Professional accountability nursing theory, nursing ethics and professional accountability and apply these concepts to your clinical practice

  1. Nursing theory used in the implementation of excellent Nursing Practices

Among the various nursing theories available in practice, I find the Nightingale’s ‘Environment Theory’ most intriguing as it has shaped my goals and values both as a student and a registered practitioner. Most fundamentally, the environment theory, propagated by Florence Nightingale (1820-1910), is based on the notion that the environment has a strong influence on patient outcomes. As such, most of the elements embedded in this theory are still practiced to date as healthcare organizations strive to provide clean air and a temperature-controlled environment for the patients hospitalized within a facility (TK & Chandran, 2017). Moreover, the environment theory comprises of seven elements that facilitate the delivery of the most optimal healthcare services to the patients. These elements focus on factors such as adequate ventilation, efficient drainage, pure water, and noise reduction. Additionally, the items in this theory put emphasis on an adequate supply of food, ample time for sleep, basking in the sun, relieving anxieties, and ensuring that the patients get a clean environment.   

More precisely, the concepts contained in the environment theory include laws of nature, human achievement of perfection, and the nursing discipline as a calling. These are coupled with the description of nursing practices as a form of art and science which is achieved through changes in the environment. Moreover, the environmental adaptation theory stipulates that nursing practices necessitate proper training and experience that differentiate it from the medicine profession (TK & Chandran, 2017).

A2. How Nurses apply the theory identified in the Implementation of their Practices

In the nursing profession, the application of these elements identified above occurs through the utilization of evidence-based practices that are supported by scientific facts and proven healthcare operations. Moreover, it involves the creation of a unique relationship between nursing practitioners and their patients. On the one hand, the environment in which a patient is placed can be manipulated to ensure delivery of the most optimal healthcare services and the achievement of positive patient outcomes. As such, nurses can adopt this model and customize a unique care plan for the patient based on his/her healthcare, spiritual, and social beliefs as well as values. On the other hand, the optimization of healthcare practices necessitates a clean setting, and nurses focus on maintaining such standards in the delivery of effective and standard healthcare practices (TK & Chandran, 2017). Nonetheless, in nursing training, the most fundamental aspect taught from the first day entails the maintenance of proper hand hygiene. It is one of the simplest and effective ways of killing germs as it prevents their spread and eradicates the development of hospital-acquired infections.

Similarly, Nightingale’s theory describes noise reduction as a variable aspect that is easily manipulated to ensure that the patients within a healthcare facility get a favorable environment during their recovery or stay. A quiet environment promotes and supports relaxation and adequate sleep while patients are recovering from different illnesses. It further eliminates or reduces the likelihood of patients developing anxiety or nervousness as they undergo different medical procedures, aspects which would prevent them from getting proper rest and sleep. The occurrence of such interruptions would further diminish the care team’s efforts to achieve positive patient outcomes (TK & Chandran, 2017). Nonetheless, nurses apply this and other elements of the environment theory in theory professional practice by adopting the notion that people are part of nature and should thus value it accordingly. They, therefore, focus on patient-centered healthcare practices to provide holistic and evidence-based services to diverse patients. Most fundamentally, the environment theory enables the utilization of nurses’ collective experiences through the placement of patients in the best physical environmental conditions (TK & Chandran, 2017). These are coupled with the manipulation of the physical conditions in whatever important ways that facilitate the prevention of diseases and the reduction of the likelihood of their health condition from escalating to worse states.

B.   Historical Nursing figures and their contributions to the practice

Florence Nightingale (1820-1910) is well-renowned as the mother of modern nursing due to her significant contributions to the practice through a patient-centered healthcare delivery system embedded in her environment theory. Moreover, Nightingale introduced the concepts of nurses acting as patient advocates, nursing education and research, and the establishment of nursing practice standards. These are coupled with the idea of improving healthcare facilities through the establishment of standards for safe and clean hospitals. For instance, in the Crimean War, Nightingale, in the company of other practitioners worked in appalling and unimaginable environmental conditions (Ellis, 2009). Most of the patients under her care died from infectious diseases that include cholera and typhoid as compared to the wounds sustained in battle. Nevertheless, amidst the dire adversities, Nightingale persevered and overcame the horrid conditions. Her compassion, yet stringent work ethics played an integral role in the improvement of the patients’ survival rate by two-thirds. Besides, her sheer determination and commitment in helping humanity inspired myriads of nurses in the contemporary world, including myself (Ellis, 2009). As such, she is credited for pioneering modern nursing practices as most practitioners have adopted her principles in spheres such as patient advocacy, leadership, and the delivery of compassionate healthcare to the widely diverse patients. These factors serve as catalysts to the delivery of profound healthcare services and the achievement of optimal patient outcomes.

The second historical figure that played a fundamental role in shaping and influencing the healthcare services practiced today entails Mary Seacole. Seacole acquired different skills related to patient care from her mother who used her herbal medicine to treat wounds and other conditions. In spite of her tremendous achievements, Seacole was never recognized for her contributions in the nursing discipline due to the color of her skin, an African American female who was prejudiced based on racial discrimination (Ellis, 2009). Nevertheless, Seacole overcame such obstacles by paving the way for other people from minority groups to venture in healthcare practices. For instance, despite numerous applications for nursing positions during the Crimean War, Seacole was rejected each time because of her skin color. Despite having string references and qualifications for the position, Seacole was further rejected in an application to work with Nightingale due to her skin color. 

Subsequently, following the numerous rejections, Seacole traveled to Crimea and financed the establishment of a healthcare unit and a restaurant. It was in this facility that most soldiers were treated for injuries sustained in battle as it was much closer to the battlefield than that of Nightingale. She thus provided vital patient care on the actual battlefield and safeguarded the welfare of numerous soldiers (Ellis, 2009). Despite the rejection and discrimination against racial backgrounds, Seacole helped patients from all walks of life.

B2. How these contributions influence Professional Nursing Practices

The contributions of these remarkable individuals have primarily influenced my professional nursing practice through the provision of standards and guidelines that should be applied in the provision of necessary care services to the patients. On the one hand, Nightingale’s story exemplifies the concept of nursing as a calling as she left the privileges in her life in England to initiate a selfless line of work in a new environment. Crimea at the time was facing scarce resources, as well as rampant infectious diseases (TK & Chandran, 2017). Nevertheless, Nightingale worked relentlessly to improve the conditions and further implement the various concepts outlined in the environmental adaptive theory. Additionally, she served as a patient advocate for better environmental conditions. These aspects entail standard practices I apply in my day-to-day activities based on a personal oath to deliver patient-centered care to my patients. As a nurse manager, I further ensure that my colleagues and the practitioners in my team get a voice through the representation of their views to the management team.

Moreover, Nightingale applied scientific approaches to the identification of a cause and effect relationship between unsanitary environment and the increase in mortality rates associated with infectious conditions such as cholera. Her efforts significantly contributed to the reduction of the death rates through the discovery and evidence-based research and practices. These were followed closely by her involvement in nursing education through the provision of scholarship programs (TK & Chandran, 2017). Similarly, Seacole’s contributions to the field of nursing mainly influence my professional nursing practice through the determination to pursue her passion. Despite racial discrimination and the rejection from numerous applications, Seacole used her resources to start her healthcare facility at Crimea. As a self-taught caregiver, she portrayed her ability to the world by providing necessary medical services to the injured soldiers (Ellis, 2009). As such, I am inspired to seek other alternatives and utilize all opportunities to achieve personal goals as well as patient outcomes. I have thus adopted a positive and ‘can-do’ attitude in all my operations and handling different tasks.

  • The differences between the roles of the State Board of Nursing and the American Nurses Association (ANA)

A state board of nursing refers to a licensing and regulatory body within a specific state whose role entails setting the standard for safe nursing services and making decisions regarding the Scope of practices within its jurisdiction. It further awards licenses to qualified candidates as they graduate to professional practitioners (Porter, 2013). More precisely, Boards of Nursing (BON) are state government agencies in each state in America which are responsible for the enforcement of the Nursing Practice Act that guides and governs nursing operations in according to the laws of a particular state. While the scope of practice for the BON varies from one state to the next, its roles include the enforcement of the Nurse Practice Act and licensure requirements (Cherry & Jacob, 2013). These are coupled with the accreditation of the training programs in various institutions, and the formulation of standards of practice. Similarly, a BON focuses on the development of policies, administrative rules, and regulations within a state.

Conversely, the American Nurses Association (ANA), formed in 1896, as the Nurses Associated Alumnae and renamed in 1911, entails a non-profit organization that focuses on the establishment and improvement of standards of nursing practices (Porter, 2013). Additionally, it advocates for the rights of registered nurses and promotes initiatives that safeguard the overall well-being of all practitioners.

C2. The influence of these organizations on personal nursing practices

These two organizations influence my nursing practice through by informing me on the dos and don’ts in the nursing profession. For instance, the Board of Nursing in Kentucky outlines the Scope of nursing practices, thereby shaping the activities carried out as stipulated by the law. It thus ensures that nurses, including myself, are responsible and accountable for actions. On the other hand, ANA works hand-in-hand with the State Board of Nursing in the establishment of a framework of standardized nursing practices within the state (Cherry & Jacob, 2013). 

In Kentucky, nursing operations are governed by the State Nurse Practice Act. As a registered nurse working in Kentucky, I am required to adhere to the various standards outlined by the law and regulation. Besides, their guiding principles facilitate the establishment of a safe and healthy working environment based on the application of ethical principles (Momennasab, Koshkaki, Torabizadeh & Tabei, 2016). Similarly, ANA facilitates the establishment of nursing practices that influence the healthcare industry through new reforms and regulations based on the issues affecting nursing operations.

C3. The requirements for Professional License Renewal in Kentucky 

Most fundamentally, the requirements for professional license renewal in Kentucky, under article 201 KAR 20: 215 of the Board of Nursing provisions, include:

  • Proof of earning fourteen approved hours of contact with patients
  • The acquisition of national certificate for carrying out the role of a nurse during the period
  • Completing a research project on a nursing topic as a principal researcher, assistant in the investigation, or project director. 
  • The publication of an article (s) on nursing
  • Nursing continuing education presentation developed by the presenter and submitted to other practitioners
  • Precept for nursing students or new recruits under orientation for at least five business days
  • Proof indicating the attainment of seven hours of contact with the patient and evaluation of employment that meets the requirements of continued hiring (Kentucky Board of Nursing, 2019)

Failure to maintain these requirements may lead to the license being revoked, termination of employment, and denial of areas of practice within the state.

C4. The difference between Registered Nurses licensing requirements in a compact versus   non-compact state

Similarly, there are different licensing requirements for registered nurses in a compact and non-compact state. On the one hand, licensure requirements for registered nurses in a compact state include a declaration that a specific state will be an individual’s primary residence and place of work. This declaration boosts the nurse’s license eligibility in various states and the adherence to the governing laws (Kentucky Board of Nursing, 2019). On the other hand, licensure requirements in a non-compact state include sending a formal letter of application to the BON in the specific state the nurse decides to practice. 

  • The differences between the functions of the FDA and those of the Center for Medicare and Medicaid Services

The Food and Drug Administration (FDA) refers to a federal government agency whose primary role entails approval or disapproval of new drugs invented by pharmaceutical companies. It further monitors the food consumed, drugs, and cosmetic products used across the nation for safety and efficacy. Contrastingly, the Center for Medicare & Medicaid Services (CMS) refers to a federal agency that operates under the Department of Health and Human Services (HHS) in the United States. Formerly Health Care Financing Administration (HCFA), the functions of the CMS include the administration of the Medicare program by working collaboratively with other governmental entities.  

According to the FDA Guidance Policy of 2007, the agency is responsible for the provision of direction in the manufacture of products and practices carried out in alternative therapeutic fields (Halpern, 2016). Nevertheless, the FDA is not mandated to evaluate other medical interventions classified under its guidance policy. For instance, it cannot evaluate practices such as the use of off-label drugs and other dietary supplements. Due to the entry of alternative therapeutic practices homeopathic products without approval of the FDA, my role as a patient advocate entails adherence to the federal and state laws when a patient requests for alternative therapy as an option (Halpern, 2016). The achievement of this goal thus necessitates the dissemination of relevant information to the healthcare practitioners working in my team and compliance with healthcare policies in the best interest of the patients, thereby safeguarding the welfare by advocating for safe perspectives.

Similarly, there are various disparities related to the alternative therapies especially when they are requested by patients or under the recommendations healthcare practitioners. For instance, in the advocacy for alternative therapeutic interventions that include acupuncture, chiropractic, the CMS provides does not cover the costs. These limitations are applied regardless of whether one or a combination of such therapies proves to be essential for the patient. As such, the CMS outlines the various guidelines for coverage in alternative therapeutic procedures. More precisely, therapeutic interventions such as acupuncture and chiropractic are not covered in the Medicare program (Momennasab, Koshkaki, Torabizadeh & Tabei, 2016). On the other hand, under the Medicare program, there are two exceptional provisions that include osteopathic medicine and chiropractic in cases where the spine needs manipulation. Consequently, patients with Medicare coverage and no health insurance forego vital interventions that involve out-of-pocket payments.  

  • The Purpose and Scope of the Nurse Practice Act in Kentucky and its influence on professional operations

In Kentucky State, Nursing Practice Act is responsible for protecting the welfare of the people through the developing and enforcing state laws that govern nursing operations. As such, the Kentucky Board of Nursing monitors nursing practices, education and training, and further promulgation of their administrative roles. These are coupled with the provision of suitable guidelines that ensure safety and effectiveness in care services rendered to their patients. Moreover, the role of a registered nurse involves carrying out activities that require special skills and knowledge biological principles, physical exercises, psychological measures, and other social sciences (Kentucky Board of Nursing, 2019). These are coupled with patient education, the creation of awareness, and sensitization of the patients. Nursing practitioners are further required to maintain health through preventing different illness and administrating medical interventions per the prescriptions of physicians. Nonetheless, these services should be consistent with the Standards of Practice postulated by the American Nurses’ Association, as well as those established by nationally accepted organizations.

E2. The definition of Delegation for the Registered Nurse in Kentucky

Most fundamentally, the delegation for the registered nurse in Kentucky necessitates the assessment of the practitioner’s judgment and appropriateness to the particular tasks. These tasks include the collection, documentation, and reporting of patient information. These are accompanied by the performance of self-care tasks that include the administration of medication. Besides, the delegation of such tasks entails performance of routine checkups that do not involve ongoing assessment and nursing input (Kentucky Board of Nursing, 2019). For instance, some of these tasks include external care to the administration of urinary catheters, ambulance operations, positioning and turning patients, and other day-to-day chores. 

  •  Application of different roles in my professional practice

Registered nurses (RNs) act as scientists through the application of evidence-based practices in the provision of safe and effective care services based on different techniques and skills. On the one hand, evidence-based practices govern the activities and interventions applied by nurses and their ability to work collaboratively with other practitioners in the delivery of desired patient outcomes. Similar to scientists, registered nurses apply different strategies and approaches to the determination of a suitable course of action that would lead to facilitate the achievement of desired patient outcomes. Most fundamentally, the nursing practices applied by registered nurses (RN) play an integral role in the identification of the unique traits exhibited by different practitioners (Momennasab, Koshkaki, Torabizadeh & Tabei, 2016). For instance, in the utilization of their skills, nurses assume the role of a scientist by exemplifying informed decision-making processes and intuitive development of courses of action decisions. These aspects are guided by knowledge and skills acquired from prerequisite training, research and experience in their professional practice (Marquis & Huston, 2017). 

As a detective, nurses use their skills to identify vital clues, especially in the diagnosis and physical examination of their patients, as well as the prediction of desired outcomes. These skills significantly contribute to informed decision-making and the determination of the causative factors associated with the occurrence and prevalence of a health condition. Conversely, as a nurse manager of the healing environment, nurse practitioners play an integral role in ensuring that patient and organizational goals are met accordingly (Marquis & Huston, 2017). The achievement of these objectives involves provision of direction and guidance on patient-driven goals, suitable interventions, and action steps. 

  • The influence of the ANA Code of Ethics provisions in Nursing Practices

G1. Analysis

The fist provision stipulated by the ANA Code of Ethics entails practicing compassionately and respecting the decisions and welfare of the patients (Halpern, 2016). According to this provision, nurses are required to recognize the unique attributes and different backgrounds of their patients in terms of cultural, economic, religious, and social preferences. As such, it influences my nursing practice through the requirement of incorporating these factors in the development of a care plan that is customized to suit the needs of the patient. Moreover, adherence to this provision implies that I have to forego or set aside personal beliefs and values when caring for patients from diverse backgrounds. Besides, the provision of patient-centered nursing care necessitates discounting a nurse’s belief system and abiding by the oath to respect the needs of the patients irrespective of their cultural, economic, social, and religious background (Halpern, 2016). Nonetheless, these requirements have primarily shaped my approach towards nursing practices as they facilitate the elimination of biased operations and the assurance of credibility.   

Additionally, the second provision that influences the nursing practices in my operations entails commitment of nurses to their patients (Momennasab, Koshkaki, Torabizadeh & Tabei, 2016). The assurance of patient-centered care begins the moment a nurse meets a patient, his or her family members, or loved ones. The patient’s decisions in terms of the type of medical treatment he/she desires should be respected by keeping him/her abreast of any operations carried out or medical interventions administered.  As a nurse, I have an obligation to uphold and serve the interests and desires of the patient. Regardless of the disagreements posed by family members, nurses must honor the desires of their patients. Similarly, concerning effective collaboration and communication between caregivers, nurses are required to establish and maintain professional boundaries. This way, aspects such as trust, respect, and communication, are enhanced, thereby ensuring flawless operations.

G2. Description of a Nursing Error in a Clinical Practice

Nonetheless, the application of the provisions mentioned herein would occur through compliance with the codes of ethics in providing necessary care services to the patients irrespective of their background. For instance, I once made a mistake by disregarding a patient’s complaint of abdominal pain. The patient had been admitted several days ago and had constantly complained of abdominal pain, but upon examination, no underlying conditions were identified. The primary care physician working with the patient thus recommended several tests and diagnostic procedure to be carried out. He further prescribed pain relief medications for the patient to take before sleeping. During my evening rounds, I realized that the patient had not taken any of his medication, despite the worsening of his condition. Upon inquiry, the patient stated that he could not take the medication as it was against his religious belief.  I could not have such an incident happen under my watch as it would interfere with the achievement of effective care and the execution of a strategic care plan. I thus insisted and persisted that the patient should take the medication, and in return, he yelled at me to leave his room. 

Shocked, I left the room and quickly realized that I had violated the codes of ethics in honoring the patient’s desire. After a short while, I returned and apologized to the patient who, surprisingly, apologized back, stating that he should have informed me of his reservations against medical procedures. Based on this incident, it is evident that nurses are required to adhere to the provision of the regulatory bodies as they guide their operations and ensure the achievement of patient outcomes.  

  • Leadership qualities and Traits that represent Excellence in Nursing 

In the nursing discipline, leadership occurs through the exemplification of qualities and traits that provide direction in challenging situations. It further involves the ability to make decisions related to the suitable course of action that should be taken based on intuitions, experiences, and evidence-based practices. As such, four leadership traits and values that I believe represent excellence in nursing include:

1.     The ability to think critically in exercising clinical and professional judgment as well as making decisions

2.     The knowledge of the requirements in the establishment of effective communication and nurse-client relationships.

3.     The enactment and understanding of the full scope of nursing practices in all operations.

4.     The application of ethical principles when dealing with complex issues involving the welfare of the patient.

As a leader at the patient’s bedside, these traits come into play when making relevant decisions regarding the suitable course of action based on his/her condition. Because the patient’s condition can change at any time, the ability to think on my feet may save his/her life by identifying the appropriate intervention. Similarly, the ability to establish an effective patient-centered care plan and relationship that is both respectful and trustworthy indicates leadership traits based on conviction (Cherry & Jacob, 2013). Similarly, the leadership traits highlighted above play a significant role within a nursing or intermediary team through the ability to critically exercise professional and clinical judgment. For instance, they foster the development of a collaborative structure in nursing care through the interaction with professionals skilled in different spheres.

Moreover, in my area of practice, the work environment influences areas such as nursing leadership, decision-making, and professional development through the requirement of feedback from the staff working in the various departments. The nursing leadership strategy applied entails the provision of recommendations and solutions to various challenges, which in turn safeguards the welfare of the patients. Similarly, all employees within the organization are encouraged to share their opinions based on independent and collaborative decision-making processes (Momennasab, Koshkaki, Torabizadeh & Tabei, 2016). However, the decisions made need to adhere to the standards, laws, and policies set by regulatory agencies and further adhere to organizational and patient outcomes. With regards to professional development, the work environment highly values personal growth and achievements. For instance, there are tuition reimbursement programs as well as academic scholarships for practitioners willing to expand their knowledge and education base (Claudette, 2014). Similar efforts and reflected in the organization hiring and recruitment processes that focus on competent and qualified personnel.              

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