Nursing practice standards for the licensed practical nurse
The nursing practice standards for the licensed practical/ vocational nurse were developed and adopted by the National Federation of Licensed Practical Nurses. These standards provide a basic model to measure and evaluate the quality of health service and nursing service and care given by LPN (Licensed Practical Nurse) and VN (Vocational Nurse). These practice standards are applicable in any practice setting.
Education
1. Complete a formal education program in practical nursing approved by the appropriate nursing authority in a state
2. Successfully pass the National Council Licensure Examination for practical Nurses
3. Participate in initial orientation within the employing institution
Legal / ethical status
1. Hold a current license to practice nursing as an LPN/VN in accordance with the law of the state where employed
2. Know the scope of nusing practice authorized by the nursing practice act in the state where employed
3. Have a personal commitment to fulfill the legal responsibilities inherent in good nursing practice
4. Take responsible actions in stuations in which there is unprofessional conduct by a peer or other health care provider
5. Recognize and have a commitment to meet the ethical and moral obligations of the practice of nursing
6. Do not accept or perform professional responsibilities outside of one’s areas of competence
Practice
1. Accept assigned responsibilities as an accountable member of the health care team
2. Fuction within the limits of educational preparation and experience as related to the assigned duties
3. Fuction with other members of the health care team in promoting and maintaining helath, preventing disease and disability, caring for and rehabilitatin individuals who are experiencing an altered health state, and contributing to the ultimate quality of life until death.
4. Know and use the nursing process in:
a. Planning (assessment of health status, analysis of information gained from the assessment, and identification of helath goals)
b. Implementing (put the nursing care plan into practice to achieve the stated goals)
c. Evaluating (measure progress toward the stated goals of the nursing care plan)
5. Participate in peer review nd other evaluation processes
6. Participate in the development of policies concerning the health and nursing needs of society and in the roles and functions of the LPN/VN
Continuing education
1. Be responsible for maintaining the highest possible level of professional competence at all times
2. Periodically reassess career goals and select continuing education activities to help achieve these goals
3. Take advantage of continuing education oppurtunities that will lead to personal growth and professional development
4. Seek and participate in continuing education activities that are approved for credit by appropriate organizations, such as the NFLPN
Specialized Nursing Practice
1. Have at least 1 years experienced in nursing at the staff level
2. Present personal qualifications that indicate potential abilities for practice in the chosen specialized nursing area
3. Present evidence of completion of a program of course approved by an appropriate agency to provide the knowledge and skills necessary to effective nursing services in the specialized field
4. Mett all of the standards of practice as set forth in this document
In 1973 standards of care were developed by the American Nurses’s Association’s (ANA) devision of psychiatric and mental health practice. These standards were revised in 1982. A two part document was published in 1994 entitled “statement on psychiatric-mental health clinical Nursing Practice and standards of Psychiatric-Mental Health Clinical Practice.” The revised standards reflect the current state of knowledge and incorporate a wider range of proffesional practice. These satndards of care apply to all settings where nurses practice psychiatric nursing. Some satndards are specifically applicable to advanced practitioners; for example, clinical specialists.
Practice setting
The setting in which nurses practice also influences the their level performance. According to peplau, 30 the role the nurse assumes in any psychiatric mental health setting depends on the following:
· The competence brought to work as a consequence of basic or postbasic nursing edication
· The definition of mental illness that prevails in a given setting
· The extent of consensus about wether each profession should have discrete and unique roles or wether there can be overlap
· The cost of certain kinds of care, the difference in status and salary levels, and the number of person needed and available to provide certain kinds of care
Standards of Psychiatric-Mental Health Clinical Nursing Practice
In these authoritative statements, the nursing profession describes the responsibilities for which nurses are accountable in the field of psychiatric and mental health nursing. In 1994, the American Nurses Association developed the following psychiatric-mental health nursing practice standards to reflect the values and priorities of the profession. They also provide direction for professional nursing practice and a framework for evaluating the practice. These standards apply to the care that is provided to all clients. The standards and the rationale for each are listed below.
Standard 1: Assessment
The psychiatric-mental health nurse coolects client data
Rationale: the assessment interview (which requires linguistically and culturally effective communication skills, interviewing, behavioral observation, database record review, and comprehensive assessment of the client and relevant systems) enables the psychiatric-mental health nurse to make sound clinical judgments and plan appropriate interventions with client.
Standard 2: Diagnosis
The psychiatric-mental health nurse analyzes the assessment data in determining diagnoses.
Rationale: the basis for providing psychiatric-mental health nursing care is the recognition and identification of patterns of response to actual or potential psychiatric illnesses and mental health problems.
Standard 3: outcome identification
The psyhiatric-mental health nurse identifies expected outcomes individualized to the client.
Rationale: within the context of providing nursing care, the ultimate goal is to influence health outcomes and improve the client’s health status.
Stndard 4: planning
The psychiatric-mental health nurse develops a plan of care that prescribes interventions to attain expected outcomes.
Rationale: a plan of care is used to guide therapeutic intervention systematically and achieve the expected client outcomes.
Standard 5: Implementation
The psychiatric-mental health nurse implements the interventions identified in the plan of care
Rational: in implementing the plan of care, psychiatric-mental health nurse use a wide range of interventions designed to prevent mental and physical illness and promote, maintain, and restore mental and physical health. Psychiatric-mental health nurses select interventions according to their level of practice. At the basic level, the nurse may select or participate in counseling, milieu therapy, self care activities, physician-ordered psychobiological interventions, health teaching, case management, health promotion and health maintenance, and variety of other approaches to meet the mental health needs of clients.
Standard 6: Evaluation
The psychiatric-mental health nurse evaluates the client’s progress in attaining expected outcomes.
Rationale: nursing care is a dynamic process involving change in the client’s health status over time, giving rise to the need for new data, different diagnoses, and modifications in the plan of care. Therefore, evaluation is a continuous process of appraising the effect of nursing interventions and the treatment regimen on the client’s health status and expected health outcomes.
Standard of Psychiatric Nursing Practice in association of Canada
1. Collects data through pertinent clinical observations based on a knowledge of nursing and behavioral and psysical sciences
Assessment factor:
· Collect data and identifies areas of need
· Observes, records, analyzes and present data based upon principles derived from nursing as well as from the behavioral and physical sciences in so far as these are relevant to psychiatric nursing practice
· Analyzes and interprets behavioral and physical patterns of behavior
· Use knowledge gained from the individual and other appropriate sources to develop a comprehensive understanding of the individuals experience
· Disscusses and validates observations with the individual and other appropriate persons
· Makes inferences from collected data to formulate psychiatric nursing interventions
2. Involves the individual, family and appropriate others in the assessment, planning, implementation, and evaluation of the individual’s nursing care program
Assessment factor:
· Assess the individuals and family’s capabilities for program participation
· Respects the individuals right to participate in decisions affecting his care
· Identifies priority of needs in collaboration with the inividual and other relevant persons
· Provides the individual, and his family, with information about the individual’s health problem
· Discusses with the individual alternatives which may be selected by the individual to deal with his health problem
· Determines with the individual the goals and method of achieving, evaluating, and revising them
· Discusses with the individual his progress in attaining stated goals
3. Uses problem-solving in developing a psychiatric nursing care plan
Assessment factor:
· Discusses the psychiatric nursing care plan with other professional and non- profesional person giving care
· Incorporates observations and reports of others in developing and modifying the psychiatric nursing care plan
· Initiates the psychiatric nursing care plan using established data base
· Involves and individual and when appropriate, family and other relevant person, in developing the psychiatric nursing care plan
· Uses the psychiatric nursing care plan to guide nursing intervention
· Records and assesses the effects of the psychiatric nursing care plan
· Modifies the psychiatric nursing care plan as indicated
4. Promotes the realization of optimal health in individuals through health teaching
Assessment factors:
· Identifies the individual’s needs for health teaching
· Uses appropriate teaching tehniques to meet the individual’s learning needs
· Seeks assistance, when needed, to deal with the individual”s learning needs
· Provides the individual with opportunities for learning new behaviors
· Teaches basic principles of mental and physical health as well as interpersonal and social skills
· Records and assesses the individual”s attainment of learning objectives
5. Uses activities of daily living in a goal-directed way when interacting with individuals
Assessment factor:
· Assesess the individual”s capability in activities of daily living based on needs strengths, and levels of functioning
· Demonstrates a consistent approach when assisting the individual with his activities of daily living
· Uses appropriate skills to encourage the individual toward independence and self direction
· Records and assesses the effects of this goal directed approach
6. Uses knowledge of somatic therapies and related clinical skills while working with individuals
Assessment factor:
· Observes and interprets pertinent reactions to somatic therapies in terms of underlying principles of each therapy
· Provides information to the individual about therapies before, during and after treatment
· Performs safely, nursing skills related to somatic therapies
· Provides emotional support to the individual receiving somatic therapies
· Provides emotional support to the family of individual receiving somatic therapies
· Encourages the individual and family to discuss, question and explore their feelings and concern about past, current or projected use of somatic therapies
· Records and assesess the effect of somatic therapies and, when appropriate, recommends changes in the tratment plan
7. Modifies the environment to establish and maintain a therapeutic milieu
Assessment factor:
· Identifies environmental factors affecting the individual health and well-being
· Identifies the effect of the individuals behavior on the environment
· Incorporates behavioral, cultural, economic and physiological concepts in developing and maintaining a therapeutic milieu
· Establishes and maintains, within the environment, communications which are congruent with identified goals
· Uses resources in the environment to meet identified goals
· Evaluates nursing participation and its effectiveness in establishing and maintaining a therapeutic milieu
8. Participates with members of the multi-disciplinary team in assessing, planning, implementing, and evaluating selected programs for the individual
Assessment factor:
· Identifies specific psychiatric nursing knowledge, skills and activities and articulates information so that it may be co-ordinated with the contribution of others working with an individual or program
· Recognizes and respect the contributions of other team members
· Seeks consultation with other team members
· Provides psychiatric nursing consultation to other team members
· Participates in the formulation of overall team goals and plans
· Use the small group decision-making process to facilitate team activities
9. Uses psychoterapeutic interventions to assist the individual in achieving optimal health
Assessment factor:
· Establish and maintains psychotherapeutic relationships with individuals
· Applies knowledge of behavioral sciences in planning and implementing programs of care
· Assists the individual to identify, test out and evaluate constructive patterns of living
· Reinforces positive behavioral patterns in the individuals interactions with others
· Employs principles of communication, problem solving, interviewing and crisis intervention in carrying through psychotheraupetic intervention
· Set limits on behavior with the ultimate goals the assisting the individual to develop internal controls and constructive ways of dealing with feelings
· Uses input from the individual, family and other team members in evaluating the individual’s behavioral changes
· Modifies nursing interventions based on the individual’s needs
10. Practice as an accauntable health professional in providing psychiatric nursing care
Assessment factor:
· Evaluates his ability to function therapeutically
· Accepts accountability for his psychiatric nursing practice
· States clearly the expectations between the individual and the registered psychiatric nurse
· Seeks supervision and consultation whenever necessary
· Assesses routinely the effectiveness of his psychiatric nursing care
· Assesses routinely the effectiveness of care planned by other team members
· Seeks peer review of care plan effectiveness
11. Participates with members of the multi-disciplinary team in community mental health planning
Assessment factor:
· Identifies the basic structure and fuction of the local community in which the registered psychiatric nurse practices
· Identifies basic ethnic, racial and socio- economic factors and their effect on mental health problems
· Recognizes current social issues that influence the nature of mental health problems
· Assists in identifying high risk population groups
12. Contributes to the leadership of personel in the provision of psychiatric nursing care
Assessment factor:
· Accepts basic leadership roles and responsibilities
· Builds on areas of strength to actively compensate for weaknesses in his own performance and that of others
· Uses judgment in accepting and delegating responsibilities
· Encourages continuing self development of team members
· Actively co-operates with the individual and team members in determining and implementing priorities for psychiatric nursing care
· Participates in teaching of ancillary and other personnel to meet the nusing needs of individuals
· Participates in predicting and evaluating outcomes of own and nursing team members actions
· Acts as role model when participating in direct nursing care
· Participates in evaluation of own performance and that other nursing team members
13. Assumes responsibility for personal and professional development and contributes to the professional growth of others
Assessment factor:
· Identifies and plans ways to meet personal and professional educational needs
· Share in identifying the educational needs of other members of the nursing team
· Show evidence of participation in professionally and or academically oriented educational activities
· Show evidence of participation in professional meetings and activities, attendance and conventions, seminars, workshop
· Applies and share knowledge and skills, acquired through continuing education endeavours, to improve psychiatric nursing practice
· Uses knowledge of developments in nursing and relevant fields to improve psychiatric nursing care
· Reads nursing and other relevant professional jurnals and share appropriate clinical content from those readings with team members to improve individual care
· Demonstrate willingness to modify role in relation to changes within the health care delivery system
14. Contributes to the development of psychiatric nursing
Assessment factor:
· Approaches nursing with an inquiring and open mind
· Co-operates actively with other health disciplines by participating in and supporting research projects or studies
· Demonstrates awareness of innovations pertinent to psychiatric nursing practice
· Seek appropriate consultation and or supervision as required to implement and evaluate nursing innovations
· Share innovations in psychiatric nursing practice with others
· Documents findings about psychiatric nursing practice
15. Understands the provincially and federally sponsored legal, limitations, statutes, and acts covering his actions as registered psychiatric nurse functioning in current health systems in Canada
Assessment factor:
· Maintains an understanding of current legal implications in relation to the registered psychiatric nurse” functioning in the health care delivery system
· Maintains membership in good standing in the professional organization
· Recognizes his own professional limitations and refers the individual to appropriate resources whenever necessary
· Uses professional judgment in carrying out prescribed orders
· Uses information about relevant federal and provincial statutes to regulate psychiatric nursing activities
· Anticipates the legal implications of his own actions and those of other team members
Registered Nurse
A registered nurse is a health care professional responsible for implementing the practice of nursing through the use of the nursing process in concert with other health care professional. Registered nurse work as patient advocates for the care and recovery of the sick and maintenance of their health. In their work as advocates for the patient, RNs use the nursing process to assess, diagnose, plan implement, and evaluate (ADPIE) nursing care of the sick and injured. RNs have more training than licensed practical nurses. To practice lawfully as a registered nurse in united kingdom, the practitioner must hold a current and valid registration with the nursing and midwifery council. The title “registered nurse” can only be granted to those holding such registration. The protected title is laid down in the nurses, midwives, and health visitors act, 1977:
1. First level nurses
2. Second level nurses
3. Specialist nurses
Position clasification standard for Psychiatric Practical Nurse
Duties:
Functions as member of psychiatric treatment team with a patient load of critically ill patients whose nursing care needs are not predictable. The employee is instrumental in changing the treatment plans established by the treatment team for assigned patients.
· Conducts patients groups using a variety of treatment procedures (reality orientation, small group therapy, large group therapy) for the purpose of helping patients to interact and function in accordance with patients treatment plans
· Establish constructive relationship with individual patients (one- to- one therapy) for the purpose of exploring behavior, feelings and attitudes and promoting interpersonal relationship, communication, and socialization skills.
· Identifies and meets needs of patients for information and guidance in daily living
· Promotes a sense of worth and dignity in the patient by such techniques as addressing the patient
· Takes vital signs, take specimens and supports the doctor in diagnostic test such as biopsies and lumbar punctures. Assesses subtle changes in the patients condition, such as slight changes in the patients ability to speak or remember
· Leads large group meetings with patients sharing thoughts and feelings with reference to the subject of the meeting and the behavior of the participants
· Prepares and administers prescribe medications orally and intramuscularly; monitors and maintains intravenous therapy
· Participates with the interdisciplinary team in the development, implementation and evaluation of the evaluation of the patient treatment plan and the ward treatment program. Participates in the addmission of the patients by collecting patients information, orienting patients to the ward, and checking them for contraband.
· Recognizes emergency situations, responds promptly, and institutes appropriate action
· Promotes patient participation in the therapeutic community by fostering increased self reliance and independence and by involving patients not only in their own treatment plan but also that of other patients. Before discharge, instructs patients and family on use of prescribed medications, contraindications of medications and the value of proper follow up care.
Determining a standard of care for psychiatric nursing practice
Professional standard of practice determined by professional association differ from the minimum qualifications set forth by state licensure for entry into the profession of nursing. The american Nurses Association has established standards for psychiatric nursing practice and credentialing of clinical psychiatric nurse specialists. Standard for psychiatric nursing practice differ markedly from minimum state requirements because the primary purpose for setting these two types of qualifications are different. The states qualifications for practice provide consumer protection by ensuring that all practicing nurses have successfully completed an approved nursing program and passed the national licensing examination.
The proffessional association”s primary focus is to elevate the practice of its members by setting standards of excellence. The ANA standards of psychiatric and Mental Health Practice are provide inside the front cover of this book. Nurses are held to the standard of care exercised by other nurses possessing the same degree of skill or knowledge in the same or similar circumstances. In the past, cummunity standards existed for urban and rural agencies. However, with greater mobility and expanded means of communication, national standards have evolved. Psychiatric patients have the right to receive the standard of care recognized by professional bodies governing nursing, wether they are in a large or a small, a rural or an urban facility. Nurses must participate continuing education courses to stay current with existing standards of care.
The most common method of establishing a standard of care in a court case is through the use of an expert witness. Expert witnesses testify about their opinions and conclusions, usually based on a hypothetical fact pattern that is presented by counsel and that resembles the fact pattern of the actual case. The testimony of expert witnesses differs from that of other witnesses. Other witnesses can tesify as to facts only. The expert testimony carries no greater weight, except for credibility, than the testimony of any other witness. In a professional negligence case or a disclipinary action, the expert witness testifying should not only be a member of the profession about which he or she is testifying but should also practice in the specialty area concerned in the case.
The witness is qualified as an expert by reason of education, clinical practice, and research. An expert’s opinion should not be bought the integrity of the expert opinoin must be protected by the nurse acting as an expert. Professional standards of practice for nursing promulgated by the ANA and other specialty nursing organizations are being advocated as a means of establishing a standard of care. This method, coupled with the use of a nurse expert, most accurately reflects view of appropriate intervention based on the use of the nursing process. Hospital policies and procedures set up institutional criteria for care and these criteria, such as the frequency of rounds on patients in seclusion, may be introduced to prove a standard that the nurse met or failed to meet.
The shortcoming of this method is that the hospital’s policy may be substandard. For example, the state licensing laws for institutions might set a minimum requiredment for stafing or frequency of rounds on certain patients, and the hospital policy might fall below that minimum. Substandard institutional policies do not absolve the individual nurse of responsibility to practice based on professional standard of nursing care. Like hospital polcy and procedures, custom can be used as evidence of a standard of care. For example, in the absence of a written policy on the use of restraint, testimony might be offered regarding the customary use of restraint in emergency situations in which the combative, violent, or confused patient poses a threat of harm to self or others. Using custom to establish a standard of care may result in the same delect as using hopital policies and procedures; custom may not comply with the laws, accrediting body recommendations, or other recognized standards of care. Custom must be carefully and regularly evaluated to ensure that substandard routines have not developed. Substandard customs will not protect the nurse when a psychiatric patient charges that a right has been violated or that harm has been caused by the staff’s common practices.
REFERENSI
Barry, patricia D. 1998. Mental health and Mental Illness, 6th ed. Philadelphia-New York: Lippincott
Clinton, michael. 1996. Mental Health and Nursing Practice. Australia: Pretice Hall australia.
Stuart & sundeen. 1995. Principles and Practice of Psychiatric Nursing. Missouri: mosby-year book, Inc.
Otong, deborah antai. 1995. Psychiatric Nursing. Philadelpia: W.B saunders company.
Bostrom, kehner schwecke. 1995. Psychiatric Nursing. Missouri : mosby-year bokk, Inc.
Tontaine, karen lee. 1999. Mental Health Nursing. California: addison wesley longman, Inc.
Varcarolis, elizabetth M. 1994. Foundation of Psychiatric –Mental Health Nursing, 2nd ed. USA: W. B saunders company.
http://www.crpnm.mb.ca/CRPNM_v0/standards/standards.pdf
http://www.docstoc.com/docs/6496047/Registered_nurse
http://www.docstoc.com/docs/14989670/Advanced-Registered-Nurse-Practitioner-Care
http://www.opm.gov/fedclass/gs0620.pdf
