NRS 430 Assignment: Contemporary Nursing Practice
Scope of Practice and Differentiated Practice Competencies: Contemporary Nursing
Nursing practice has changed over the decades from when nurses had minimal education to having complex nursing training programs and when nurses provided basic care to performing complex medical and nursing procedures. Nursing was initially a woman’s work where women cared for the sick at home in the era where there were no hospitals (Egenes, 2017). Modern nursing is attributed to Florence Nightingale, who developed nursing practices that created new standards for nursing practice. In this regard, this paper will discuss the evolution of nursing practice, the differences between ADN and BSN nurses, and the significance of evidence-based practice in nursing.
Nurses were formerly not provided formal nursing education but were instead given on-job training on how to provide basic care such as clean and dress wounds. They did not have autonomy and received instructions from physicians. As the nursing practice evolved and more hospitals were established, women began receiving nursing training in small to medium-size hospital systems (Egenes, 2017). However, the training was observation-based, taking two to three years, and the scientific rationale for interventions was not emphasized.
Advances in medicine and technology created a need for complex and specialized nursing education. As a result, nursing training shifted from hospital observation to the classroom. Certification programs have been created, changing the scope of nursing practice (Egenes, 2017). Nurses also have Master’s and Doctorate levels, which increase a nurse’s scope of practice to include duties similar to physicians such as taking history and physical exams, making diagnoses, interpreting diagnostic results, and initiating treatment plans. Furthermore, standards of nursing practice have been created to ensure quality nursing care, and nurses are educated on ethical practice and providing culturally sensitive care.
Practice Competencies between an Associate and Baccalaureate Education in Nursing
Nurses with an Associate Degree in Nursing (ADN) and with a Baccalaureate Degree (BSN) are both registered nurses (RNs). Both BSN and ADN programs prepare nursing students to deliver patient care that meets the set standards. Besides, both programs equip the future RN with nursing skills and ensure they attain the clinical practice competencies necessary for nursing practice (Northrup-Snyder et al., 2017). However, the BSN program emphasizes more on areas of informatics and research. It also has courses not offered in the ADN program, such as nursing theories, social sciences, public health, leadership, and management. The differences in the ADN and BSN training result in differences in the scope of practice. ADN RNs are generally more focused on technical, clinical duties and everyday direct patient care, including monitoring patients, administering treatment, performing basic nursing procedures, and updating charts (Ghaffari, 2017). On the other hand, the scope of BSN nurses includes nursing educator, research, public health, administrative, leadership, management roles, and direct patient care.
Approaches to Decision-Making in a Patient Care Situation of a BSN vs.ADN
Approaches to decision‐making would differ in a BSN and ADN nurse caring for a diabetic patient with uncontrolled sugars and a worsening foot ulcer. An ADN nurse will care for the patient by providing basic care such as dressing the wound, administering insulin or hypoglycemics, and monitoring blood sugar levels. Conversely, the BSN nurse will perform these tasks but get concerned about the uncontrolled sugars and delayed wound healing. As a result, the BSN will assess the patient’s diet and exercise patterns and educate the patient on the needed changes to promote optimal glycemic levels. Besides, the nurse will apply evidence-based interventions to promote healing of the ulcer and educate the patient on foot care.
Applying Evidence‐Based Practice to Nursing Care
In the past decades, evidence-based practice (EBP) has become a key element of excellent patient care. EBP is applied in various aspects of nursing as it offers valuable insight into clinical care approaches backed by evidence to address issues in direct patient care, infection control, and patient workflow (Mackey & Bassendowski, 2017). It enables nurses to apply the latest research methods in the patient care setting, including direct patient care. It focuses on established outcomes, thus promoting enhanced patient care. The BSN program equips students with knowledge and skills on EBP, which helps to analyze patient care approaches that can improve health outcomes (Mackey & Bassendowski, 2017). Students are trained on scientific research, gathering, and analyzing evidence, which they apply to establish the best patient care interventions.
Interdisciplinary Communication and Collaboration in Nursing Practice
Nurses today are part of the interdisciplinary teams and play a major role in developing patients’ care plans. Nurses communicate with the interdisciplinary teams using CUS and SBAR protocols. CUS is an acronym for Concerned, Uncomfortable, and Safety. It is a communication tool used by nurses to express concerns to the interdisciplinary team about changes in a patient’s health status respectfully and professionally. The SBAR protocol representing situation, background, assessment, and recommendations is used by nurses when having a clinical problem that needs to be conveyed to the team (Müller et al., 2018). Communication using the SBAR protocol is usually purposive, straight, and prepared and promotes information exchange between the nurse and the team. The CUS and SBAR protocols foster quality and safe patient care since patient information is communicated through an efficient and well-organized format.
Unlike in the past, where nurses conducted similar tasks, nurses’ scope today is determined by their level of education and the specialized courses they have undertaken. Both BSN and ADN nurses have the same licensing level; however, some of their roles are different. ADNs focus on technical, clinical duties, while BSNs focuses on research, management, leadership, and informatics. Nurses need to communicate accurately, succinctly, and purposeful with the interdisciplinary teams to promote collaborative care.
Egenes, K. J. (2017). History of nursing. Issues and trends in nursing: Essential knowledge for today and tomorrow, 1-26.
Ghaffari, M. (2017). Preparing Nurses for Community Health Care: A Comparative Study of the ADN and BSN Programs. International Journal, 5(2), 32-45. https://doi.org/10.18488/journal.9.2018.52.32.45
Mackey, A., & Bassendowski, S. (2017). The history of evidence-based practice in nursing education and practice. Journal of Professional Nursing, 33(1), 51-55. https://doi.org/10.1016/j.profnurs.2016.05.009
Northrup-Snyder, K., Menkens, R. M., & Dean, M. (2017). Student competency perceptions from associate degree to bachelor degree completion. Journal of Nursing Education, 56(10), 581-590. https://doi.org/10.3928/01484834-20170918-02
Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W. E., & Stock, S. (2018). Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review. BMJ open, 8(8), e022202. https://doi.org/10.1136/bmjopen-2018-022202
The field of nursing has changed over time. In a 7501,000 word paper, discuss nursing practice today by addressing the following:
1. Explain how nursing practice has changed over time and how this evolution has changed the scope of practice and the approach to treating the individual.
2. Compare and contrast the differentiated practice competencies between an associate and baccalaureate education in nursing. Explain how scope of practice changes between an associate and baccalaureate nurse.
3. Identify a patient care situation and describe how nursing care, or approaches to decisionmaking, differ between the BSNprepared nurse and the ADN nurse.
In a hypothetical scenario, an 84-year-old man has been diagnosed with Alzheimer’s disease and clinically stabilized by the hospital’s clinical team. A recent hospital policy mandates that all clinical care providers limit unplanned patient readmissions; thus, the hospital has prioritized patient discharge and health promotion to accomplish the policy’s goals. The patient will be discharged after receiving patient education. An ADN nurse will educate the patient on safety, with an emphasis on safety considerations such as drug side effects, fall risk, and medication adherence. In contrast, a BSN-prepared nurse will deliver this clinical patient education in addition to care coordination, which will involve interprofessional teams and the usage of community resources to reduce unexpected readmissions. Therefore, the BSN nurse will require nursing leadership, cooperation, and communication skills in order to identify the relevant stakeholders, communicate with them about the patient by sharing key patient information, and collectively plan the remote care. While both the ADN and BSN nurses would have accomplished the goals, their focuses and patient education and discharge techniques would have been distinct.
4. Discuss the significance of applying evidence-based practice to nursing care and explain how the academic preparation of the RNBSN nurse supports its application.
5. Discuss how nurses today communicate and collaborate with interdisciplinary teams and how this supports safer and more effective patient outcomes.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
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You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.
1. Compare practice competencies between associate and baccalaureate nursing education.
2. Define the scope of practice for a baccalaureate prepared nurse.
3. Discuss how the general public is educated about the role of nursing.
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Topic 5 DQ 1
May 2-4, 2022
Discuss how professional nursing organizations support the field of nursing and how they advocate for nursing practice. Explain the value professional nursing organizations have in advocacy and activism related to patient care.
REPLY TO DISCUSSION
May 3, 2022, 3:15 AM
Replies to Billie Gabbard
Topic: Lobbying and Million Nurse March
As we discuss our professional organizations and advocacy for our nursing practice, often, organized events bring groups of individuals together for a cause. This week, the Million Nurse March is taking place in Washington, D.C. to advocate for safe practice. Many of our professional organizations will support these efforts. Have any of you had the opportunity to attend a lobbying session to support or decline support for a healthcare legislation? The process is quite interesting to be a part of if you have not had an opportunity.
replied toBillie Gabbard
May 4, 2022, 1:41 AM
Replies to Billie Gabbard
I have not yet participated in something like this. However, as I am learning more about political entities shaping parts of the profession I chose, I become more intrigued about being involved. Some of the issues in the march are very similar to the ones currently on my union’s negotiation table for the new hospital contract.
The most prominent topic is the recent one about the pay cap. I’m going to go out on a limb and see if I get this right, but you have to be kidding me. This domino effect started with the hospital’s inefficient management and investment of nurses during a raging pandemic. The hospitals invest in themselves, not the patients or the people who care for them. We got furloughed when the surgeries got canceled, and they needed to keep up with the profit margins. Then when everyone and their mother got sick, we had to work extra to make up for it, have unsafe patient ratios, which through patients and us in even more danger, and work in the worst conditions. Nurses got tired of being treated like garbage. So many went to travel. At least that money was worth the crap hospitals put us through. Then the hospitals are saying travel agencies make too much profit. Free market people, supply and demand. Do you hear that? It’s the dominos coming down the road, full circle. If they would of cared and invested in their staff and not the profits of themselves and stakeholders they would of had nurses to staff their hospitals.
So, If I could be there to do a march, I would. The topic of workplace violence is on the docket for our new contract. The hospital I currently work had a huge fall out with racial discrimination and workforce violence not being address. They attempted and got away with some of it but stated we didn’t de-escalate the situation appropriately, and it’s our fault it happened to us. No, sir, workplace violence is unacceptable on all levels, period. This was a huge ordeal, and many nurses left because of it. Experiencing this firsthand and knowing the hospital did not support us confirms the feeling of being indispensable, not valued and not a collaborative team. This is why I support my union in the fight against these issues.
If I wasn’t taking a super fast pace class, or wasn’t sick as snot right know, I could see myself down their marching.
If the hospital and the Union can’t reach an agreement in June I might be striking if it comes to it. Watch the news, you might see me.
replied toPepper Wooters
May 4, 2022, 4:39 AM
Replies to Pepper Wooters
Thank you so much for the great depth to your discussion. Activism and advocacy are essential if nursing is to continue to evolve and to earn what is deserved. You bring up great current information regarding the pay cap for travel nurses.
Read “What is Nursing,” located on the American Nurses Association (ANA) website.
Contemporary Nursing Practice
Nursing practice has drastically changed from nurses having very little training, and nursing involved women taking care of the sick. When nursing began, it was not considered a profession, nor was it respected since nurses were women, and being a woman was not perceived as a respectable gender (Keeling, 2015). Nursing was more of an extension of the roles women played at home of taking care of their families, and skills were passed down from mother to daughter with no formal training. There have been radical changes in the nursing field that have significantly contributed to the efficient delivery of healthcare services. The purpose of this essay is to discuss the evolution of nursing and current nursing practices.
Evolution of Nursing Practice
Nursing training has evolved, and nurses today have in-depth training, and there are specific qualifications for one to become a nurse. There is currently a wide range of nursing training programs and specialties with nurses having trained up to the Doctor of Nursing program (Keeling, 2015). Besides, nurses are offered different practicing licenses depending on their level of education. Initially, the care setting for nurses was mostly in battlefields and homes, but the setting has now changed to consultation offices, hospitals, home-based care services, schools, and correctional facilities.
Nursing responsibilities in the past involved offering only basic care services such as dressing, cleaning patients, and nurses worked under doctors’ instructions (Masters, 2018). Nursing training programs have changed the scope of practice for nurses over time with their responsibilities now involving patient assessment, making diagnoses, prescribing treatment, performing complex procedures and offering emergency care independently (Masters, 2018). Therefore, in the contemporary dispensation, nursing is an independent profession, and education qualifications dictate the scope of practice.
Practice Competencies of an Associate vs. Baccalaureate Education in Nursing
To become a registered nurse, one can pursue an Associate Degree in Nursing (ADN) program or a Bachelor’s of Science in Nursing (BSN) program. Both programs include courses that train nursing students on the competencies of nursing and clinical practice to equip them with practical skills for healthcare settings (Ghaffari, 2017). However, the BSN curriculum has courses that are not offered in the ADN program. The courses include management, leadership, critical thinking and communication, public health, social sciences, nursing theories, nursing practice, and specialized courses (Ghaffari, 2017). The ADN program focuses on training clinical skills, while BSN focuses on management, leadership, nursing research, and also clinical skills.
ADN and BSN nurses have similar tasks in the healthcare setting, such as providing direct patient care, administering treatment, and monitoring patients (Ghaffari, 2017). However, the scope of practice is a bit different, and the ADN nurse is not qualified for some roles that require one to have additional education such as nurse educator, hospital unit coordinator, and managerial position.
Approaches to Decision-Making in a Patient Care Situation of a BSN vs. ADN
An example of a patient care situation would be a patient with a history of hypertension and diabetes who present with a persistently high blood pressure despite taking antihypertensive medication. A physician then prescribes an intravenous antihypertensive, and the ADN nurse will prescribe the medication to the patient since they are trained on clinical skills and may not provide health education, which is key in managing hypertension. On the other hand, a BSN nurse will take a comprehensive patient history to identify the current medication the patient is taking, previous history of hypertensive crises, family history of chronic illnesses, and social history. The history will help in understanding why the blood pressure is not controlled by medications and the patient’s behaviors that could be worsening the condition. The BSN nurse will be able to take the role of the nurse educator and educate the patient on lifestyle modification to help lower blood pressure and prevent complications of hypertension (Ghaffari, 2017). Furthermore, the BSN nurse will advocate for the patient to be initiated on lipid-lowering medications to avoid cardiac complications since the patient is at risk of atherosclerosis due to a history of diabetes.
The Significance of Applying Evidence-Based Practice to Nursing Care
Evidence-based practice (EBP) has developed over the years to be the gold standard of care and significantly influenced the BSN program. EBP involves taking into consideration the latest healthcare research when deciding the course of treatment and nursing care (Kalb et al., 2015). The adoption of EBP in nursing care has had an impact in promoting better health outcomes in patients. EBP has helped lower complications and morbidities associated with chronic illness, and in lowering healthcare costs (Kalb et al., 2015). The BSN program has incorporated EBP in the curriculum, and it supports the adoption of EBP by focusing on increasing students’ knowledge and professional accountability (Kalb et al., 2015). Besides, the program emphasizes on the usage of scientific research to guide in deciding the best interventions for patient care. BSN students are trained in nursing research and are familiarized with research methodologies that equip students with EBP research skills.
Interdisciplinary Communication and Collaboration in Nursing Practice
Interdisciplinary teams in healthcare include physicians, nurses, pharmacists, and other health care professionals. The team works together in decision-making and problem-solving to prepare patients’ care plans (Gausvik et al., 2015). Nurses communicate with the interdisciplinary teams through several tools such as the situation, background, assessment, and recommendation (SBAR) and during Structured interdisciplinary bedside rounds (SIBR). The SBAR tool is used to briefly communicate a patient’s condition, assessment findings, the current plan of care, and recommendations (Gausvik et al., 2015). The SIBR is a validated structure that enhances interdisciplinary communication by bringing together health professionals at the patient’s bedside. The SIBR allows the health team to interact and provides the chance for members to give opinions on how to best improve patient outcomes (Gausvik et al., 2015). Interdisciplinary communication and collaboration help improve patient outcomes, reduce medication errors, lower healthcare costs, and improve interactions with members of other disciplines.
Gausvik, C., Lautar, A., Miller, L., Pallerla, H., & Schlaudecker, J. (2015). Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, and understanding of care plan and teamwork as well as job satisfaction. Journal of multidisciplinary healthcare, 8, 33.
Ghaffari, M. (2017). Preparing Nurses for Community Health Care: A Comparative Study of the ADN and BSN Programs. International Journal, 5(2), 32-45.
Kalb, K. A., O’Conner-Von, S. K., Brockway, C., Rierson, C. L., & Sendelbach, S. (2015). Evidence-based teaching practice in nursing education: Faculty perspectives and practices. Nursing education perspectives, 36(4), 212-219.
Keeling, A. W. (2015). Historical perspectives on an expanded role for nursing. OJIN: The Online Journal of Issues in Nursing, 20(2).
Masters, K. (2018). Role development in professional nursing practice. Burlington, MA: Jones & Bartlett Learning.
NRS-430V NRS-430V-O503 Contemporary Nursing Practice 150.0
Criteria Percentage Unsatisfactory (0.00%) Less than Satisfactory (75.00%) Satisfactory (79.00%) Good (89.00%) Excellent (100.00%)
Evolution of Nursing Practice Over Time and Resulting Changes to Scope of Practice and Approach to Patient Care 10.0% Explanation of how nursing practice has changed over time and how this evolution has changed the scope of practice and the approach to treating the individual is not presented. Explanation of how nursing practice has changed over time is incomplete. A partial summary of how scope of practice and approach to treating the individual have changed over time is presented. There are major inaccuracies. More information is needed. A general explanation of how nursing practice has changed over time is presented. How scope of practice and approach to treating the individual have changed over time is summarized. There are some minor inaccuracies. Some information is needed for clarity. An explanation of how nursing practice has changed over time is presented. How scope of practice and approach to treating the individual have changed over time is discussed. Minor detail is needed for clarity. The explanation is accurate and captures all significant aspects. A thorough explanation of how nursing practice has changed over time is presented. How scope of practice and approach to treating the individual have changed over time is discussed in detail. An insightful account of the evolution of nursing practice and its influence on scope of practice and patient care is presented. NRS 430 Contemporary Nursing Practice Assignment
Comparison of Differentiated Practice Competencies of ADN and BSN 15.0% The differentiated practice competencies of the ADN and BSN are not compared. An incomplete comparison of the differentiated practice competencies of the ADN and BSN is presented. Differences between ADN and BSN scope of practice is unclear. There are significant inaccuracies. More information is needed. A general comparison of the differentiated practice competencies of the ADN and BSN is presented. Differences between ADN and BSN scope of practice are summarized. Some information is needed for clarity or support. A comparison of the differentiated practice competencies of the ADN and BSN is nursing is presented. Differences between ADN and BSN scope of practice are described. Minor detail or rationale is needed for clarity or support. A comparison of the differentiated practice competencies of the ADN and BSN is clearly presented. Differences between ADN and BSN scope of practice are described in detail. The narrative demonstrates a strong understanding of differentiated competencies and scope of practice for the ADN and BSN.
Use of Patient Care Situation to Describe Differences in Approach to Nursing Care Based Upon ADN and BSN Education 20.0% A patient care situation illustrating the difference between ADN and BSN in decision making and approaches to patient care is not presented. Summary of patient care situation is incomplete or is not relevant to illustrating the differences in decision making or approach to nursing care based upon ADN and BSN education. Summary of relevant patient care situation is presented. Differences in decision making and approach to nursing care based upon ADN and BSN education are generally described. Difference between ADN and BSN scope of practice is summarized. More detail is needed for clarity and support. Relevant patient care situation is described, including differences in decision making and approach to nursing care based upon ADN and BSN education. Difference between ADN and BSN scope of practice is described. Minor detail is needed for clarity. Relevant patient care situation is thoroughly described. The differences in approach to nursing care and scope of practice based upon ADN and BSN education are described in detail. Narrative demonstrates insight into patient care, decision making, and differing approaches between ADN and BSN.
Application of Evidence-Based Practice and RN-BSN Education in Nursing Care 20.0% Significance of evidence-based practice to nursing care and how the BSN supports its application is not discussed. The significance of evidence-based practice to nursing care and how the BSN supports the application of evidence-based practice is partially discussed. The discussion contains significant inaccuracies. A summary of the significance of evidence-based practice to nursing care and how the BSN supports the application of evidence-based practice is presented. The discussion contains minor inaccuracies; or, more evidence or rationale is needed to support claims. A discussion on the significance of evidence-based practice to nursing care and how the BSN supports the application of evidence-based practice is presented. Some evidence or rationale is needed to support claims. A discussion of the significance of evidence-based practice to nursing care and how the BSN supports the application of evidence-based practice is thoroughly presented. Strong evidence and rationale is provided to support claims.
Communication and Collaboration With Interdisciplinary Teams to Support Patient Outcomes 15.0% A discussion of how nurses today communicate and collaborate with interdisciplinary teams, and how this supports safer and more effective patient outcomes, is not presented. An incomplete discussion of how nurses today communicate and collaborate with interdisciplinary teams, and how this supports safer and more effective patient outcomes, is presented. The discussion contains inaccuracies and fails to demonstrate the importance of working with interdisciplinary teams. A summary of how nurses today communicate and collaborate with interdisciplinary teams, and how this supports safer and more effective patient outcomes, is presented. The summary generally illustrates the importance of working with interdisciplinary teams. Some information is needed for accuracy or to support claims. A discussion of how nurses today communicate and collaborate with interdisciplinary teams, and how this supports safer and more effective patient outcomes, is presented. Overall, the discussion illustrates the importance of working with interdisciplinary teams. A detailed discussion of how nurses today communicate and collaborate with interdisciplinary teams, and how this supports safer and more effective patient outcomes, is clearly presented. The discussion is well supported and strongly illustrates the importance of working with interdisciplinary teams.
Organization and Effectiveness 15.0%
Thesis Development and Purpose 5.0% Paper lacks any discernible overall purpose or organizing claim. Thesis is insufficiently developed or vague. Purpose is not clear. Thesis is apparent and appropriate to purpose. Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose. Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.
Argument Logic and Construction 5.0% Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.
Mechanics of Writing (includes spelling, punctuation, grammar, language use) 5.0% Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present. Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.
Paper Format (use of appropriate style for the major and assignment) 2.0% Template is not used appropriately or documentation format is rarely followed correctly. Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent. Template is used, and formatting is correct, although some minor errors may be present. Template is fully used; There are virtually no errors in formatting style. All format elements are correct.
Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style) 3.0% Sources are not documented. Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors. Sources are documented, as appropriate to assignment and style, although some formatting errors may be present. Sources are documented, as appropriate to assignment and style, and format is mostly correct. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error. NRS 430 Contemporary Nursing Practice Assignment
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