Running head: SELF ASSESSMENT OF NURSING PRACTICE

Paper # 3 Self-Assessment of Nursing Standards of Practice Denise S. VanderWeele Ferris State University, NURS 440

SELF-ASSESSMENT OF NURSING PRACTICE Abstract This self-reflection paper uses the standards of practice set forth by the Association of Womens Health and Neonatal Nurses (AWHONN) to evaluate my own practice and consider

the trajectory of my career into retirement. (Note; an abstract was not required by the instructor for this paper)

SELF-ASSESSMENT OF NURSING PRACTICE Paper # 3: Self-Assessment of Nursing Practice The practice of every Registered Nurse (RN) is bound by the nursing practice law of her state. Additional standards, ethics and scope of practice are defined by the American Nurses

Association (American Nurses Association [ANA], 2010). As an obstetric nurse, the standards that drive my practice above and beyond those of the ANA are those set forth by the Association of Womens Health, Obstetric and Neonatal Nurses [AWHONN] ( 2009). This paper will use the AWHONN (2009) standards as a guide to assessing my competence for practice. A professional development plan will be examined that will carry my career into retirement. AWHONN Standards of Practice The AWHONN (2009) standards of practice are divided into two sections. The first section addresses specific standards of practice that each nurse should experience daily as part of caring for patients. The standards include assessment, diagnosis, outcomes identification, planning, implementation, coordination of care, health teaching and health promotion and evaluation (Standards I-VI, AWHONN, 2009). Standards VII-XV are under the heading of professional performance and center on professional growth and development. They include quality of practice, education, professional practice evaluation, ethics, collegiality, collaboration, communication, research, use of resources and technology. The following sections look at each standard individually and how they apply to my practice of nursing. Standard I. Assessment The registered nurse collects health data about women and newborns in the context of woman-centered and family-centered care (AWHONN, 2009). Family-centered care is at the core of my nursing practice. Birth can not take place outside of the context of the family. When assessing a woman in labor, it is important to me that

SELF-ASSESSMENT OF NURSING PRACTICE I understand not only her physical condition but also her cultural and emotional needs. The

support system that is in place, or sometimes lacking, directs my approach to her care. If there is great support, I include the family in her care and support them as they can contribute to the experience. If there is little or no support available, then I become her advocate and support person. Assessing, to me, is asking a lot of questions about the patients vision for birth and motherhood and supporting or making it happen for her if safely possible. Standard II. Diagnosis The registered nurse formulates nursing diagnoses by analyzing assessment data to identify and differentiate normal physiologic and developmental transitions from pathophysiologic variations and other clinical issuer in the context of womancentered and family-centered care (AWHONN, 2009). Based upon the assessment, I validate the nursing diagnosis with the patient, family (if appropriate) and health care team. The nursing diagnosis takes into consideration not just the physiological state of the patient but the emotional and spiritual needs of the patient and her extended family. This is particularly true when the patient is having a miscarriage. Offering emotional and spiritual support for the patient and her family can impact their lives far beyond the physical act of giving birth. Standard III. Outcomes Identification The registered nurse individualizes expected outcomes for women and newborns in the context of woman-centered and family-centered care (AWHONN, 2009). Identifying outcomes cannot happen without completing the first two standards. Once the patient needs are identified, the outcomes flow naturally. For example, the patient may wish to exclusively breastfeed her newborn. Successful breastfeeding requires instruction and support

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as the woman gains confidence in her ability to provide for her baby. An outcome may include helping the father of the baby become aware of ways of supporting the breastfeeding and learning to cope with feelings of exclusion during the feeding process. Standard IV. Planning The registered nurse develops a plan of care that includes interventions and alternatives to attain expected outcomes for women and newborns in the context of woman-centered and family-centered care (AWHONN, 2009). The plan of care is not developed in a vacuum. The woman, her significant other and extended family along with other members of the healthcare team have input into the plan of care. Occasionally, the plan may include social services or another agency that can support the new parents during their transition into parenthood by providing safe housing or items needed to care for the infant such as a safe car seat. I make it a priority to address these needs when planning the care of a woman and her infant. Standard V. Implementation and V(a) Coordination of Care The registered nurse implements the interventions identified in the womans or newborns plan of care in the context of woman-centered and familycentered care (Standard V, AWHONN, 2009). The registered nurse coordinates care delivery to women and newborns in the context of woman-centered and familycentered care and within her/his scope of practice (Standard V(a), AWHONN, 2009). Carrying out the plan of care is crucial in maintaining family-centered care. A great care plan is useless unless it is communicated, modified and documented as having been completed. End of shift report is crucial in ensuring that all issues are addressed by the oncoming shift in providing seamless care to the mother and newborn. I give bedside shift report in an effort to

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include the patient in the care plan, evaluate what has been accomplished and communicate what remains to be completed prior to the discharge of the new family. Standard V(b) Health Teaching and Health Promotion The registered nurse employs teaching strategies that promote, maintain, or restore health in the context of woman-centered and family-centered care (AWHONN, 2009). The largest piece of the care plan involves education throughout the childbirth experience. Prior to hospitalization, the woman and her significant other may seek childbirth classes as a means to educating themselves about the impending birth of their baby. As their instructor, I inform them of the choices in care that they may have during labor, delivery and postpartum periods. I also promote healthy choices during their pregnancy such as moderate exercise and healthy snacking. Once a woman is hospitalized, as a labor nurse it is my responsibility to continue to support and promote healthy choices for the mother/infant through the birthing process. If the patient and significant other are unsure of what was explained to them by the doctor, I will review again the risk/benefits to the procedure and answer any more questions that they may have, then support the decision that they make. Patient education during the postpartum period takes up the bulk of my nursing care in an effort to prepare the parents to care for their new infant at home. Some patients have little experience around babies or need a lot of support with breastfeeding or routine infant care. Patient education also includes referring the families to community resources that can continue to support them once they are home. Standard VI. Evaluation

SELF-ASSESSMENT OF NURSING PRACTICE The registered nurse evaluates the progress of women and newborns toward attainment of expected outcomes in the context of woman-centered and familycentered care (AWHONN, 2009). Ongoing evaluation and modification of a plan of care is essential to individualized care that

centers on the woman and her family. By updating care plans and documenting teaching that has been completed, I am communicating with my health care team and progressing toward expected outcomes for the patient. Standard VII. Quality of Practice The registered nurse systematically evaluates and implements measures to improve the quality, safety and effectiveness of nursing practice for women and newborns (AWHONN, 2009). Each RN in our unit is expected to perform two quality initiatives each year. These usually involve a survey, some education and a small change in practice that improves the delivery of care. As a member of the Unit Based Council, I have also had an active part in review policies and participating in the collection of data, review of evidence-based practice and implementing changes that enhance care within the unit. For example, I did an informal study on the use of correct nomenclature for documenting electronic fetal monitoring. I discovered that many doctors and some nurses were unfamiliar with changes in terminology that the National Institute of Child Health and Human Development began using in 2008. As a result of this, I wrote a grant to the hospital foundation for a multidisciplinary online education program in fetal monitoring that incorporated the nomenclature changes. The result was that doctors and nurses now speak the same language in their documentation and communication with each other with regard to fetal monitoring.

SELF-ASSESSMENT OF NURSING PRACTICE Standard VIII. Education The registered nurse acquires and maintains knowledge and competencies that reflect current evidence-based nursing practice for women and newborns (AWHONN, 2009). To meet this standard, my certifications in Basic Life Support (BLS), Neonatal Resuscitation Protocol (NRP) are renewed every two years. Although not required, I attend advanced fetal monitoring class every two years and plan to become a certified instructor by

February of 2014. I also plan to pursue certification as an instructor of NRP within the first six months of 2014. I am certified as a Perinatal Nurse by the American Nurses Credentialing

Center (ANCC), and maintain my certification through continued education. I am an advocate of lifelong learning, as evidenced by pursuing a BSN in my late 50s. I am considering attending graduate school after completing my BSN. All of these certifications and educational opportunities are driven by current research and result in evidence-based practice. Standard X Ethics The registered nurses decisions and actions on behalf of women, fetuses, and newborns are determined in an ethical manner and guided by a sound framework for an ethical decision-making process (AWHONN, 2009). The ANA Code of Ethics for Nurses (2010) is my guide for practice. By advocating for my patients, protecting their privacy and delivering care in a compassionate and nonjudgmental manner I am meeting this standard. I maintain my ethical and moral compass by sustaining relationships with mentors in my personal, professional and spiritual lives. Standard XI. Collegiality The registered nurse interacts with and contributes to the professional develop-

SELF-ASSESSMENT OF NURSING PRACTICE ment of peers, colleagues, and other health care providers (AWHONN, 2009).

I am meeting this standard through mentoring nursing students and novice nurses on our unit. I also maintaining a supportive and positive work environment, respect and embrace diversity in the workplace and participating in committees within the practice setting. Giving peers constructive feedback regarding their practice is perhaps the most difficult expectation and uncomfortable aspect of this standard. Standard XII. Collaboration and Communication The registered nurse collaborates and communicates with women, families, health care providers, and the community in providing safe and holistic care (AWHONN, 2009). Clearly communicating with other health care team members, my peers, the patient and her family are the cornerstone to my practice. Without communication, it is impossible to work together to deliver excellent care and meet the needs of the whole person. In emergency situations, it is essential that the entire team works together and clearly communicates their needs to each other. I believe the best way to maintain communication and collaboration is to deal with any disruption in the process immediately. This is often an uncomfortable process but fruitful in supporting collaboration and communication. Standard XIII. Research The registered nurse generates and/or integrates evidence to identify, examine, validate and evaluate interprofessional knowledge, theories and varied approaches in providing care to women and newborns (AWHONN, 2009). The idea that participating in research is an expectation for my profession is a change in paradigm for me. I was trained as a nurse in an era when nursing was just beginning to

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understand that nursing research is integral to nursing being regarded as a valid profession. Over the past two years, I have learned to analyze, assimilate, and yes, even appreciate nursing research. I will more actively seek opportunities in the future to participate in nursing research. One of the best ways I can support evidence-based practice is to review the evidence available and contribute to the body of knowledge if possible. Standard XIV. Resources and Technology The registered nurse considers factors related to safety, effectiveness, technological advances, and cost in planning and delivering care to women and newborns (AWHONN, 2009). In caring for women and newborns, I am open to advances in technology while considering the balance of cost versus benefit. Over-riding this is a realization that there is no substitute for the human touch. While technology can provide many wonderful tools to assist me in the delivery of safe care, I believe technology must be balanced by humanity. Standard XIV. Leadership. Within appropriate roles in the settings in which the registered nurse functions, she or he should generally seek to serve as a role model, change agent, consultant and mentor to women, families and other healthcare professionals (AWHONN, 2009). This last standard was added for the first time in 2009. It defines leadership in terms of being a team player, role model, mentor, consultant or change agent. While I am not in a formal leadership position, I believe I am a leader based on these criteria. I have a strong work ethic that promotes teamwork and loyalty. I love to mentor novice nurses. I participate in selfgovernance committees and will continue to do so. I belong to AWHONN to promote the health of women and infants. I am a lifelong learner and value advanced education.

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During the course of pursuing my BSN, classes in leadership and research have produced in me a better understanding of the importance of participation in quality initiatives, research and leadership. I now have tools at my disposal that I can use to increase the effectiveness of my experience, education and personal power in being an agent of change within an organization. Academic Journey and Professional Goals Setting professional goals and developing a plan for the remainder of my career has been a challenge for me. Over thirty-five years after obtaining my nursing license, I am finally achieving the personal goal that I set for myself in earning a BSN. My motivation for returning to school was purely academic: I wanted to see what I could learn in the process. The act of earning a BSN would not advance my position as a staff nurse in Obstetrics, make me a nurse manager or otherwise change what I do professionally. Or so I thought. Throughout the process of taking classes, I have had to examine where I want to go in my career and what I still want to accomplish as a nurse. In NURS 320, I was challenged to plan my BSN completion program. The plan I had set forth was changed due to some circumstances in my personal life. I will actually be completing my program one semester earlier than planned. I was able to take more classes than I had planned for a few semesters after I left my position as a staff nurse to provide short-term care for my elderly mother. In NURS 324, I was again challenged to think beyond the BSN degree to what I still want to accomplish in my professional life. I tailored my service learning project to help me discern if becoming a Certified Nurse Midwife (CNM) was something I wanted to pursue. My desire to promote the health of mothers and infants in under-served areas became even stronger than before the project. The wisdom in becoming a CNM at the age of 60 (by the time I complete the training), however, is still unclear. The reality of the physical toll that delivering babies at all

SELF-ASSESSMENT OF NURSING PRACTICE hours of the day and night will have on me is daunting. The cost of school over a 2-3 year

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period can be from $32,000 at the Frontier School of Nursing (2013) to $56,000 at the University of Michigan (2013). I need to decide if this is the right path for me at this time in my life. I know that my passion for caring for moms and newborns could be transferred to the next generation of nurses through becoming a nursing instructor, and I also have an interest in teaching. I am actively exploring graduate programs at Ferris State University, Western Michigan University and Davenport University at this time. I plan to make a decision before the end of this month. Whatever I decide, my expertise as a perinatal nurse will always be a part of me and I hope to continue contributing to the profession of nursing for many more years.

SELF-ASSESSMENT OF NURSING PRACTICE References American Nurses Association [ANA] (2010). Nursing: Scope and standards of practice. (2nd ed.) Silver Spring, MD: Author. Association of Womens Health, Obstetrics and Neonatal Nurses [AWHONN] (2009). Standards professional practice in the care of women and newborns. (7th ed). Washington, DC: Author. Frontier School of Nursing (2013). Tuition. Retrieved from http://www.frontier.edu/tuition University of Michigan (2013). Nurse midwife program. Retrieved from http://www.nursing.umich.edu/academic-programs/masters-programs/nurse-midwife

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COMMENTS Grader Feedback8/11/13 3:52 PM

Excellent job on the assignment. You have clearly demonstrated your understanding of the assignment. Take a look at the APA formatting of the Running head on page 2...it should be centered to the left margin not the right. Secondly, look at the indentions of the paragraphs; they are not aligned equally. What makes this particular assignment unique is that students have the opportunity to validate what they do in their practice to what is expected in the Standards of Practice. IN addition, it also allowed the students an opportunity to critically think what they hope to accomplish within the next 5 years or so. Once again, thank you for a great summer and the hard work and efforts you have put forth. Eppie