Domain of Nursing Practice

The Role of Nursing in Today’s Health Care

Nursing practice today encompasses a wide variety of roles and responsibilities essential to meeting society’s health care needs. As a nurse, you are the frontline professional in health care . You practice in virtually all health care settings and communities across the country, and you have never been more important to health care than you are today.

Your responsibilities as a nurse include:

1. Offering skilled care to those recuperating from illness or injury.
2. Advocating for patients’ rights.
3. Teaching patients so they can make informed decisions.
4. Supporting patients and their caregivers at critical times.
5. Helping patients navigate the increasingly complex health care system.

Although the majority of nurses work in acute care facilities, many also practice in long-term care, home care, primary and preventive care, ambulatory clinics, and community health. Wherever you practice, the recipients of your care may be individuals, groups, families, or communities.

The American Nurses Association (ANA) states that the authority for the practice of nursing is based on a contract with society that acknowledges professional rights and responsibilities, as well as mechanisms for public accountability. The knowledge and skills that define nursing practice stem from society’s expectations and needs. Nursing practice continues to evolve according to society’s health needs and as knowledge and technology expand.

Question: An elderly, emaciated patient is admitted to the ICU. The nurse plans an every-2-hours turning schedule to prevent skin breakdown. In this case, the nursing action is considered to be.

– Definitions of Nursing

Several well-known definitions of nursing indicate that the basic themes of health, illness, and caring have existed since Florence Nightingale described nursing. Following are two such examples:

• Nightingale: “Nursing is putting the patient in the best condition for nature to act.”
• Henderson: “The nurse’s unique function is to assist patients, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that they would perform unaided if they had the necessary strength, will, or knowledge—and to do this in such a way as to help them gain independence as rapidly as possible.”

In 1980, the American Nurses Association (ANA) defined nursing as:

“The diagnosis and treatment of human responses to actual and potential health problems.”

In this context, a nurse caring for a person with a fractured hip would focus on the patient’s possible responses to immobility, pain, and loss of independence.

The widely accepted ANA definition of nursing was reaffirmed in the 2010 edition of the ANA’s Nursing: A Social Policy Statement to reflect the continuing evolution of nursing practice:

“Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.”

This definition reflects nurses’ increasing role in promoting health and wellness and advocating for the recipients of care.

Question : Which of these tasks is appropriate for the registered nurse to delegate to a licensed practical nurse?

Question: An example of a nursing activity that reflects the American Nurses Association’s definition of nursing is?

• Nursing’s View of Humanity

The Holistic Perspective of the Individual in Nursing

Nursing theorists are in widespread agreement that an individual has physiologic (or biophysical), psychologic (or emotional), sociocultural (or interpersonal), spiritual, and environmental components or dimensions. In this context, the human individual is considered “a biopsychosocial spiritual being in constant interaction with a changing environment.”

The individual is composed of dimensions that are interrelated and not separate entities. Thus, a problem in one dimension may affect one or more of the other dimensions.

An individual’s behavior is meaningful and oriented toward fulfilling needs, coping with stress, and developing one’s self. However, at times, an individual needs help to meet these needs, cope successfully, or develop his or her unique potential.

• Scope of Nursing Practice

Like all health care professions, nursing’s scope of practice has a flexible boundary that reflects the changing needs of society and advancement of knowledge. The essential core of nursing practice is to deliver holistic, patient-centered care. It includes assessment and evaluation, administration of a variety of interventions, patient and family teaching, and being a member of the interdisciplinary (also referred to as the interprofessional) health care team.

The extent that individual nurses engage in the scope of practice depends on their educational preparation, experience, and role, and is guided by individual state laws. To enter into practice, a nurse must complete an accredited program and pass an examination verifying the nurse has the skills necessary to provide competent care. Entry-level nurses with associate or baccalaureate degrees are prepared to function as generalists. At this level, nurses provide direct health care and focus on ensuring coordinated and comprehensive care to patients in a variety of settings. They work collaboratively with other health care providers to manage the needs of individuals and groups.

With experience and continued study, nurses may specialize in an area of practice. Certification is a formal way for nurses to obtain professional recognition for their expertise in a specialty area. A variety of nursing organizations offer certification in a number of nursing specialties. Certification usually requires a certain amount of clinical experience and successful completion of an examination. Recertification usually requires ongoing clinical experience and continuing education. Common nursing specialties include ambulatory care, cardiovascular care, critical care, women’s health, diabetes education, nursing informatics, and geriatric, medical-surgical, perinatal, emergency, psychiatric/mental health, and community health nursing.

Additional formal education and experience can prepare nurses for advanced practice. An advanced practice nurse (APN) or advanced practice registered nurse (APRN) is a nurse with at least a master’s degree in nursing; advanced education in pathophysiology, pharmacology, and health assessment; and expertise in a specialized area of practice. Examples of APNs/APRNs are clinical nurse specialists, clinical nurse leaders, nurse practitioners, nurse midwives, and nurse anesthetists. In addition to managing and delivering direct patient care, APNs/APRNs have roles in health promotion, case management, administration, research, and interdisciplinary health systems.

Nurses with a PhD typically serve as faculty in schools of nursing, policy analysts, and researchers. However, they are being increasingly employed in clinical settings as clinical experts and health care system executives.

In response to patient care needs and in anticipation of the needs of the current and future health care system, the doctorate of nursing practice (DNP) degree was endorsed in 2004 by the American Association of Colleges of Nursing (AACN). The DNP moves the educational preparation for advanced nursing practice from the master’s degree to the doctoral level. It is designed for nurses seeking a practice-focused terminal degree in nursing. The DNP degree moves nursing in the direction of other health professions that offer practice doctorates (e.g., pharmacy [PharmD], psychology [PsyD], and physical therapy [DPT]).

Question: A nurse working on the medical-surgical unit at an urban hospital would like to become certified in a medical-surgical specialty. The nurse knows that this process would most likely require?