ORGANIZING FRAMEWORK

I. COMMUNICATE EFFECTIVELY

II. ACT PROFESSIONALLY

III. MAKE CLINICAL DECISIONS

IV. PROVIDE A SAFE AND EFFECTIVE ENVIRONMENT

V. PROVIDE PHYSIOLOGICAL INTEGRITY

VI. PROVIDE PSYCHOSOCIAL INTEGRITY

VII. PROMOTE AND MAINTAINING HEALTH

I. COMMUNICATE EFFECTIVELY

Communication in nursing is an interactive process through which there is an exchange of information that may occur verbally, non-verbally, in writing, or through information technology. Those who may be included in this process are the nurse, client, significant support person(s), other members of the healthcare team, and community agencies. Effective communication demonstrates caring, compassion, and cultural awareness, and is directed toward promoting positive outcomes and establishing a trusting relationship. (Educational Competencies for Graduates of ADN Programs)

Effective therapeutic communication is an interactive verbal and non-verbal process between the nurse and client that assists the client to cope with change, develop effective interpersonal relationships, and integrate new knowledge and skills.

A. Caring

Caring is the “being with” and “doing for” that contributes to the client’s health and well-being. Caring behaviors are nurturing, protective, compassionate, and person centered. Caring creates an environment of hope and trust, where client choices related to cultural values, beliefs, spiritual values and lifestyle are respected.

B. Culture

Culture represents nonphysical traits, such as values, beliefs, attitudes, and customs shared by a group of people and passed from one generation to the next. Although basic human needs are the same for all people, the way a person seeks to meet those needs is influenced by culture. Various aspects of one’s culture affects all dimensions of health. (Potter & Perry)

C. Compassion

Compassion is a feeling that motivates one to help or show concern. The willingness to understand how another individual feels or views the situation enhances the ability to express compassion.

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II. ACT PROFESSIONALLY

Professional behaviors within nursing practice are characterized by a commitment to the profession of nursing. The nurse adheres to standards of professional practice, is accountable for individual actions and behaviors, and practices nursing within legal, ethical and regulatory frameworks. The nurse values the profession of nursing and participates in ongoing professional development.

A. Ethics for Nursing

Ethics is part of the foundation upon which nursing is built. A code of ethics makes explicit the primary goals, values and obligations of the profession. The Code of Ethics is a succinct statement of the moral obligations and duties of every individual who enters the nursing profession. While used by the profession as its nonnegotiable moral standard of practice, the Code also articulates for the public nursing’s own understanding of its commitment to society. Obligations as expressed in the provisions of the Code constitute a general framework, providing guidance for nurses when confronted with moral uncertainty. The Code of Ethics provides a framework from which nurses can engage in ethical analysis and decision-making, a process to which nurses also bring their own moral understanding and world view. The Code of Ethics for Nursing is the foundation for all nursing practice. Adapted: ANA Code of Ethics.

B. Legal Framework

Nurses are expected to follow all federal and state laws. Legal accountability is an essential concept of professional nursing practice. The Nurse Practice Act, the law passed by a state legislative body, defines the scope of nursing practice. The practice of nursing is further defined by the rules and regulations enacted by each state’s Board of Nursing, standards of care defined by professional nursing organizations, and policies and procedures of employing institutions. Legal guidelines serve to protect the public.

1. Regulatory Frameworks

Nurses practice under the Nurse Practice Act, Rules and Regulations of the Board of Nursing, and other regulatory administrative bodies. The laws, rules, and regulations establish and govern the nurse’s professional scope of nursing practice. The regulatory practice framework has the primary intent of protecting the public.

2. Standards

The practice of nursing is guided by standards of nursing practice and standards of client care. These standards are agreed upon levels of excellence and describe the responsibilities for which nurses are accountable. These standards are defined by professional nursing organizations and employing institution’s policies and procedures.

a. Standards of nursing practice are written expectations of care the nurse should give.

b. Standards of client care are written expectations of care the client should receive.

C. Accountability

Accountability and autonomy are essential elements to the practice of nursing. With increased autonomy comes greater responsibility and accountability. Accountability involves follow-up and reflective analysis of one’s own decisions which affect client outcomes. The nurse is accountable for maintaining and updating skills and knowledge needed to perform nursing care. The nurse is accountable to clients, the profession, employer and society. To remain accountable nursing professionals -evaluate practices and act to preserve nursing excellence.

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III. MAKE CLINICAL DECISIONS

Clinical decision-making encompasses the performance of accurate assessments, the use of multiple methods to access information, and the analysis and integration of knowledge and information to formulate clinical judgments. Effective clinical decision making results in finding solutions, individualizing care, and assuring the delivery of accurate, safe care that moves the client and support person(s) toward positive outcomes. Evidence based practice and the use of critical thinking provide the foundation for appropriate clinical decision making. It incorporates the process of assessment, analysis, planning and evaluation.

A. Assessment

Assessment is the orderly collection of relevant data from multiple sources for the purpose of appraising the client’s health status and establishing a foundation of nursing practice. Comprehensive assessment provides a holistic view of the client that includes dimensions of physiological integrity, psychosocial integrity, learning needs, and functional status. Assessment is an ongoing process.

B. Analysis

The analysis of assessment data requires the comparison of relevant information against identified standards. After a reasoning process utilizing critical thinking, this analysis of the data results in a plan of care.

C. Planning

Planning is the process of designing nursing strategies required to meet a client’s needs. Planning involves the nurse, the client, support persons and other healthcare providers. Activities associated with planning include: setting priorities, establishing client goals, planning nursing strategies, writing nursing orders and writing a nursing care plan.

D. Evaluation

Evaluation is the assessment of the client’s progress and comparing it to the targeted outcomes. Evaluation is purposeful and organized. Evaluation may be ongoing, intermittent or terminal and includes documentation and adjustment of the plan as needed.

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IV. PROVIDE A SAFE AND EFFECTIVE ENVIRONMENT

Basic health needs include the need for an environment that provides for safe and effective care related to physiological integrity, psychosocial integrity, and promotion and maintenance of health. The nurse promotes achievement of client outcomes by providing and directing nursing care that optimizes the care delivery setting to protect clients, family/significant others and other health care personnel.

A. Managing and Coordinating Care

Managing care is the efficient, effective use of human, physical, financial and technological resources to meet client needs, and support organizational outcomes. Effective Management is accomplished through the processes of planning, organizing and directing. The Nurse, in collaboration with the health care team, uses these processes to assist the client to move toward positive outcomes in a cost efficient manner, to transition within and across health care settings and to access resources.

B. Collaboration

Collaboration is the shared planning, decision-making, problem solving, goal setting, and assumption of responsibilities by those who work together cooperatively, and with open professional communication. This requires consideration of the client needs, priorities and preferences available, resources and services, shared accountability and mutual respect.

C. Environmental Safety

Nursing is concerned with the protection of clients, families, significant others and health care personnel within their environment.

D. Safe and Effective Treatment and Procedures

Physiological, psychological and knowledge needs are all considered in the process of providing caring interventions.

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V. PROVIDE PHYSIOLOGICAL INTEGRITY
Physiological integrity, a state of dynamic homeostasis, is a basic health need for all clients. Physiological integrity includes acute or chronic changes in homeostasis as well as complications or untoward effects of management modalities that may affect homeostasis.

A. Physiological Responses and Adaptations

Acute or chronic health conditions initiate physiological responses and adaptations. These responses and adaptations must be anticipated, recognized, and analyzed by nurses when assisting clients to meet physiological needs.

B. Provision of Care and Comfort

Providing for care and comfort requires the nurse to use clinical decision making skills to implement planned strategies that are directed toward identified client goals.

C. Providing Caring Interventions

Caring interventions are those nursing behaviors and actions that assist clients in meeting their needs. These interventions are based on a knowledge and understanding of the natural sciences, behavioral sciences, nursing theory, nursing research, and past nursing experiences. Caring is the “being with” and “doing for” that assist clients to achieve the desired results. Caring behaviors are nurturing, protective, compassionate, and person-centered. Caring creates an environment of hope and trust, where client choices related to cultural values, beliefs, and lifestyle are respected.

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VI. PROVIDE PSYCHOSOCIAL INTEGRITY

Psychosocial integrity, a state of dynamic psychological and sociological homeostasis, is a basic health need for all clients. Psychosocial integrity may be affected during periods of stress, illness or crisis related situations throughout the life cycle.

A. Psychosocial Adaptation and Coping

Threats to emotional, mental and social well-being disrupt psychosocial integrity. Alterations in adaptive and coping responses may result in maladaptive ways of thinking, communicating, feeling and acting. These responses must be anticipated, recognized and analyzed by nurses when assisting clients to meet psychosocial needs.

B. Provision of Care and Comfort

Providing for care and comfort requires the nurse to use clinical decision making skills in implementing planned strategies directed toward client goals.

C. Providing Caring Interventions

Basic health needs include the need for an environment that provides for safe and effective care related to physiological integrity, psychosocial integrity and promotion and maintenance of health. The nurse promotes achievement of client outcomes by providing and directing nursing care that optimizes the care delivery setting to protect clients, family/significant others and other health care personnel.

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VII. PROMOTE AND MAINTAINING HEALTH
Clients’ need for health promotion and maintenance exist throughout the life span. The nurse must be able to provide and direct nursing care for clients and their significant others in response to these needs.

A. Life Span Growth and Development

All individuals, throughout the life span, pass through identifiable, cyclical stages of growth and development that determine who and what they are and can become. A client’s growth and development status must be a part of clinical decision making.

B. Self Care and Support Systems

Assisting clients and significant others to cope with and adapt to stressful events and changes in health status. Nursing interventions are used to assist the client to move toward increased self-care while considering the client’s values, customs, culture, and/or habits. Self-care encompasses achieving optimum comfort and functioning. Clients, families and significant others participate in interventions and treatment modalities when making health care and end-of-life decisions.

C. Prevention and Early Treatment

The importance of illness prevention, need for early treatment and anticipation of complications is emphasized as an integral aspect of promotion and maintenance of health.

D. Teaching and Learning

Teaching and learning processes are used to promote and maintain health. These processes are implemented in collaboration with the client, significant support persons, and other members of health care team. Teaching encompasses the provision of health education to promote and facilitate informed decision-making, achieve positive outcomes, and support self-care activities. Integral components of the teaching process include transmission of information, evaluation of the response to teaching and modification of teaching based on identified responses. Learning involves the assimilation of information to expand knowledge and change behavior (ADN Competencies).

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