. Communitarianism focuses on showing a preference to what is good for the community and not the good of the individual. Social ethics involves looking at race, culture, norms, customs and class. I need to advance my knowledge on these ethical tenets. The provision discusses nursing responsibilities in world health. I agree with Vessey, that health is a “fundamental human right” (2009, p. 303).

Having a better understanding of what is lacking in world health will help me determine how I can contribute to the changes needed in these areas. Provision Eight also focuses on respect for cultural diversity. I am extremely conscious and sensitive to diversity. I respect my patients’ cultural differences. I do not attempt to impose my ideas or beliefs on to patients. I believe this not only enhances my practice but as helps to develop trust and a good rapport with my patients. The role of professional nursing associations in social ethics is the focus of Provision Nine. There are three functions of social ethics. Reforming the profession is the first aspect. It begins with assessment of the profession. This is done to ensure that the profession remains true to its core values. Epidictic discourse, the second function, is communication that reaffirms the values of the community. The third function is social reform, presenting the values of the group to the public to produce change that aligns with the groups’ values. I practice in congruence with the core values of the profession. My communication with the community is limited to my patients and their families.

I believe that I share the values of the community. I affect social reform on a small scale through my patients. Getting out into the community would enhance my practice (Fowler, 2010). Philosophical forces influence my practice in many ways. Moral philosophies have the greatest influence. Moral reasoning is basically deciding if something is good or bad, or right or wrong. In nursing there are many rules to handling situations. We have protocols to follow. Sometimes these protocols do not apply and I have to make a decision. I make a conscious effort to do what I believe to be right or good. Right and wrong are relative ideas. So, what may seem right to me may seem wrong to someone else. In my nursing practice I do what is best for my patient. All of my actions come from a place of caring and I know that it is morally good. I practice according to the “Golden Rule” philosophy (Burkhardt & Nathaniel, 2008, p. 5). It means to do for others what you would have done for yourself if you were in the same situation. I treat all of my patients with respect and dignity. I treat them the way I would want my parents or my children treated. My personal value system directs my practice.

I evaluate my values frequently. Most of the values I have are the result of close-knit, loving family. When I look at my patients, I see someone who is loved. That brings me back to thoughts of the people I love. This leads to the desire to do everything I can to help. I function in accordance with the seven ethical principles in my nursing practice. My patients have the freedom to make choices that affect their lives. I do not believe it is my place to deny them autonomy. When I have a patient who is noncompliant, I reiterate the information they need to know. I will explain why certain things are important. Then I respect their decisions. “Nursing is a materialization of a value according to which it’s morally good to promote physical and psychological well-being” (Breier-Mackie, 2008, p. 303). Beneficence is to do or promote good and prevent harm. Nonmaleficence is to avoid causing harm.

Good can be defined in many different ways. Every situation should be evaluated. Personally, I used my nursing judgment and act based on what I think is best for the patient. Sometimes that is how “good” is determined. In the process of doing good patients can be harmed. I do everything I can to keep my patients safe. Many rules are in place to prevent harm. Most accidents can be prevented by following protocols. For example, many hospitals have fall risk protocols and skin protocols. I follow the set protocols. If it is not a clear, concise situation, I use my nursing judgment. Veracity and fidelity are not only ethical principles that I follow in my nursing practice, they apply in my personal life. Truthfulness is very important to me because it is the basis of the relationship I form with all of my patients. I want them to believe that they can count on me. So I am always honest with them. Faithfulness gives patients comfort.

My patients know that I will do what I said I would do. I try to always keep my word. If for some reason I am unable to do what I promised, I go back to the patient and explain why. This reiterates that their needs are important to me. I value privacy for many reasons. The main reason being, that am a private person. I can empathize with patients when they have to share their body with nurses. The lack of privacy does not stop there. We have to know everything. When was their last period? When did they start smoking? When did they quit smoking? The list goes on and on. Because patients want the best care we can provide, they tell us everything. We ask things that they may not share with their significant others. This is why I respect their privacy and confidentiality. This is why I try to offer them as much privacy as I can. It is hard enough on them that they have to share these things with us. Justice is the ethical principle that to applies to fair and appropriate treatment. Because I live by the “Golden Rule” this is natural for me. I attempt to allocate my time with patients fairly but it is also based on their individual needs. My ultimate goal is to take care of their needs.

Some patients have more needs than others. As an operating room nurse, if I have a patient who is very nervous I spend more time with them. If a patient is comfortable I may spend less time with them. I address the needs of each patient individually (Burkhardt & Nathaniel, 2008). In conclusion, I have explained my nursing practice. I have also identified the relationship between my practice and ANA’s scope of practice. Pennsylvania state code determined many aspects of my practice. It is fair to say my nursing practice literally began and could end with state regulations. I then went on to evaluate how I could us Provisions Seven, Eight, and Nine to develop my practice. I expressed what areas of the provisions that my practice met and which area needed improvement. Lastly, I have shown many examples of how my nursing practice directly relates to the seven ethical principles. As my nursing practice continues to develop and change I will reevaluate its relationship with these important ideas, standards and regulations.

References

Breier-Mackie, S. (2008). What’s your contribution to the clinical ethics process? Nursing Management, 39 (2), 35-43. Retrieved from http://www.nursingcenter.com/lnc/JournalArticle?Article_ID=775638 Burkhardt, M. A., & Nathaniel, A. K. (2008). Ethics & issues: In contermporary
nursing, (3rd ed.) Clifton, NJ: Delmar. Fowler, M. D.M. (Ed)(2010). Guide to the code of ethics for nurse: Interpretation and application. (Reissue). American Nurses Association. Silver Spring, MD: Nuresbook.org. The Pennsylvania State Board of Nursing. Chapter 49: PA Code 21.3. Retrieved from http://www.pacode.com/secure/data/049/chapter21/chap21toc.html#21.3. Vessey, J. A. (2009). Editorial: Expanding the paradigm. Nursing Research, 58 (5), 303. Retrieved from http://www.nursingcenter.com/lnc/JournalArticle?Article_ID=933408