ANA Nursing Scope and Standards of Practice 4th Edition PDF

Scope of Copyright © 2021. American Nurses Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted...

Scope of Copyright © 2021. American Nurses Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted Nursing Practice “Imagine a world without nurses. Think of a world without persons who know what nurses do; who have the effect that nurses have on the health of individuals, families, and the nation; who enjoy the trust that nurses enjoy from the American p ­ eople. Imagine a world like that, a world without nurses.” Margretta “Gretta” Madden Styles, EdD, RN, FAAN DEFINITION OF NURSING Nursing integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and ­human functioning; prevention of illness and injury; facilita- tion of healing; and alleviation of suffering through compas- sionate presence. Nursing is the diagnosis and treatment of ­human responses and advocacy in the care of individuals, families, groups, communities, and populations in recognition of the connection of all humanity. This revised definition pre­sents reordering the content from the 2015 version (ANA, 2015b), including the art and science of caring, replacing abilities with h ­ uman functioning, and incorporating references to com- passionate presence and recognition of the connection of all humanity. under U.S. or applicable copyright law. Such refinements reflect an evolution of thinking over the past five years and pre­sent enhancements intended to lead into the f­ uture. Formatting the definition as a bullet list provides an opportunity to further appreciate the richness and diversity of the integrated concepts: EBSCO Publishing : eBook Collection (EBSCOhost) - printedNursing: Scope5:46 on 6/19/2024 and Standards of Practice, PM via OAKLAND 4th Edition UNIVERSITY 1 AN: 2935865 ; American Nurses Association.; Nursing : Scope and Standards of Practice, 4th Edition Account: s9275379  Nursing: Copyright © 2021. American Nurses Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted Integrates the art and science of caring Protects, promotes, and optimizes health and ­human functioning Prevents illness and injury Facilitates healing Alleviates suffering through compassionate presence Nursing is: the diagnosis and treatment of h ­ uman responses and advocacy in the care of individuals, families, groups, communities, and populations in recognition of the connection of all humanity. OTHER DEFINITIONS ­ ese definitions are provided to promote clarity and understanding for Th all readers: Healthcare consumers are the patients, persons, clients, families, groups, communities, or populations who are the focus of nurses’ attention. Health- care consumers receive nursing ser­v ices as sanctioned by the state reg- ulatory bodies. The more global term “healthcare consumer” is intended to reflect a proactive focus on health and wellness care, rather than a reac- tion to disease and illness. Registered nurses (RN) are individuals who are educationally prepared and then licensed by a state, commonwealth, territory, or government regulatory body to practice as a registered nurse. “Nurse” and “professional nurse” are synonyms for a registered nurse in this document. Numerous jurisdictions have identified “nurse” as a protected title. under U.S. or applicable copyright law. Graduate-­level prepared registered nurses are registered nurses prepared at the master’s or doctoral educational level; have advanced knowledge, skills, abilities, and judgment; function in an advanced level as designated by ele­ments of the nurse’s role; and are not required to have additional regulatory oversight. Advanced practice registered nurses (APRN) are a subset of graduate-­ level prepared registered nurses who have completed an accredited 2 Scope of Nursing EBSCO Practice Publishing : eBook Collection (EBSCOhost) - printed on 6/19/2024 5:46 PM via OAKLAND UNIVERSITY AN: 2935865 ; American Nurses Association.; Nursing : Scope and Standards of Practice, 4th Edition Account: s9275379  graduate-­level education program preparing the nurse for special licensure Copyright © 2021. American Nurses Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted recognition and practice for one of the four recognized APRN roles: certi- fied registered nurse anesthetist (CRNA), certified nurse-­midwife (CNM), clinical nurse specialist (CNS), or certified nurse practitioner (CNP). APRNs assume responsibility and accountability for health promotion and/or maintenance, as well as the assessment, diagnosis, and management of healthcare consumer prob­lems, which includes the use and prescription of pharmacologic and nonpharmacologic interventions (APRN Joint Dia- logue Group, 2008). Some clinicians in this classification began APRN prac- tice prior to the current educational preparation requirement and have been grandfathered to hold this designation. DESCRIPTION OF THE SCOPE OF NURSING PRACTICE The Scope of Nursing Practice describes the who, what, where, when, why, and how associated with nursing practice and roles. Each question must be answered to provide a complete picture of the dynamic and com- plex practice of nursing and its membership and evolving bound­aries. The definition of nursing provides a succinct characterization of the “what” of nursing. All registered nurses, including ­those identified as graduate-­ level prepared nurses or advanced practice registered nurses, comprise the “who” constituency and have been educated, titled, and maintain active licensure to practice nursing. Nursing occurs “when” t­ here is a need for nursing knowledge, wisdom, caring, leadership, practice, or education, anytime, anywhere. Nursing occurs in any environment “where” t­ here is a healthcare con- sumer in need of care, information, or advocacy. The “how” of nursing under U.S. or applicable copyright law. practice is defined as the ways, means, methods, and manners that nurses use to practice professionally. The “why” is characterized as nursing’s response to the changing needs of society to achieve positive healthcare consumer outcomes in keeping with nursing’s social contract and obli- gation to society. The depth and breadth in which registered nurses engage in the scope of nursing practice are dependent on their education, experience, role, and the population served. Formal periodic review and EBSCO Publishing : eBook Collection (EBSCOhost) - printedNursing: Scope5:46 on 6/19/2024 and Standards of Practice, PM via OAKLAND 4th Edition UNIVERSITY 3 AN: 2935865 ; American Nurses Association.; Nursing : Scope and Standards of Practice, 4th Edition Account: s9275379  revision of the scope of nursing practice statement ensure a con­temporary Copyright © 2021. American Nurses Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted description of nursing practice is in place. DEVELOPMENT AND FUNCTION OF THE STANDARDS OF PROFESSIONAL NURSING PRACTICE Standards of Professional Nursing Practice accompany the Scope of Nurs- ing Practice statement. The standards are authoritative statements of the actions and be­hav­iors that all registered nurses, regardless of role, popu- lation, specialty, and setting, are expected to competently perform. Th ­ ese published standards may serve as evidence of the standard of practice, with the understanding that application of the standards depends on con- text. The standards are subject to change with the dynamics of the nursing profession as evidence is discovered and new patterns of professional practice are developed and accepted by the nursing profession and the public. In addition, specific conditions and clinical circumstances may also affect the application of the standards at a given time, e.g., during a natu­ral disaster, epidemic, or pandemic. As with the scope of practice state- ment, the standards are subject to formal, periodic review and revision. The Standards of Professional Nursing Practice are divided into two components, Standards of Practice and Standards of Professional Per­for­mance. The Standards of Practice describe a competent level of nursing practice demonstrated by the critical-thinking model known as the nursing pro­cess. The nursing pro­cess encompasses significant actions completed by registered nurses and forms the foundation of the nurses’ decision-­making. The Standards of Professional Per­for­ mance describe a competent level of be­hav­ior in the professional role. under U.S. or applicable copyright law. All registered nurses are expected to engage in professional role activities, including leadership, reflective of their education, experi- ence, and position. The competencies accompanying each standard may be evidence of demonstrated compliance with the corresponding standard. The list of competencies is not exhaustive. ­W hether a par­ tic­u ­lar standard or competency applies depends on the context, cir- cumstances, or situation. Registered nurses are accountable for their 4 Scope of Nursing EBSCO Practice Publishing : eBook Collection (EBSCOhost) - printed on 6/19/2024 5:46 PM via OAKLAND UNIVERSITY AN: 2935865 ; American Nurses Association.; Nursing : Scope and Standards of Practice, 4th Edition Account: s9275379  professional actions to themselves, healthcare consumers, peers, and Copyright © 2021. American Nurses Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted ultimately to society. THE ART AND SCIENCE OF NURSING Nursing is a learned profession built on a core body of knowledge that reflects multiple ways of knowing, integrating both art and science. Nursing requires judgment and skill based on princi­ples of the ­human biological, physical, behavioral, and social sciences. Nursing promotes the health, well-­being, comfort, dignity, and humanity of all individuals, families, groups, com- munities, and populations. Nursing’s focus on the healthcare consumer is enhanced by interprofessional collaboration, sharing knowledge, scientific discovery, integrative healthcare approaches, and social justice. Registered nurses integrate objective data with knowledge gained from an assessment of the subjective experiences of healthcare consumers. They promote the delivery of w­ hole person care to achieve optimal health outcomes throughout the life span and across the health–­illness contin- uum. This is accomplished within an environmental context that encom- passes resources, culture, ethics, law, politics, economics, and competing priorities. Similarly, nurses promote community and population health by advo- cating for social and environmental justice, community engagement, and access to high-­quality and equitable health care. The goals focus on maxi- mizing health outcomes and eliminating health disparities. Nurses con- tinually apply creativity, critical thinking, and clinical judgment to craft new methods for evaluating the quality, safety, and effectiveness of nurs- ing practice. under U.S. or applicable copyright law. The Art of Nursing The art of nursing is demonstrated by unconditionally accepting the humanity of o ­ thers, respecting their need for dignity and worth, while providing compassionate, comforting care. Th ­ ese actions support the belief that h ­ umans manifest a mind, body, and spirit unity; the h ­ uman experience is contextual and culturally defined; and the presence of ill- ness does not preclude health. Nurses provide safe, quality, and competent EBSCO Publishing : eBook Collection (EBSCOhost) - printedNursing: Scope5:46 on 6/19/2024 and Standards of Practice, PM via OAKLAND 4th Edition UNIVERSITY 5 AN: 2935865 ; American Nurses Association.; Nursing : Scope and Standards of Practice, 4th Edition Account: s9275379  care, practicing in­de­pen­dently or collaboratively with interprofessional Copyright © 2021. American Nurses Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted colleagues. The healthcare consumer is always at the center of care. Rogers (1992) identified that the art of nursing is the creative use of the science of nursing for ­human betterment. Nurses protect, promote, and optimize health and quality of life in the context of chronic illness, dis- ease, or disability; facilitate healing and alleviate suffering; and support the transition to a dignified and peaceful death. Nursing practice includes the diagnosis and treatment of h ­ uman responses to a­ ctual or potential health prob­lems or challenges. Identifying care needs involves a ­whole person approach and nurse partnership with the healthcare consumer. That partnership continues with the design of innovative, culturally sen- sitive, supportive, and restorative plans of care. Care and Caring in Nursing Practice “If nursing does not fulfill its societal mandate for sustaining h ­ uman caring, preserving ­human dignity and humanness in self, systems, and society, it w ­ ill not be carry­ing out its covenant to humankind and its reason for existence as a profession.” — Jean Watson The act of caring is foundational to the practice of nursing. As sug- gested by Moffitt (2004, p. 30), “A ­great truth, the act of caring is the first step in the power to heal.” Watson (2012, p. 28) in her H ­ uman Caring Science Theory: Emphasizes the personal relationship between patient and nurse; Highlights the role of the nurse in defining the patient as a unique ­human being to be valued, respected, nurtured, understood, assisted; and under U.S. or applicable copyright law. Stresses the importance of the connections between the nurse and patient. ­ uman care and caring are upheld as the moral ideal of nursing. Human-­ H to-­human interactions attempt to protect, enhance, and preserve human- ity and ­human dignity, integrity, and ­wholeness. ­These connections assist a person to find meaning in health, illness, suffering, pain, and existence. 6 Scope of Nursing EBSCO Practice Publishing : eBook Collection (EBSCOhost) - printed on 6/19/2024 5:46 PM via OAKLAND UNIVERSITY AN: 2935865 ; American Nurses Association.; Nursing : Scope and Standards of Practice, 4th Edition Account: s9275379  ­ uman caring helps self and o H ­ thers gain self-­k nowledge, self-­control, Copyright © 2021. American Nurses Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted self-­caring, and self-­healing, leading to restoration of a sense of inner har- mony regardless of the external circumstances. Caring is the compassionate application of professional knowledge, skills, and competencies. It is central to building relationships that lead to effective healing, cure, alleviation of illness, or actualization of ­human potential. Caring is grounded in ethics, beginning with re­spect for the autonomy of the care recipient. This attribute may be taught, modeled, learned, and mastered, and reflects the nurse’s ability to establish a caring relationship with the care recipients in concert with the dynamics of each situation. While recognized as a nursing science, caring is not unique to nurses. Caring is studied within caring science institutes and academies world- wide and can be analyzed and mea­sured. H ­ uman caring involves presence, empathy, values, knowledge, caring actions, ac­cep­tance of con- sequences, a w ­ ill, and a commitment to care. Caring in the healthcare environment is related to: Intersubjective h ­ uman responses to health–­illness–­healing conditions, Knowledge of health-­illness, Cultural humility, Environmental-­personal relations, The nurse caring pro­cess, Co-­designing creative solutions to individual and systems issues that arise; and Self-­k nowledge. under U.S. or applicable copyright law. Ah­ uman caring relationship in nursing involves an intentional partner- ship of the care recipient and the nurse. The nurse must possess compe- tence, professional maturity, interpersonal sensitivity, a moral foundation that supports caring actions, and the ability to create an environment conducive to caring. Every­one has an innate ability within to heal. Nurses promote that healing in what­ever way the person is ready to receive support and care. EBSCO Publishing : eBook Collection (EBSCOhost) - printedNursing: Scope5:46 on 6/19/2024 and Standards of Practice, PM via OAKLAND 4th Edition UNIVERSITY 7 AN: 2935865 ; American Nurses Association.; Nursing : Scope and Standards of Practice, 4th Edition Account: s9275379  CARING ONE Copyright © 2021. American Nurses Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted Set Aside for Special Work Caring is weaving each thread of concern, by a chosen person with compassion, so tenderly Intertwined with e­ very h ­ uman connection. Each nurse and client is unique in what they bring to the relationship, so as to interact for the basic social purpose of connecting, growing, developing, leading, even healing and rest. Caring is the bind that weaves throughout the fabric in ­ every action of a caring nurse, be it: A kind word of hope; A soft touch of love; A smile of understanding; A bright glance of life; A whispered prayer; An embrace for a lost soul; A song to share from one’s heart; A short minute to listen to the dream, the thoughts, even the sighs when in sickness, sorrow, discomfort, or sharing in the last breaths of life; A bright mind of knowledge to share the “now” by being pre­sent, to heed what was past, and to sense what is coming. Caring is being pre­sent in each precious moment to share one’s tiny slice of life, in the World’s fabric with another; under U.S. or applicable copyright law. Such special moments leave a legacy— a block in The Quilt of Life. Such unique moments stay with the client forever, ­whether remembered or not, to: Give hope to the forlorn; Share love with the lonely; Believe in the power of healing. 8 Scope of Nursing EBSCO Practice Publishing : eBook Collection (EBSCOhost) - printed on 6/19/2024 5:46 PM via OAKLAND UNIVERSITY AN: 2935865 ; American Nurses Association.; Nursing : Scope and Standards of Practice, 4th Edition Account: s9275379  For in the end, in life’s fabric, the nurse is the: Copyright © 2021. American Nurses Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted Thread b­ earer of a greater purpose; Instrument of healing; Tool to deliver special care; Voice for the voiceless, the forlorn, the broken, the abandoned, the misdirected, even the lost. Advocacy, the knitted threads in all the fabric, is the gridline in the created quilt Through each professional action of the nurturer. This role, caregiver, is paramount to the ethos of one dedicated to nursing—­one set aside for this special work. -­Carla A. Lee, RN Development of a trusting, safe partnership ­will enable the person to learn, grow, adapt, and find meaning that in turn promotes well-­being for both partners. In a caring relationship, the nurse uses well-­developed assessment skills to accurately identify nuances and help find meaning in the care recipient’s situation. Interventions that reflect a caring consciousness may require innovation, creativity, and daring but also can be demonstrated in s­ imple gestures of interpersonal connection. Such gestures may include attentive listening, making eye contact, touching, and verbal reassurances demonstrating sensitivity to and respect of the care recipients’ cultural meanings associated with caring be­hav­iors (Finfgeld-­Connett, 2007). The caring embraced by nursing does not compete with nor is it diminished by technological advances, individual or group wealth or its absence, pro- under U.S. or applicable copyright law. fessional or socioeconomic status or prestige or its lack, or any other con- dition that attempts to categorize the place of the person in society. Professional Nursing Model The new ANA Professional Nursing Model (Figure 1) created by the ANA Workgroup represents the synergy of the nurse’s caring, values, wisdom, and energy, all undergirded by ethical princi­ples and situation ethics in EBSCO Publishing : eBook Collection (EBSCOhost) - printedNursing: Scope5:46 on 6/19/2024 and Standards of Practice, PM via OAKLAND 4th Edition UNIVERSITY 9 AN: 2935865 ; American Nurses Association.; Nursing : Scope and Standards of Practice, 4th Edition Account: s9275379  FIGURE 1 Professional Nursing Model (2021) Copyright © 2021. American Nurses Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted G RIN S CA E OM LU GY VA SD ER WI EN ETHICS nursing practice. The flame is the inner light of the nurse and of nursing, always evolving, transforming, continuously lighting the way. The flame is intended to represent the seminal nursing attributes of courage, endur- ance, passion, and creativity. The Professional Nursing Model also pro- vides a framework within the ­human sciences to reflect the work and under U.S. or applicable copyright law. evolution of nursing for all nurses in all settings. This model can be tested and used for ­future theory development. Caring is integrated with the creative portion on the left of the model holding the values that arise from the shared beliefs grounding the profes- sion. The logical side of the model is comprised of the wisdom and energy needed to practice as a nurse. The w ­ hole of the flame is supported by ethics. 10 ScopeEBSCO of Nursing Practice Publishing : eBook Collection (EBSCOhost) - printed on 6/19/2024 5:46 PM via OAKLAND UNIVERSITY AN: 2935865 ; American Nurses Association.; Nursing : Scope and Standards of Practice, 4th Edition Account: s9275379  Caring: This h­ uman approach promotes dignity, healing, and wholeness—​ Copyright © 2021. American Nurses Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted the essence and heart of nursing and its practice. It occurs when ­there is a positive intention and action depending on context, directed t­oward the highest good, on behalf of the healthcare consumers. Caring is given freely and wholly to enhance the well-­being and comfort of ­others, while also adding to the goodness and trustworthiness of the nursing profession. The caring component of the flame represents compassion, kindness, and calm. Values: The values component of the flame represents re­spect, inspiration, and empathy. Nursing and its practice are based on values including, but not ­limited to, compassion, presence, trustworthiness, diversity, ac­cep­tance, and accountability. Th ­ ese values emerge from nursing practice beliefs: the importance of relationships, ser­vice, re­spect, willingness to bear witness, self-­determination, and the pursuit of health. Wisdom: Wisdom’s component represents the movement from data to information to knowledge and eventually to wisdom in which nurses pro- mote theory-­guided, evidence-­based practice, a culture of inquiry, critical thinking, and research to inform professional practice. Energy: Energy’s segment of the flame represents the energy and action sparked by nurses as evidenced by responsibility, communication, com- fort, innovation, and transcendence. Ethics: The ethics component represents trust, confidence, and loyalty, creating calmness and security. This foundation encompasses advocacy, integrity, justice, benevolence, and grace; and provides stability to the model. The Code of Ethics for Nurses with Interpretive Statements (ANA, 2015a), the blueprint for ethical practice, outlines the expectations of each nurse’s intentions and actions as well as ­those of the nursing profession. under U.S. or applicable copyright law. Nursing Pro­cess Regardless of the theoretical knowledge base upon which nursing and its practice are derived, that knowledge fits within the multidimensional nurs- ing pro­cess, the analytical, critical-thinking framework guiding profes- sional thinking and activities. The nursing pro­cess is conceptualized as a cyclic, iterative, and dynamic pro­cess, including assessment, diagnosis, out- comes identification, planning, implementation, and evaluation. The Nursing: EBSCO Publishing : eBook Collection (EBSCOhost) - printed Scope and on 6/19/2024 5:46Standards of Practice, PM via OAKLAND 4th Edition UNIVERSITY 11 AN: 2935865 ; American Nurses Association.; Nursing : Scope and Standards of Practice, 4th Edition Account: s9275379  FIGURE 2 Nursing Process Copyright © 2021. American Nurses Association. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted Assessment