One of the key attributes of professional nursing practice is the demonstration of professional responsibility and accountability during care delivery. Actions like the development of therapeutic relationships with patients promote communication between the patient and the nurse and demonstrate professionalism. For example, I recently managed a 16-year-old female patient admitted due to a breast abscess. I noticed that she was reluctant to speak to other nurses including resistance to physical examination in the presence of her parents. To address this issue, I began by explaining to the patient the relevance of obtaining enough information about her condition. I took her to a separate room, gave her full attention, and conducted a physical examination while maintaining privacy (Competency #1). I realized that she opened up and explained that she did not want her parents to know she had previously pierced her nipples. This information was important in planning for health education and medical management of the patient.
During care delivery, psychological support is important to patients, especially those suffering from long-term illnesses. While working in the medical unit, there was a 55-year-old male recently diagnosed with lung cancer. Having cared for these types of patients before, I understood that providing psychological support and stress reduction interventions were crucial (Competency #2). I encouraged the patient to express emotions honestly and allow healthcare providers to assist as much as possible. I also realized that the patient did not want the family to be informed about his condition. To address this issue, I spoke to the patient about the relevance of involving families to provide emotional support since his condition was long-term. Additionally, I understood that the family could assist the healthcare team in providing care including home care of the patient upon discharge (Competency #6) After a series of talks, the patient agreed the immediate family be informed about his health status (Competency #7a).
Patient assessment is among the initial steps that guide healthcare professionals to identify needs and appropriate measures to provide care. For example, while working in the emergency and trauma care unit, there was a patient brought with hip dislocation after sustaining an accident. The initial steps of care involved administering pain medication and collaborating with the patient and family to take complete history (Competency #3). Upon review by the medical officer, the patient was scheduled for manual manipulation, relocation, and reduction of the hip. The doctor ordered the administration of diazepam 5mg and hydromorphone 2mg. I ensured to inform the patient about the drugs, the purpose, and seek consent before administration while ensuring privacy was maintained (Competency #7b).
Critical thinking and problem solving are key skills that nurses use to effectively assess patients and deliver quality healthcare. During the management of the patient with hip dislocation, The initial medication given to achieve moderate sedation did not yield any results. After consultation with the doctor, we agreed to add another dose of 5mg diazepam and 2mg hydromorphone. However, I later remembered one of the reasons achieving sedation could be a challenge was if the patient was using other narcotics (Competency #4). I reviewed the patient’s current medications and realized he was using oxycodone for the management of lower back pain making it difficult to achieve sedation immediately. Upon realizing the potential for oversedation, I assigned one of the UCPs to monitor the patient for changes in breathing including placing the patient on a BP monitor and pulse oximeter (Competency #9).
The application of critical thinking and problem-solving skills can aid in managing difficult healthcare situations and preventing adverse events. I remember was I was managing the patient under sedation, mild respiratory distress was observed as a result of oversedation. To address this challenge, I placed the patient on supplemental oxygen and set the automatic BP monitoring every five minutes (Competency #36). At the same time, I realized the patient could require special attention and therefore informed the doctor and respiratory therapist to be around to address any emergency that could arise. (Competency #18). I ensured to reassure the patient’s family who were anxiously waiting for the patient to recover after noticing changes in his condition after the procedure (Competency #12). To minimize the risk of complications, I instructed the UCP not to leave the patient alone and to sound an alarm immediately there was danger.
After a few minutes, the patient’s condition seemed to deteriorate. The UCP reported that the patient’s oxygen saturation was dropping below 95% and repeat BP readings showed slightly low readings. Interventions by the respiratory therapy at this time included increasing oxygen supplementation and re-positioning the patient (Competency #56). Eventually, the patient was stabilized and the vitals normalized. The UCP served an important role in monitoring the patient and reporting changes in the patient’s health to the nurse (Competency #58). The patient’s vitals were monitored for two more hours and he seemed stable for admission to the ward for further management. The application of critical thinking in this situation helped to prevent adverse outcomes like severe respiratory distress that could otherwise have led to the patient’s death (Competency #52).
Nursing theories provide the foundational knowledge for nursing practice and help distinguish nursing as a separate discipline from medicine. Nurses should use these theories to help provide care that respects patients and improves outcomes. For example, when I was working in the surgical unit, I met a young Mexican patient admitted with a diagnosis of cellulitis. She was unable to communicate well with other patients and care providers because she was a foreigner. To meet her needs, I used Hildegard Peplau’s interpersonal relations theory to observe, formulate, and validate interventions for the patient. It was important to assume the roles of a stranger, counselor, and teaching role as stipulated in the theory to promote the patient’s care (Competency #5). Using Peplau’s theory, I was able to develop a strong relationship with the patient and made her hospital experience interesting.
Every healthcare organization has its own culture that helps promote growth and maintain relationships between healthcare providers. The implementation of new change and the use of evidence-based practices to guide nursing care is one of the organizational cultures I have observed in my institution. For example, we recently incorporated strict adherence to CLABSI prevention bundles in the ICU as a strategy to minimize the CLABSI rate in the unit. The new strategy is supported by literature to improve patient outcomes including reduction of costs (Competency #10). This culture of using evidence-based practices has greatly improved patient outcomes in the ICU and other units while minimizing the cost of hospitalization. Nurses and other healthcare providers are now able to improve the quality of care for ICU patients through the culture of evidence-based practice use (Competency #8). Since the implementation of the new practice, the intensive care unit has seen a reduction of CLABSI by one-third, and the patient satisfaction scores have greatly improved (Competency #57).
Nurses are always involved in workplace conflicts that should be effectively solved to minimize harm. For example, when I was working as a manager of the medical unit, I observed conflict between the day shift and night shift staff. The morning shift staff complained that night duty staff left the nursing station untidy and repeatedly failed to file all reports before the transition of care. To address this issue, I joined one of the morning shift handoffs and listened to both parties before making a decision (Competency #11). During the resolution process, the night duty staff agreed that they did not finish their tasks on time because of understaffing. I maintained a calm tone, let all parties explain their concerns, and showed a willingness to collaborate to solve the issue (Competency #22).
The ability to successfully manage and solve conflict depends on various conflict resolution skills like assertiveness, the establishment of relationships, and providing feedback. During the resolution of the conflict between day and night duty staff, I assessed the reasons for failed relationships between staff and generated an action plan to ensure all duties were completed in each shift (Competency #46). Both parties agreed to work together to complete documentation in the morning and I ensured management was aware of the shortage of staff in the unit. After a week of working together, I realized that the conflict was resolved and both teams demonstrated a strong ability to work together (Competency #59).
Nursing leadership is an important tool for dealing with today’s changing healthcare environment and the increasing complexity of patients’ needs. The nurse leader should possess knowledge of leadership styles to apply and skills that can promote leadership. For example, when I was working in the emergency trauma unit, there was a shortage of staff. At one point, the nurses were hesitant to assume their duties including refusal to admit new patients because of the increased workload. To address this issue, the hospital administration seemed to issue threatening warnings to those who failed to cope with the current situation. As the nursing team’s leader, I understood that the authoritative style could only affect the quality of patient care and ruin relationships in the unit (Competency 13).
To address the issue of staff shortage, I called a meeting with all nurses and allowed them to describe their problems and propose solutions. I also engaged the administration to consider the needs of the nurses before issuing threats that could otherwise be costly to patients (Competency #25). During the talks, the nurses wanted the employment of additional staff to cover the extra patients. Peaceful talks were made and it was agreed that more nurses will be recruited for locum as the organization planned for the hiring of extra permanent staff (Competency #48). The democratic approach to addressing the needs of trauma and emergency care unit nurses restored positive relationships among staff in the organization. I observed that the quality of care improved in the unit and nurses were ready to admit more patients while working hard to cover the shortage (Competency #61). Involving employees in decision-making can be an important aspect of maintaining and improving quality care in healthcare organizations.
Health education is an important tool that enables patients to take control of their health during hospitalization and discharge. Using appropriate health teaching strategies can ensure retention of knowledge and effective management of one’s health. For example, when I was working in the surgical unit, I observed that most patients did not know how to take care of their wounds until the last education given during discharge. To address this issue, patients suggested that early information sharing could enhance their ability to perform self-care at home (Competency #14). Providing timely information could serve as a strategy to improve the patient’s understanding of their condition and long-term retention of information about wound care.
Collaboration between healthcare teams is a strategy that serves to improve relationships and patient outcomes during care delivery. During the initial stages of solving the issue of information sharing, I formed a small group consisting of stable patients, students, and senior nurses to come up with strategies to ensure the timely sharing of wound care information to patients (Competency #28a). The team was responsible for searching for appropriate literature to guide evidence-based strategies that could improve information sharing with patients. Additionally, consultation with senior members of the institution was allowed to ensure the selected strategy was feasible (Competency #28b). Different strategies were chosen to ensure sharing of information about wound care with patients. The senior leaders proposed educating patients about wound hygiene during routine wound dressing until the patient was discharged. From the literature perspective, the use of whiteboards placed in the patient’s rooms was suggested to promote information sharing (Competency #28c).
Upon formulation of these strategies, both the patients and nurses agreed that using whiteboards could improve the retention of information about wound care. Routine education about wound hygiene during wound dressing was found to be ineffective because most patients were in pain and distracted (Competency #28d). During the implementation of the whiteboards approach, patients agreed to read the notes daily and share the information with family members. Patients were expected to understand various aspects of wound hygiene, wound care, and infection prevention upon discharge (Competency #28e). Additionally, students were tasked with providing mandatory health education each week about wound care to patients including comprehensive education during discharge (Competency #28f). Apart from the nursing team, I ensured to involve the doctors and nutritionists in the plan of improving wound care approaches before patient discharge. These teams could also write information about nutrition and medical care for the wounds on the whiteboards for patients to read and internalize (Competency #29).
During the implementation of these strategies, patients were informed about wound hygiene practices like hand washing and infection prevention. Each week new information was written on the whiteboards and patients were encouraged to read (Competency #49). Family members were also encouraged to read the information and remind their patients about wound care at home. During discharge, most patients demonstrated marked retention of information about wound care. Using the teach-back approach, the majority were able to identify key points about hygiene practices and nutritional care (Competency #62). Collaboration between patients, nurses, and other healthcare providers assisted in addressing the challenge of information retention among surgical patients regarding the issue of wound care.
Determinants of health are behavioral, ecological, biological, sociocultural, or economic factors that influence one’s health. Understanding these factors can help nurses manage patients and plan for subsequent care delivery upon discharge. For example, I once handled a 35-year-old patient admitted to the medical unit with diabetes and hypertension. During assessment and history taking, I realized that there was a family history of these diseases that served as predisposing factors to his condition. His history of smoking, unhealthy eating habits, and lack of exercise also seemed to contribute to his poor health (Competency #15).
To address this issue, the first approach involved medical management with drugs to lower his BP and blood sugar. Upon stabilization, the plan was to provide comprehensive health education on the determinants of health and lifestyle changes to manage his condition (Competency #30). During health education, I explained how the patient’s health could be improved through lifestyle changes like quitting smoking and doing exercise. I stressed the importance of regulating his diet for weight management and taking the medication until his condition was stabilized (Competency #50). The patient demonstrated an understanding of the determinants of health and how to manage his conditions upon discharge.
One of the nursing care aspects emphasized internationally is patient or nursing advocacy. Advocating for the patient’s rights is a role that makes nurses demonstrate exceptional patient care inside and outside the hospital environment. For example, working in the surgical unit made me appreciate the relevance of the right to informed consent. I realized that most patients signed for surgeries without adequate knowledge about the procedure and risks involved. To address this issue, I proposed a method of educating patients about prescribed procedures and associated risks (Competency #16). Apart from emergency surgeries where quick decisions needed to be made, nurses and doctors were supposed to fully educate the patient and seek consent a day before scheduled surgeries.
There are different programs in the community that can contribute to the health of populations. Nurses should help patients to identify community resources that can be used to address their health concerns. For example, during the discharge of the 35-year-old patient, I encouraged him to utilize local programs available for weight reduction. I encouraged him to join groups in the community fighting to reduce their weight through exercise and other interventions (Competency #17). The utilization of community resources like support groups and recreational facilities like parks can help during the management of chronic diseases.
Clinical judgment development in nursing is important because it helps in making appropriate diagnoses and care decisions for patients. For example, when I was working in the emergency unit, I attended to a patient with complaints of difficulty breathing, cough, and congestion for 3 days. At the time of this call, I was the only senior nurse in the unit and the attending doctor was in a meeting. I noticed that the patient used the tripod position to breathe and could only say a few words before he was out of breath. I immediately put him on a monitor to assess his BP and his pulse was 84%. I placed a nasal cannula and initiated oxygen therapy at 2L and also started an IV (Competency #19). I immediately informed the respiratory therapist about the patient and called the doctor to order more tests.
Continuous assessment of patients during care delivery is crucial to determine the effectiveness of interventions and to guide in making required changes. For example, I reassessed the patient with breathing difficulty after 30 minutes of medical intervention and noticed his oxygen saturation had improved to 92%. A chest X-ray ordered by the doctor revealed he had pneumonia and he required admission for a few days (Competency #20). I informed the patient about his new plan of care and updated the family on what to expect.
Time management in nursing is a skill that helps nurses prioritize patient care and other personal obligations. Nurses who manage their time and organize their workload easily achieve balance in the face of time limitations. When I was working in the medical unit, time was a barrier, especially when staffing was limited. To address this issue, we used to divide tasks according to the available workforce. For instance, one nurse was responsible for administering and documenting medication while the other could order tests and organize discharges (Competency #21). Most sick patients were given priority during shifts and most documentation was done during breaks to save time.
Effective communication helps nurses and other healthcare providers establish rapport with patients and solicit crucial health information to enable care delivery. Acquiring various communication skills can aid in managing different situations during care delivery. When I was working in the intensive care unit, I dealt with a situation involving a family that was unable to cater to their patient’s bills. The financial status of the patient prohibited access to essential services. The patient’s mother persistently explained that they had no means to transfer his son to another healthcare facility. After actively listening, I offered to talk to the social worker to see if there were any available means to cover the patient’s care (Competency #23).
During communication with the patient’s mother, I listened more, let her express feelings, and demonstrated empathy. I expressed my sincere apologies for putting the family in such a dilemma, especially when her son was fighting for his life (Competency #47). I also made her aware of the hospital policies and provided reassurance that I was going to do my best to see if exceptions could be made. After talking to the social worker, a new plan to continue supporting the patient until full recovery was made. I was pleased that my active listening skills and demonstration of empathy solved the problem (Competency #60).
Unregulated care providers are a crucial part of the healthcare team because of their input during patient care. The nurse should assess the knowledge of UCPs and provide teaching based on learning needs. When I was working in the ICU, UCPs were a crucial part of the healthcare team and provided a wide range of activities including ambulation, taking vitals, and tube feeding. I used to plan for the education of these individuals on tube feeding and charting information (Competency #24). During routine patient care, I could assign duties like monitoring vitals and performing a range of motion exercises to recovering patients (Competency #43).
UCPs lack special training to provide special services like nurses and doctors. During care delivery, these individuals should be supervised and closely monitored when providing specialized care. For example, during medication administration to patients, I used to give UCPs controlled drugs like morphine to administer to patients under my supervision (Competency #44). In all cases involved, my role was to withdraw the drug, ascertain the dosage and instruct IV administration to the right patient. During my stay in the ICU, UCPs helped nurses to provide care to patients and reduced workload by performing different nursing tasks.
During care delivery, errors can result from inappropriate assessment and faulty technology leading to adverse outcomes. Providers must be keen to identify potential health problems and issues and their consequences to clients. For example, there was a time when the doctor prescribed antibiotics to patients without taking notes on drug interactions and patient allergies. The patient was allergic to amoxicillin and the doctor had missed this consequence because he was unconscious. During drug administration, I noticed the change in medication and compared the notes in the EHR when I noticed the penicillin allergy. I recommended the change of medication and indicated on the patient’s treatment sheet about the allergy to prevent adverse outcomes (Competency #26).
Interprofessional collaboration in healthcare is important in improving patient outcomes and minimizing errors. Multiple healthcare workers should work together to achieve common goals. An example that I can recall is when we worked together with a psychiatrist to solve a case of depression in a teenager. The 16-year old was brought to the emergency department due to attempted suicide. On assessment, the patient had refused to go to school, spent most of her time locked in the room, and lost interest in her friends. The detailed assessment indicated that it was her second suicidal attempt and these changes began after her parents separated. I consulted the psychiatrist to review the patient and help in guiding the treatment (Competency #27a).
Apart from this detail, I noticed that the patient’s father was overprotective and did not want to excuse the little girl to express herself. During the physical examination, I noticed that the patient had marks on her thighs and refused to explain what had happened. I suspected a case of abuse based on the presentation of the patient and asked the psychiatrist to dig more (Competency 27b). It was later realized that the girl had developed depression due to abuse and the suicidal attempts were a sign of helplessness.
Nursing care delivery involves offering preventive, promotive, rehabilitative, and palliative care services to patients across the care continuum. A professional nurse should demonstrate competency in these areas to provide quality care in both rural and urban communities. For example, when I was working in the medical unit, I helped organize a campaign to increase awareness of infection prevention strategies in the facility. The aim was to promote the health of patients by minimizing infections acquired during hospitalization (Competency #31a).
Disease prevention in healthcare can be done through primary, secondary, and tertiary approaches. For example, when I was working in the medical unit, I insisted on the use of side rails to prevent falls for unconscious patients (Competency #31b). Preventing falls helped minimize injuries to patients that were the leading cause of preventable harm in the unit. Apart from actions to prevent disease and injury, a nurse is directly involved in maintaining and restoring health. An example I can remember is the provision of parenteral nutrition in the ICU to help maintain the nutritional requirements of patients (Competency #31c).
The increasing number of chronic illnesses and disabilities today has increased the need for rehabilitative care services. Nurses should be prepared to help patients get back up after suffering long-term illnesses including restoration of normal functioning. For example, when I was working in the ICU, I planned for the care of recovering patients and it included early mobility (Competency #31d). I also educated patients and families on simple exercises to prevent loss of function and to fasten quick recovery following long periods of immobility.
Palliative care is required for a wide range of diseases including cancer, cardiovascular diseases, and HIV/AIDs. Professional nurses should understand the special type of care these patients require including the important aspect of pain management. During my care of patients in the medical unit, I helped patients with terminal illnesses like cancer through pain relief and psychological support (Competency #31e). I could encourage families to support the patient and be available when needed.
Interprofessional collaboration is the collective involvement of various professionals to provide care to patients. Nurses should involve other healthcare teams during care delivery to optimize care given to the patient. For example, when I was working in the medical unit, a 67-year-old patient I was attending developed a behavior change. She refused to see her relatives and threw objects at any healthcare provider entering her room. She refused to take her medication and also failed to leave her room all day. I realized that she might have been battling with depression due to her diagnosis and the need for psychological care required interventions from a psychiatrist (Competency #32). She was later diagnosed with depression and counseled appropriately. Part of the routine care involved the administration of antidepressants to manage her new diagnosis while continuing with other medications (Competency #33).
The prevention of infections during care delivery requires the use of the aseptic technique alongside other hygiene practices. These interventions help prevent the entry of pathogens that can cause illness in patients. For example, when I was working in the surgical unit, I used the aseptic technique to dress the patients’ wounds. I would use sterile gloves and ensure the environment is clean to prevent the spread of microorganisms to the open wound (Competency #34). While working in the same unit, I was tasked with collaborating with doctors and subordinate staff to prepare patients for surgical procedures. For example, I ensured patients were informed about their procedures and signed informed consent. I actively participated in activities like shaving surgical sites, providing labels, and gowns to patients before wheeling them to theatre (Competency #35).
Professional nurses should be ready to challenge decisions made by doctors and other healthcare teams to promote patient safety. For example, I observed a case of an 89-year old patient admitted to the medical unit with quadriplegia. The patient was compelled to total dependence and needed continuous assistance. Due to his unstable condition, the patient refused treatment and asked the doctor to withdraw all medications and allow the illness to take course. After reflecting, the doctor decided to continue with treatments and ignored the patient’s right to refuse medication. To advocate for the patient’s rights, I engaged in deep conversations with the doctor and stressed that he was wrong to make such a decision to the patient (Competency #37). Eventually, conversations were held with the patient and the family to plan for other alternative approaches to managing the patient’s condition.
Involving the family in patient care is an important step toward meeting all the needs of the patient during illness. When I was working in the medical unit, a 55-year-old was diagnosed with lung cancer. He was stressed and refused to disclose the information to the family because he thought it could be overwhelming. Because I understood the importance of involving the family, I explained to the patient how family members could be an important source of emotional support. The patient agreed to involve the immediate family in his care and including sharing crucial medical information (Competency #38). During the treatment period, I educated the patient on nutritional management of his condition and healthy habits like smoking cessation that could worsen his condition (Competency #40).
The use of health information technology provides numerous opportunities to transform healthcare and improve patient outcomes. Nurses should utilize these technologies to influence decisions and improve efficiency. For example, when I was working in the ICU, I used the electronic health record system to document patient data. This technology was crucial in documenting medications and charting vitals that aided in determining the improvement of the patient’s health (Competency #39). The technology also helped in maintaining clear, concise, and accurate records of care. For example, the system could indicate when medications were administered and the arrival of results from the labs (Competency #42)
Cultural competence involves recognizing that patients are diverse and how care is affected due to diversity. It allows nurses to understand the beliefs and practices that are important to patients. For example, when I was working in the medical unit, I managed an Islamic patient admitted with breast cancer. During her care, she made it clear that she could only be examined by older nurses and doctors with others allowed to administer medication. I respected her decision because it was cultural and assigned another nurse to do the examination and dressing (Competency #41).
The professional code of ethics requires nurses to be accountable for their actions. The nurse should be willing to accept responsibility for their actions and work towards improving care for patients. For example, when I was working in the emergency and trauma unit, I was responsible for triaging patients and administering treatments before discharge to home or the wards (Competency #45a). A professional nurse also understands the policies and organizational procedures that guide care delivery. For example, there was a day when the unit admitted a lot of patients on a weekend following a road traffic accident. To address this situation, I initiated the backup call protocol that allowed extra staff to arrive quickly to help the other care providers (Competency, 45b).
Continuing professional development is central to keeping nurses in a position to influence healthcare decisions and improve the future of nursing. Nurses must engage in professional activities involving education and training. For example, when I was working in the ICU, I participated in a meeting aimed at improving private practice for nurses (Competency #51). I also participated in a meeting aimed at developing strategies to address the issue of nursing shortage in the facility. During this meeting, I encouraged the administration to consider improving the retention of nurses first because it was among the top causes of high turnover rates leading to shortages (Competency #53).
Assessment and reassessment of care is an important approach to ensure the patient’s needs are met on time. Modifying care plans and involving interprofessional teams can be used to address persistent problems in patients. For example, when I was working in the surgical unit, I had a patient with a wound that seemed to be unresponsive to treatment. The initial plan was to dress the wound until it was clean to allow skin grafting. However, I realized that opening the wound after two days did not significantly improve healing. I informed the attending doctor and we agreed to do daily dressing for a week and observe changes (Competency #54). Within three days, I noticed that the wound started healing and the margins dried faster with daily dressing. By day seven of daily dressing, we evaluated the results and ascertained great progress (Competency #55).
During care delivery, nurses engage with patients from different cultural, ethnic, and racial groups. The nurse should be able to challenge care to meet the needs of these diverse clients. For example, when working in the medical unit, I managed a patient who did not want to take pain medication because of his strong belief in Hispanic culture. According to the patient, men were supposed to endure pain and suffering (Competency #63). I respected the patient’s decision and tried to understand what it meant to the patient’s culture (Competency #73). He later explained that pain was far less important than respecting the culture that required men to be strong even during difficult situations.
Every individual has values, beliefs, and personal experiences that guide care delivery to patients. The nurse should understand the effect of their beliefs on patients and work towards improving the negative effects. For example, when I was working in the ICU, I demonstrated deep care to patients who solely depended on the nurse. I worked tirelessly to ensure their daily needs were met ad involved their families in providing supportive care (Competency #64). During this period, I inspired so many nurses and students to demonstrate compassionate care to patients. They were able to demonstrate caring in all aspects and asked for guidance on how to deal with terrified families (Competency #65). However, I ensured to maintain a professional relationship with patients and families. I remember there was a patient who kept asking for favors because of our social relationship but I knew it could affect care delivery and lead to bias (Competency #82).
In meaningful patient relationships, the nurse is always the person upon whom the patient relies. The nurse must understand the nature of their relationship with patients to prevent violation of work ethics. For example, when I was working in the medical unit, I managed a patient who was rude and abusive to nurses. During care delivery, I understood that he was perhaps having anger issues and this could not affect how care was delivered (Competency #66). While other nurses avoided assessing the patient and giving treatment, I would routinely ask for permission and ensure the loved ones were around while providing care (Competency #73). Eventually, the patient realized nurses were not his enemies and became cooperative and apologetic. I was glad that I managed to establish professional boundaries with the patient that allowed delivery of care despite the social relationship (Competency #71).
Nurses should understand the ethical responsibilities and legal rights of patients when delivering care. This understanding is important to deal with ethical dilemmas and to avoid violating the patient’s rights. For example, when I was working in the emergency and trauma unit, a 14-year-old girl was brought with a mild concussion after getting involved in an accident. The patient’s father did not want her to be hospitalized for monitoring arguing that her little girl was okay. As a nurse, I understood that parents had the right to make healthcare decisions for their children. Also, I knew that it was my responsibility to protect the health of the patient through the principle of non-maleficence (Competency #67).
I decided to preserve the patient’s right to receive appropriate medical care and involved the management in deciding the case. After a series of talks, the patient’s father was able to understand that her child was at risk and required monitoring before being discharged (Competency #69). During this time, the patient’s head CT scan results came back and indicated a subdural hematoma that needed immediate attention. In collaboration with the doctor and the surgical unit, the patient was scheduled for emergency surgery to prevent bleeding (Competency #70). The patient’s father was informed about the new diagnosis and its appropriate management. Informed consent for surgery and treatment was given and signed to allow the continuation of care (Competency #68).
The healthcare environment influences important aspects of care like patient satisfaction. Healthcare providers must provide a stable environment that promotes recovery and healing. For example, when I was working in the medical unit, we used to use overhead paging at night and it created a lot of noise for patients who required a quiet sleep. To address the challenge, I proposed the use of mobile phone technology to minimize noise at night (Competency #72). Additionally, we were able to implement quiet hours from 10 p.m to 4 a.m to minimize the noise in the wards. These approaches ensured that patients and a calm night and had adequate sleep to promote recovery (Competency #74).
Healthcare delivery involves evaluating and choosing among alternatives to provide competent care to patients. The nurse should base care on ethical principles and make appropriate choices when faced with ethical dilemmas. For example, I had this patient in the trauma unit admitted after sustaining dangerous injuries during a fight. I was faced with the dilemma of administering opioid analgesics for adequate pain relief given his history of drug addiction. After careful assessment, I decided to give the medication anyway because the patient’s pain was excruciating (Competency #75). I chose to advocate for the patient’s needs and ignored the consequences.
Autonomy is among the ethical principles that allow patients to make their own decisions. The nurse should guide the patient in making medical decisions and respect them fully. When I worked in the medical unit, I helped patients make decisions about treatment including those who requested early discharges (Competency #77). On other occasions, I actively advocated for the patient’s rights when I felt they were being oppressed. An example is when I noticed issues with the hospital billing system that affected the total costs of hospitalization. After receiving complaints from many patients about unreasonable charges, I contacted the administration and finance department to ensure system errors that added extra costs were cleared (Competency #78).
Maintaining confidentiality during care delivery is important to ensure a trustworthy relationship between nurses and patients. When I worked in the surgical unit, a patient requested me not to disclose the nature of his illness to family members. He strongly believed one of the family members was behind his illness and wanted to deal with the condition alone. I respected his decision and avoided disclosure of his diagnosis to the family until he recovered (Competency #79). During routine care, I also avoided sharing the patient’s information with providers that were irrelevant to his care. I ensured to communicate the nature of the patient’s condition to immediate doctors and asked them to keep his illness a secret since it was not life-threatening (Competency #80).
Self-awareness is a skill that allows nurses to respond to challenging healthcare situations while providing culturally competent care. For example, there was a time when I administered the wrong dosage of a sedative to a patient leading to oversedation. I had failed to calculate the dosage given the patient’s history of drug addiction and it nearly cost the patient’s life. I was summoned by the unit manager and admitted my mistake (Competency #81).
Professional boundaries in nursing represent the space between the nurses’ power and the patient’s vulnerability. Nurses should differentiate social from professional relationships to allow quality care delivery. When I was working in the medical unit, one of my relatives was admitted and frequently asked for favors that violated professional boundaries. I had to inform him that all patients were equal and there was no exception despite our personal relationship (Competency #82). While maintaining professionalism, the nurse should ensure patient safety and report unsafe practices. For example, when I was working in the surgical unit, I noticed a few unstable beds that posed threats to falls in the unit. I reported the matter to the unit manager and helped prevent adverse outcomes that could be costly to patients (Competency 83).
Research has long been a tool for improving healthcare practices, especially in addressing the issue of quality. Professional nurses should monitor trends in research and implement changes to improve care delivery. When I was working in the ICU, I followed trends in managing CLABSI where the use of the bundled approach was recommended (Competency #84). I engaged in research to determine its effectiveness and delivered a comprehensive report to allow the use of the prevention bundles to improve patient care (Competency #88). I was part of the team that educated nurses and doctors on routine care for central lines, assessment of their needs for patients, and timely removal of the catheters (Competency 91). Upon the implementation of these approaches, we were able to reduce CLABSI rates by 70% in the first year. Additionally, ICU healthcare providers improved their hygiene practices that reduced the rate of infections in the unit (Competency 99).
The healthcare team is made up of different members with different expertise and experiences. Nurses should recognize the unique duties of all teams and utilize them to influence patient care. When I was working in the ICU, I worked closely with doctors, nutritionists, and occupational therapists. I noticed that each member was specialized to provide care that was exceptional and meaningful to patients (Competency #85). I maintained a partnership with these members and called them when necessary to provide care to patients. For example, I could invite nutritionists regularly to evaluate patients on parenteral nutrition and recommend any changes to improve their well-being (Competency #93).
Good relationships between healthcare organizations and communities can help improve care delivery and patient outcomes. The nurses and other healthcare providers should involve communities in making important decisions. For example, when I was working in the medical unit, I noticed that most patients suffered from heart disease. Over 70% of the conditions managed in the ward involved hypertension and coronary artery disease (Competency #87). To address this need we planned for educational programs to reach the members of the community on effective ways to prevent the burden of heart disease (Competency #90). To implement the plan, we used the local radio and television stations to create awareness of the burden of heart disease in the community. Using community outreaches, we managed to educate people on healthy eating habits and regular checkups for early detection of the disease (Competency #92).
Nurses, like any other professionals, have limitations that should be recognized and managed during care delivery. For example, when I was working in the surgical unit, I realized that I lost track of my work-life balance because of overworking. We had a shortage of staff and I had to work long hours including overtime to meet the demands of the patients. I consulted with senior nurses and other co-workers about how they managed to attain balance (Competency #89). I later realized that one can only do what they can and spending time with the family was equally important as work.
Nurses must always strive to protect human rights and uphold the values and ethics of the profession. The nurse’s primary responsibility is to protect the patient from harm. For example, when I was working in the trauma unit, we had a patient who was violent after sustaining a head injury. The day was very busy and the attending doctor was frustrated by the available workload. Because of his frustrations, he instructed sedation of the patient with diazepam using a dosage that I felt could be harmful to the patient (Competency #94). I ensured the patient was secluded to avoid distractions and administered a reasonable dosage of the drug. I later talked to the doctor and informed him about his mistake that could have cost the life of a patient (Competency 101#). He agreed that he was frustrated and I was right to administer the right dosage that ensured no complications resulted.
Nurses utilize various resources like personnel, capital, and physical resources like machines to provide care to patients. Management of these resources is among the steps to ensure quality and safety during care delivery. For example, when I was working in the medical unit, I noticed that one of the BP monitors was faulty. I was not convinced that the measurements observed were a true reflection of the patient’s condition. I called for a checkup of the machines to ensure wrong readings did not guide monitoring and medication administration to patients (Competency 95). After a checkup of the machine, it was observed that we had been using wrong readings to administer medication to patients. Awareness of this problem helped save patients from the wrong dosage of drugs that could cause adverse outcomes (Competency #102).
Interprofessional collaboration in healthcare can help improve patient outcomes. Nurses should use their knowledge to influence patient care and involve other teams in addressing challenging situations. When I was working in the ICU, there was a patient with a head injury who started convulsing a few minutes after my shift had started. I called the doctor about the issue to confirm medication and I administered phenobarbital to stop the convulsions (Competency #96). Later when I was going through the patient’s treatment plan, I realized that he was not on any anticonvulsant and I consulted the doctor about the same (Competency #97). The doctor confirmed that it was an omission error and instructed the administration of phenytoin. After a subsequent administration of the drug, the patient did not experience any convulsions (Competency, #98). I provided feedback to the doctor and asked him to follow up on other treatment plans to ensure no drugs were omitted (Competency #100).
Professionalism in nursing involves the embodiment of core values and commitment to the role of the nurse while upholding high standards of ethical behavior. While working in the ICU, I used to supervise students and guide them during care delivery. There was a time during a ward round when students were asked to identify types of skull fractures and unfortunately none knew the answers. As their instructor, I stepped in and explained the four types of skull fractures and explained that the students were still learning (Competency #103). As a professional nurse, I understood that being helpful to others was good and I prevented embarrassment that my students could have faced. I believe the students grasped the concept and regarded me as the savior of the day (Competency 104). I later took my time to educate students about the topic and what to expect during ward rounds in the unit.
The introduction of technologies in healthcare can come with changes that affect nursing practice. For example, when I was working in the emergency and trauma unit, the introduction of EHR documentation caught me by surprise. I realized that I was poor at documenting all required information because my primary focus was on direct patient care (Competency #105). After some time I realized that the technology was there to stay and I needed to up my game in ensuring effective documentation. I enrolled in a few computer classes and online courses dealing with EHR documentation (Competency #116). After a few weeks, I adapted to the new changes and began to improve my documentation process while delivering patient care (Competency #120). I came to realize that the technology saved more time to offer direct patient care because of its customized documentation approach.
The standards of nursing practice and professional performance define how nurses are supposed to act during care delivery to improve patient outcomes. The nurse should assess and evaluate their performance to align with the professional standards. For example, when I was working in the surgical unit, I realized that I had issues with communication and collaboration with other healthcare team members (Competency #106a). I was slow at involving other members of the nursing team in patient care and preferred doing tasks alone. I knew that I needed to improve in this aspect because collaborative patient care produced better patient outcomes (Competency #106c). to address this issue, I consulted with my mentor on how to involve other healthcare team members in patient care. I began to use the team nursing approach to be close to other members and eventually observed improvement in this area (Competency #106b).
The increasing complexity of healthcare systems and the increasing number of diseases today call for the use of evidence-based practices to improve outcomes. When I was working in the surgical unit, I appreciated the use of IHI infection prevention guidelines to minimize infection in the unit. I was part of the healthcare team that implemented these guidelines alongside aseptic wound dressing approaches to prevent infection (Competency #107). the department massively reduced hospital stays because infections were reduced and recovery was hastened.
The nursing profession is guided by professional associations and governing bodies that regulate the roles and responsibilities of nurses worldwide. The College of Nurses of Ontario (CNO) is the body that governs nurses in Canada. Among the duties of the CNO is to regulate standards of nursing practice and engagement in legislative processes to advocate for nurses (Competency #108a). Nurses in Canada are represented by professional organizations including RPNAO and RNO among many others that help to fight for the rights of nurses in the country (Competency #108b). About 90% of nurses in Canada fall under unions that assist with issues in the workplace like salaries and staffing. These unions help in fighting for the rights of nurses to prevent oppression and to improve the quality of care given to patients (Competency #108c).
The use of informatics in healthcare has seen an improvement in quality care and patient outcomes today. For example, the use of EHRs has improved the documentation of patient data and reduced errors that could otherwise cause adverse outcomes (Competency, #109). When I was working in the ICU, I used EHRs to document patient data including charting vitals which proved crucial in evaluating the progress of patients (Competency 110a, 117a). Apart from documenting patient data, I used the EHR system to order tests in the laboratory and controlled drug substances from the pharmacy (Competency #110b, 117b). During patient transfers to other healthcare facilities, I communicated patient care through emails and shared important patient information like tests performed through the EHR system (Competency 110c, 117c).
Computers can be used to validate evidence and help in improving patient outcomes. For example, when I was working in the medical unit, we implemented the use of alarm systems placed at the patient’s bedside as a fall prevention strategy. The information was recorded in the EHR system and later used to determine the effectiveness of the program. Statistical analysis based on the computer data indicated that more than 90% of patients who utilized the alarm system when they needed help avoided intentional falls (Competency #110d, 117d). The utilization of EHR technology to implement this practice saved nurses time to follow each patient alarm and made it easy to determine those patients who utilized the technology (Competency #113f). The utilization of the EHR technology in the unit proved that patient outcomes can be improved with the use of computer systems (Competency #118). The utilization of the EHR technology was able to address the challenge of patient falls and improve documentation of data while saving time for other tasks for nurses (Competency 121).
Seeking opportunities for professional growth and development is key for nurses to keep up with the current nursing practice. For example, when I was working in the ICU, I participated in training in areas like parenteral nutrition and CPR to ensure the delivery of quality patient care (Competency #111). In other areas, I have undergone training in the prevention of infection, especially during the COVID-19 pandemic. I have attended seminars on COVID-19 prevention and the use of PPEs by healthcare providers (Competency #116).
During care delivery, nurses are supposed to adhere to standards of the profession while ensuring quality care delivery. For example, when I was in the ICU, I upheld the standard of evidence-based practice use by implementing prevention bundles to manage CLABSI in the unit (Competency 113a). Nurses are supposed to demonstrate professionalism by responding appropriately to unacceptable behavior. For example, when I worked in the medical unit, there was one nurse who used to shout at patients and refused to respond appropriately to their needs. Instead of confronting the nurse, I informed the ward in-charge about the unacceptable behavior (Competency 113b).
Professional misconduct in healthcare can jeopardize the health and well-being of patients. For example, there was a time when I heard my colleagues discussing confidential patient information in the presence of other subordinate staff. I was not pleased with the act and later I called the two nurses and warned them against acting unprofessionally (Competency #113c). During care delivery, undesirable incidences can occur leading to harm or injuries to patients. For example, there was a patient in the medical unit who fell and broke his arm after slipping on a wet floor. I documented the incident and actions taken to the janitor who failed to place the warning sign for patients to see (Competency #113d). To address this challenge, all cleaning staff were summoned and a mandatory safety program was introduced to educate staff on the prevention of future safety events in the unit (Competency #113e).
Continuing professional development programs are essential to nurses to keep them updated on current practices and diseases. When I was working in the medical unit, I actively participated in a research program aimed at determining the effectiveness of IHI infection prevention guidelines in reducing hospital-acquired infections (Competency #114). The research was among the many projects funded by the hospital to address issues of quality and required nurses to actively engage in the activities. During professional development, nurses are required to mentor junior staff and students in an attempt to guide them towards quality care delivery. For example, when I worked in the ICU, I took a few students under my wing and mentored them to provide compassionate and patient-centered care (Competency #115).
The future of healthcare is shaping up with the introduction of technologies like EHRs and artificial intelligence among many others. Today, almost all organizations have implemented electronic documentation of patient data using EHRs and this has changed care delivery. For example, when I worked in the ICU, the EHR system helped in charting patients’ vitals and generating analyses that were predictive of the patient’s outcomes based on current and subsequent management (Competency #118). The technologies also proved critical in communicating information across different departments without the physical presence of the healthcare provider. Continued use of informatics and technologies in healthcare is likely to improve many aspects of quality care and lead to desirable healthcare outcomes.
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