Running head: SELF-ASSESSMENT OF STANDARDS 1

Self-Assessment of Nursing Standards of Practice

Joshua J. Gibson
Ferris State University




SELF-ASSESSMENT OF STANDARDS 2


Self-Assessment of Nursing Standards of Practice
To ensure the highest quality of practice in the nursing profession, the American Nurses
Association (ANA) has several resources available. Among these are the Nursing Scope and
Standards of Practice (American Nurses Association [ANA], 2010) and the Code of Ethics
(American Nurses Association [ANA], 2010); both of which help in analyzing the progress and
insight gained through three years of nursing education. The 16 standards and nince provisions
are referenced, and clinical experience is reflected upon to assess whether these criteria have
been reached.
Standards of Practice
Assessment
Assessment is imperative to successful patient care. Data collection provides not only a
starting point for treatment, but also a means of gauging the efficacy of interventions. One of the
many duties of the registered nurse is to perform assessments of patients, and doing so
effectively is a skill that needs honing (ANA, 2010). The nurse must collect comprehensive data
that addresses a patient holistically. Beyond the physical assessment, other areas of
consideration include the following: functional, psychosocial, emotional, spiritual, and many
others (ANA, 2010).
I have met this standard. Head-to-toe assessments are completed on up to four patients
every clinical day. Through performing numerous assessments, both focused and general, I have
learned to observe changes in patient conditions and view each case in an individualized, holistic
manner. I plan to maintain this competency by continuing to assess patients with a holistic
mindset.

SELF-ASSESSMENT OF STANDARDS 3


Diagnosis
The second standard is a continuation of the first; the ANA (2010) states that the nurse
must analyze the data collected in order to develop diagnoses. Competence in this area has been
achieved when a registered nurse is able to develop diagnoses that reflect assessment data.
Furthermore, diagnoses must be from standardized classification systems, such as those in place
by NANDA International, and documentation must provide for an expected outcome (ANA,
2010).
I have met this standard by completing weekly clinical reasoning worksheets. Each
patient is evaluated and given NANDA International-approved nursing diagnoses based on
assessment data. For example, a patient came in to the hospital with pneumonia and sepsis; they
were tachypneic and had inspiratory rales. The priority nursing diagnosis given was ineffective
airway clearance related to increased sputum production as evidenced by changes in rate and
depth of respirations. I plan to maintain this competency by continuing to use the NANDA
International nursing diagnoses and by assigning diagnoses based on assessment data.
Outcomes Identification
According to the third standard, a nurse must involve the patient, family, and other
providers in creating an appropriate outcome for the diagnoses (ANA, 2010). These outcomes
must be measurable, evidence-based, and culturally appropriate. Additionally, the outcomes
must be attainable and include an estimation of time (ANA 2010).
I have not met this standard. When caring for patients in the clinical setting, outcomes
are identified prior to my arrival. I plan to achieve this standard by completing case studies in
which patient outcomes are required. Doing so will ensure competence and allow for optimal
care of future patients.
SELF-ASSESSMENT OF STANDARDS 4


Planning
Planning builds upon the outcomes identification, and is the method in which the
outcome is attained (ANA, 2010). The process is one of individuality because of the unique
nature of each patient. These plans, or strategies, promote health, reduce suffering, and prevent
future complication of relatable disease processes (ANA, 2010).
I have not met this standard. Attaining competence in the third standard is a prerequisite
for planning. To gain competence in this area, I plan to use case studies that provide practice in
both outcomes identification and planning.
Implementation
The fifth standard is the process of intervention; the outcome is achieved through the
completion of the plan (ANA, 2010). Furthermore, the standard is broken into four parts and
consists of the following: coordination of care, health teaching and promotion, consultation, and
prescriptive authority (ANA, 2010, pp. 40-44). The latter two are specific to advanced practice
competencies.
I have met this standard. One patients plan of care stated that wound dressings needed
daily changing; the wound needed cleansing as well. Using knowledge of evidence-based
practice, the wound was cleansed in a proximal-to-distal approach, which limited contaminating
the open flesh. I plan to maintain this competency by remaining up-to-date on procedures using
nursing journals and hospital policies and procedures as resources.
Evaluation
Evaluation is the process of determining whether interventions are successful (ANA,
2010). Born of the first standard, perpetual assessment of the patient is crucial to quality patient
SELF-ASSESSMENT OF STANDARDS 5


care. If the assessment determines an outcome has been unachieved, then the process reverts to
the planning stage (ANA, 2010).
I have met this standard. Many patients require medication for pain in the clinical
setting. I am well versed in performing pain assessments before and after the administration of
analgesics; the intervention is effective if a patient experiences pain relief. I plan to maintain
competence in this area by performing assessments through the course of patient care.
Ethics.
The seventh standard states that nurses must practice in an ethical manner (ANA 2010).
Care must be professional, therapeutic, and abide by a strict moral code. I have met the standard
of ethics through my practice. This topic is discussed in full through the nine Ethical Provisions.
Education.
The accumulation of knowledge and the ability to relay that information clearly to a
patient is the essence of the Eighth Standard (ANA, 2010). In addition to patient education, the
nurse must share findings with his or her peers, engage in consultations that addresses concerns,
and maintain an environment where education can thrive. An important quality of the registered
nurse is the commitment to life-long learning (ANA, 2010).
I have met this standard. A patient was experiencing idiopathic thrombocytopenia and
had no knowledge regarding the diagnosis. I obtained resources for patient education on the
subject and taught her about the disease process. Competence in this area will be maintained
through continuing to educate patients.
Evidence-Based Practice and Research
Nursing care that is both safe and effective is grounded in current scientific evidence
(ANA, 2010). If studies prove a current technique obsolete, then it is the duty of the nurse to
SELF-ASSESSMENT OF STANDARDS 6


learn and adapt care accordingly. Participation in research studies and sharing new findings with
peers are signs of a competent nurse (ANA 2010).
I have met this standard. While volunteering in a wellness clinic for diabetics, it was my
role to obtain blood samples for testing. The lancet was used on the side of the finger rather than
the center of the fingertip; doing so makes for a less painful experience. I plan to maintain this
standard by attending seminars at my place of employment, and by reading current articles in
nursing journals.
Quality of Practice
The tenth standard is attained when every aspect of an individuals practice becomes
patient-centered (ANA, 2010). It requires the registered nurse to contribute to improving nursing
care and the profession as a whole. This is possible by being actively involved in quality
improvement activities (ANA, 2010).
I have partially met this standard. While I strive to provide excellent patient care, I
cannot yet be actively involved in quality improvement activities. I will attain full competence in
this area by participating in quality assurance committees as a registered nurse.
Communication
This standard states, The registered nurse communicates effectively in a variety of
formats in all areas of practice (ANA, 2010, p. 54). Nurses must communicate in a meaningful
manner to patients, staff, and members of the interdisciplinary team. He or she must also
constantly strive for improvement in conflict resolution as it relates to practice (ANA, 2010).
I have met this standard. Communication is essential in the clinical setting. For example,
a patient I had been assigned had low oxygen saturation levels. It was necessary to tell the nurse
I was working under; the physician was called and orders were given to administer oxygen
SELF-ASSESSMENT OF STANDARDS 7


through a nasal cannula. The nurse then told the nurse technician and I that we should look for
changes in oxygen levels and contact her if the levels were below 92 percent.
Leadership
This standard demands demonstration of leadership qualities in ones practice (ANA,
2010). Competence in this area is demonstrated by the drive for advancement in the professions
accountability and autonomy. Taking on a mentor role, participating in committees or events,
and treating peers with respect exemplify the actions of a nurse with a strong sense of leadership
(ANA, 2010).
I have not met this standard. As a student nurse, I have not had much experience in being
a leader in the profession. When I am practicing as a registered nurse, I plan to attain
competence by taking on mentor roles and initiating events that further the profession.
Collaboration
The practice of including each member of the interdisciplinary team in patient care is the
art of collaboration (ANA, 2010). This means involving the patient and their family in the
decision-making process. Doing so will increase patient compliance and improve overall
success of treatment.
I have met this standard through volunteering at a local wellness center for diabetics. I
collaborated with two other student nurses, a pharmacist, a physician, and an optometrist to
provide a complete cycle of care for every patient visit. I have learned the importance of
communication and teamwork within an interdisciplinary team.
Professional Practice Evaluation
This standard states that a registered nurse must constantly evaluate his or her own
professional practice (ANA, 2010). Evaluation is achieved through assessing ones own practice
SELF-ASSESSMENT OF STANDARDS 8


using informal feedback, practice standards, and policies. Much like the nursing process, if he or
she finds the desired outcome unachieved, they must reevaluate their plan (ANA, 2010).
I have met this standard. At the completion of each clinical day, students fill out an
evaluation for that day. By learning to constantly observe and criticize my own work, as well as
receive criticism from the preceptor, I gain an understanding for professional practice evaluation.
I plan to maintain this standard by self-evaluating and seeking evaluation in my practice.
Resource Utilization
The registered nurse utilizes appropriate resources to plan and provide nursing services
that are safe, effective, and financially responsible (ANA, 2010, p. 60). This means a nurse
must be mindful when using resources to provide care, and safely modifying their care when
necessary. The standard further states that one must also identify and advocate for resources that
they feel will benefit their practice (ANA, 2010).
I have met this standard. I am frequently assigned patients in isolation rooms where
gowns, masks, and gloves were required prior to entry. With these patients, as with the others, I
am careful to cluster care; by limiting the number of times needed to reenter the room, thus I use
less hospital resources in personal protective equipment. I will maintain this standard by
continuing to cluster care, as well as advocate for responsible use of resources in any future
places of employment.
Environmental Health
The essence of Standard 16 is that a competent nurse will practice in such a way that care
is both healthy and innocuous to the environment (ANA, 2010). Environment here is both that
of the workplace and in a more global sense. Competence in this area is about assessing the
SELF-ASSESSMENT OF STANDARDS 9


current condition for both staff and patients, and advocating for environmentally safe techniques
(ANA, 2010).
I have partially met this Standard by maintaining an environment that is safe for the
patient and myself. As an individual who stands nearly six-and-a-half feet tall, it is important to
raise patient beds prior to intervention. Doing so help to ensure that I am free of injury, and
provide optimal access to the patient. I will fully attain this standard by continuing to act in a
mindful manner, and by being familiar with the policies and procedures of future places of
employment.
Code of Ethics
Provision 1
The first provision calls for the nurse to practice with compassion and respect to both
patients and colleagues (American Nurses Association [ANA], 2001). It consists of five
subcategories: respect for human dignity, relationship to patients, the nature of health problems,
the right to self-determination, and relationships with colleagues and others. By practicing
without bias, and providing equality in patient care, the nurse can achieve this provision (ANA,
2001).
I have easily met this provision because it coincides with my worldview. By holding
compassion in high regard, I am able to provide care to patients free of discrimination. An
example of this is when I was assigned two contrasting individuals: one an elderly white male,
and the other an African American of the same age. During conversation, the former made some
highly racially offensive comments toward people of color; the latter was pleasant and rather
nondescript. Both patients were treated with respect and compassion, and received
undifferentiating care. I plan to maintain this provision by valuing a compassionate mindset.
SELF-ASSESSMENT OF STANDARDS 10


Provision 2
Provision two states that the commitment to a patient is to take priority (ANA, 2001).
The Code of Ethics further divides it into four parts: primacy of the patients interests, conflict of
interest for nurses, collaboration, and professional boundaries. Through the preservation of this
provision, nursing practice turns into patient-centered care (ANA, 2001).
I have met this provision by placing the needs of the patients above those of my own.
An experience that demonstrates this is when I was caring for a patient with a different religious
background than mine. She was scared about her diagnosis and asked me to pray with her. I felt
comfortable doing so and, through the small gesture, was able to give her some comfort. I will
maintain this provision thorough continuing to do everything in my power to provide holistic
care.
Provision 3
The third provision states, the nurse promotes, advocates for, and strives to protect the
health, safety, and rights of the patient (ANA, 2001, p. 6). This is attained through privacy,
confidentiality, the protection of participants in research, standards and review mechanisms,
acting on professional practice, and addressing impaired practice (ANA, 2001, pp. 6-8). I have
partially met this provision by advocating for a confused patient. She would lie on a bedpan for
extended periods, and she would feel the need to urinate whenever I tried removing it. The
patients skin was becoming tender and reddened, so I notified the nurse; we were able to
provide her with skin cream. While the solution was imperfect, it presented improvement. I am
going to maintain this provision by treating each patient as I would want to be treated.


SELF-ASSESSMENT OF STANDARDS 11


Provision 4
The fourth provision declares, The nurse is responsible and accountable for individual
nursing practice and determines the appropriate delegation of tasks consistent with the nurses
obligation to provide optimum patient care (ANA, 2001). I have met this Provision. At first, I
was uncomfortable delegating care to others; I felt guilty asking the nursing assistant to collect
vital signs or assist patients to the toilet. I have become increasingly better at asking for
assistance when it is necessary, and am grateful that such an opportunity exists. I plan to
maintain this provision by delegating tasks whenever it is in the best interest of the patients.
Provision 5
Provision five reads, The nurse owes the same duties to self as to others, including the
responsibility to preserve integrity and safety, to maintain competence, and to continue personal
and professional growth (ANA, 2001, p. 9). I have met this provision through the process of
becoming a registered nurse. The schooling required to graduate with a Bachelor of Science in
Nursing degree has illustrated the dedication to personal and professional growth. I plan to
maintain this provision by continuing to further my knowledge of both the profession and disease
processes.
Provision 6
This provision states, The nurse participates in establishing, maintaining, and improving
health care environments and conditions of employment conducive to the provision of quality
health care and consistent with the values of the profession through individual and collective
action (ANA, 2001, p. 11). Due to my status as a student, I have not met this provision. I plan
to attain competency by actively participating in quality improvement committees and events in
any future places of employment.
SELF-ASSESSMENT OF STANDARDS 12


Provision 7
The seventh provision declares, The nurse participates in the advancement of the
profession through contributions to practice, education, administration, and knowledge
development (ANA, 2001, p. 12). I have not yet met this standard. When I am practicing as a
registered nurse, I plan to attain competence in this area by furthering my education or working
towards specialization. Furthermore, I await future opportunities of aiding the research in the
field of nursing.
Provision 8
Provision eight states, The nurse collaborates with other health professionals and the
public in promoting community, national, and international efforts to meet heath needs (ANA,
2001, p. 12). I have met this provision. An example would be my experience with community
health. The county I was practicing in lacked animal control measures and had high rates of dog
bites. During downtime, I was able to research and create educational posters that have been
used to inform the community how to properly respond to an animal attack. I aim to maintain
this provision by being active in the community; disease prevention and healthcare promotion
starts on the streets, and as a nurse, these are paramount.
Provision 9
The final Provision reads as follows, The profession of nursing, as represented by
associations and their members, is responsible for articulating nursing values, for maintaining the
integrity of the profession and its practice, and for shaping social policy (ANA, 2001, p. 13). I
have not yet met this provision due to my lack of experience in the field. Once I am registered, I
aim to take an active role in the creation and revision of policies and procedures.

SELF-ASSESSMENT OF STANDARDS 13


Professional Development Plan
Goals
The goals for attaining or maintaining competence in the 16 standards of practice and
nine ethical provisions are outlined in the respective sections. The majority are met through
maintaining a holistic, compassionate mindset and practicing with vigilance. Others require
completion of the nursing program and experience in the field, or advancement in education or
specialization. The overarching goal is to provide the best possible health care in both the
clinical and community setting, and advance the professional practice of nursing.
Action Plan
Maintaining a holistic, compassionate mindset is an ongoing practice. I plan to perform
periodic self-evaluations and self-awareness exercises to identify any existing biases. By
becoming familiar with personal thought patters, an individual can better understand and correct
any deficits in this area.
The goal of becoming a skilled, competent nurse is a two-fold process. First, I plan to
graduate from the Ferris State University nursing program within six months. Within the next
six months, I plan to study daily in order to pass the National Council Licensure Examination.
Once a registered nurse, I aim to practice for no less than one year on a medical-surgical or
progressive floor to become more familiar with general nursing practice. From there I may
either seek specialization or continue as a medical-surgical nurse; once adequate experience is
obtained, I plan to participate in policy changes and advocacy groups.
Evaluation Plan
The first goal set will be evaluated by setting aside one day every six months to perform a
self-assessment of goals, beliefs, and values. Marking these dates on a wall calendar will ensure
SELF-ASSESSMENT OF STANDARDS 14


that they are not forgotten. I will also be receptive to feedback from both patients and staff; by
listening without active defensive, I may find areas in my practice that are lacking.
The second goal set will present results that are more physical. I will get a degree once
graduated, a license once registered, and certifications for any areas that I seek certification in.
After completing a year on a medical-surgical floor, I will evaluate whether I feel experienced
enough to seek specialization or advancement. Lastly, once comfortable in the position, I will
keep track of the opportunities I have passed or embraced to become part of a team or committee
to advocate for patients, staff, or the advancement of the profession.
Conclusion
Using tools provided by the ANA, a nurse is able to reflect upon and analyze their
practice. This exercise has given me more confidence in what was achieved so far, but also
identified areas that need improvement. Nursing is a career choice that demands a commitment
to living ethically, practicing mindfully, and being a life-long learner. I am proud to be on that
path.









SELF-ASSESSMENT OF STANDARDS 15


References
American Nurses Association (2001). Code of ethics for nurses with interpretive statements.
Silver Spring, MD: American Nurses Association.
American Nurses Association (2010). Nursing: Scope and standards of practice (2nd ed.). Silver
Spring, MD: Nursesbooks.org.