1. American Nursing Association NURS 320 Jennifer Milliron Audrey Gauthier Deborah Lackey Kitty Miller

2. Introduction In 1896, a small group of people led by Isabel Adams Hampton Rob formed the Nurses Associated Alumnae of the United States and Canada which later became the ANA in 1911. The ANA is a professional organization that represents the best interest of Registered Nurses by promoting the rights of nurses in the workplace, lobbying congress regarding healthcare issues that affect the public and workforce while maintaining high standards of practice. The ANA developed the Nursing Social Policy Statement, the Code of Ethics for Nurses with Interpretive Statements and Nursing: Scope and Standards of Practice. This presentation will discuss the six standards of practice outlined by the ANA which are as follows Assessment Diagnosis Outcomes Identification Implementation Evaluation American Nurses Association (2014). Nursing World. Retrieved from http://www.nursingworld.org/FunctionalMenuCategories/AboutANA/History

3. Assessment The American Nursing Association is based on dedication, principles and guidelines for the nursing profession which in term defines values and prioritizes our duties across the nation. “The American Nurses Association's (ANA) Code for Nurses with Interpretive Statements explicates the goals, values and ethical precepts that direct the profession of nursing. The ANA believes the Code for Nurses is nonnegotiable and that each nurse has an obligation to uphold and adhere to the code of ethics.” (Nursing World, 1994). As an RN we use a dynamic approach to assess our patients daily we collect data to create the first step in our nursing care. We analyze and look at things like: 1.Assessment (skin, pain, wounds, nutrition) 2.Life style factors (eating habits, smoker?, exercise) 3.Economical (do they have money to pay for their prescriptions, transportation, insurance) 4.Social (support groups, home care, family support) All of these things play a huge roll in being able to complete the next few steps of the nursing process and create/individualize the best way to assist our cliental in the proper and best way.

4. Diagnosis This step is based on findings related to the assessment and is analyzed to evaluate the patients plan of care. This piece is critical in achieving the next phase, the nursing care plan. As a nursing profession we develop a lot of collaborative relationships with other specialists to help provide broader interventions for our ill patients. As we diagnose we supply our resources from a broad range of knowledge including discipline, biology, medicine, pharmacology, nutrition, physical therapy and psychology. Our goal is to improve, restore, maintain health or achieve a peaceful death. 1.Clinical findings (lab work, signs and symptoms, assessments) 2.It uses the critical-thinking skills analysis and synthesis in order to identify client strengths & health problems that can be resolved/prevented by collaborative and independent nursing interventions. 3.A synopsis that describes a client’s actual or potential health problems that a nurse can identify and for which she can order nursing interventions to maintain the health status, to reduce, eliminate or prevent alterations/changes. DIAGNOSING = Data Analysis + Problem Identification + Formulation of Nursing Diagnosis

5. Outcomes Identification The American Nurses Association (2010) identifies expected outcomes for Registered Nurses and additional competencies for Specialty Nurses and Advanced Practice Nurses. The Registered Nurse Involves the healthcare consumer, family healthcare providers, and others in formulating expected outcomes when possible and appropriate. Derives culturally appropriate expected outcomes from the diagnoses. Considers associated risks, benefits, costs, current scientific evidence, expected trajectory of the condition, and clinical expertise when formulating expected outcomes. Defines expected outcomes in terms of the healthcare consumer, healthcare consumer culture, values, and ethical considerations. Includes a time estimate for the attainment of expected outcomes. Develops expected outcomes that facilitate continuity of care. Modifies expected outcomes according to changes in the status of the healthcare consumer or evaluation of the situation. Documents expected outcomes as measurable goals.

6. Outcomes Identification The Specialty & Advance Practice Nurses Identifies expected outcomes that incorporate scientific evidence and are achievable through implementation of evidence-based practices. Identifies expected outcomes that incorporate cost and clinical effectiveness, healthcare consumer satisfaction, and continuity and consistency among providers. Differentiates outcomes that require care process interventions from those that require system-level interventions (ANA 2010)

7. Planning Plan of care (care plan) recording our intended actions in a permanent record. Required in most facilities, enhancing continuity of care. It is important to accurately assess, diagnose and identify outcomes for planning to be a success. Planning relies on previous steps, integrating assessment data and applying scientific knowledge to form a strategy of interventions (White, 2012). Complexity of planning includes “nurse-related, patient-based, resource-based, evidence based, and environmental ( White, 2012. pg 76 )” factors. Continuation of learning and applying evidence-based practice is important in this stage. According to ANA, White (2012) suggests planning: Promotes and restores health of the patient Prevents illness, disease and injuries Alleviates suffering of the individual Provides supportive care for the dying person The licensed individual executes orders planned The goal of planning is to achieve desired outcomes White, K.M. & O’Sullivan, A. (Eds.). (2012). The essential guide to nursing practice. Washington D.C: Author

8. Implementation White (2012) states the GOAL is to: “Implement the best possible evidence to provide the quality health care that meets expected outcomes to resolve problems as designed in the plan of care for the patient” (p. 97) Implementation involves two levels of action: First, nurses must question and critically appraise the evidence for implementation of interventions used in nursing practice. Second, nurses must design and implement research to evaluate interventions in nursing. Research evaluating the implementation of physiological, psychosocial, and educational interventions will contribute to the advancement of nursing science and will improve the quality of health and health care (White, 2012, p. 97).

9. Evaluation Is defined as: “the process of determining the progress toward attainment of expected outcomes, including the effectiveness of care” (ANA, 2010, p.65) It is accomplished through direct observation; through interviews with the healthcare consumer, family, and /caregiver; and through reviews of record documentation including progress notes, flow sheets, and results and reports from other departments (White, 2012, p.105).

10. Nursing Practice Standards by Audrey Gauthier In my current position as a registered nurse the practice standards influence my job each and every day. I have a mindset of the 6 practice standards with each and every patient. I assess and diagnose in collaboration with physicians, pharmacist, specialists, and families. I then take the data I have collected and plan, implement and create a goal. My overall plan is to improve, restore, maintain health or achieve a peaceful death for my patients. The Joint Commission Accreditation of Health Organization influences my job everyday. We are required to abide by policies and procedures to the liking of JCAHO. Hospitals face increasing demands to participate in a wide range of quality improvement activities, the role and influence of nurses in these efforts is also increasing from bedside to management; growing demands to participate in more and more, often duplicative, quality improvement activities. The burdensome nature of data collection and reporting and the high demand of more patients and less staff creates shortcomings of traditional nursing creating what I feel like at times is a lesser efficient nurse. Consequently, hospitals’ pursuit of high-quality patient care is dependent, at least in part, on their ability to engage and use nursing resources effectively, which will likely become more challenging as these resources become increasingly limited.

11. Nursing Practice Standards by Jennifer Milliron As a charge nurse in a busy skilled long term facility, I use the six standards on a daily basis. With the addition of a rehab unit and doubling our memory care unit, being able to quickly and accurately assess a situation is vital to the wellbeing of our residents. In my position, it is up to me to apply the standards of practice to the situation in order for a positive outcome to be accomplished, and in a lot of times, the life of a person is in my hands alone. Our facility is run like a mini hospital except we don’t have all of the advance lifesaving equipment due to only being a skilled long term care facility. Applying critical thinking to quickly diagnose the problem and an outcome is needed in order to accomplish a plan of action, which in a lot of cases includes making a fast decision in order to get the resident the life saving care they may need. A proper assessment is vital to the residents future. With orders from a doctor, we can then implement the plan of action and evaluate the outcome.

12. Nursing Practice Standards by Deborah Lackey In my nursing practice I have used assessment as the initial step to determine my patients need for ongoing education and to begin an individualized written plan of care for each of my patients. I determine the proper nursing diagnosis’ after analyzing the assessment data with the active participation and validation of each nursing diagnosis,or problem, with the patient, family, and other healthcare providers. I am then able to identify expected outcomes, and write out a nursing care plan,. I am able to identify the expected outcomes for the patient, only after proper diagnosis’ have been made. Outcome identification helps me to develop strategies and alternatives, with the patients approval, to achieve those outcomes. Planning, with the patient, takes into consideration the current scientific evidence, trends, research, and the economic impact for the patient and possibly family, There may be other factors to include in the planning effort I then Implement the identified plan using evidence – based interventions and treatments. I include collaborating with the healthcare team, and partnering with the patient, family and others. We coordinate our care delivery. All of us work together to implement the plan in a safe, realistic, and timely manner. I Evaluate the progress toward attainment of outcomes. Documentation, measurement, communication, and collaboration are the tools I use to ensure criteria has been met during the implementation steps. Ongoing assessment data informs me if revision of diagnosis, outcomes, plan and implementation are needed (ANA, 2012).

13. Nursing Practice Standards by Kitty Miller In my current practice as a Registered Nurse in Surgical Services, American Nurses Association Practice Standards influence my Nursing Practice in every patient I work with. As a circulating nurse I have to perform an ongoing assessment of not only my patient but the providers in the room as well. My first priority is my patients safety. I make sure they are comfortable and safe from harm. Once the patient is in their proper state for the surgery I then make sure they are in a position that will not harm them. I make sure that a safe position is maintained throughout the procedure. As certain surgeries require a change in the position of the patient. During the surgeries I make sure that sterility is maintained by the surgeons, residents and surgical technologists involved in addition to my many roles. I also assess the patients history. Therefore I can alert the surgical team and anesthesia group of any potential problems, drug interactions, etc. In surgery there are many policies specific to the department and the orientation even for an experienced nurse can be quite lengthy because there are many outcomes to prepare for. The plan is specific to the patient and the surgeon has preferences so there is a lot of discussion and learning to make it successful. Implementing the plan is a team effort. Evaluation is done on a case to case basis so that we can continue to provide the best care for our patients.

14. Reference American Nurses Association (2014). Nursing World. Retrieved from http://www.nursingworld.org/FunctionalMenuCategories/AboutANA/History American Nurses Association. (1994) The Nonnegotiable Nature of the ANA Code for Nurses with Interpretive Statements. Nursing World. Retrieved from: http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and- Resolutions/ANAPositionStatements/Position-Statements-Alphabetically/prtetcode14446.html http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and- American Nurses Association (ANA). (2010). Nursing Scope and Standards of Practice (Second Edition). Silver Spring, MD American Nurses Association (ANA). (2010). Nursing Scope and standards of practice (2 nd ed.). Silver Spring, MD: Nursebooks.org. White, K.M., & O’Sullivan, A. (Eds.) (2012). The Essential Guide to Nursing Practice: Applying ANA’s Scope and Standards in Practice and Education. Silver Spring, MD: Nursebooks.org. White, K.M. & O’Sullivan, A. (Eds.). (2012). The essential guide to nursing practice. Washington D.C: Author