Report on Standards and Domains for Professional Nursing Practice

This report provides an analysis of the standards and domains of professional nursing practice, focusing on key areas such as analysis of nursing practice, engaging in therapeutic and professional relationships, providing safe, appropriate, and responsive quality nursing practice, and evaluation of outcomes to inform practice. The report uses a case study of a patient post-lap sleeve gastrectomy to illustrate the application of these standards, highlighting the importance of cultural sensitivity, effective communication, and patient safety. It discusses nursing interventions, the significance of therapeutic relationships built on trust and respect, and the need for nurses to provide patient-centered care. Furthermore, the report emphasizes the importance of quality care practices, continuous patient assessment, and responsive environments to ensure optimal patient outcomes. The references used in this report support the application of these standards in a clinical setting.

Standards and Domains for
Professional Practice

Table of Contents
FOUR DOMAINS OF PROFESSIONAL PRACTICE..................................................................1
STANDARD 1: Analysis of Nursing practice.................................................................................1
STANDARD 2: Engaging in therapeutic and professional relationships.......................................2
STANDARD 6: Providing safe, appropriate and responsive quality nursing practice...................4
STANDARD 7: Evaluation of outcomes to inform practice...........................................................6
REFERENCES................................................................................................................................7

FOUR DOMAINS OF PROFESSIONAL PRACTICE
STANDARD 1: Analysis of Nursing practice
Lap sleeve gastrectomy is a laparoscopic procedure which helps in removing approximately
75% of the stomach which leads to narrowing down of gastric tube or sleeve. No modification
in intestine is done during this type of surgery. The event discusses regarding deteriorated
condition of Mr. ‘X’, who is a middle-aged man post his lap sleeve gastrectomy day 2. A
redon drain tube was inserted in his body after his surgery so as to drain material in the form
of pus and blood through suction. Since, it is a flexible tube made up of plastic and silicone, it
is pierced with numerous holes one part of its wall. It can easily remove unwanted material
from the body which could have been produced during surgery (Kohno and et.al., 2013).
The issue faced by Mr. X was that redon tube was not able to drain appropriately and hence,
was changed on day 2. After change, a huge amount of blood was coming out of that tube
leaving the patient in unbearable pain. It requires proper actions to be taken by nurse so that
the pain and impact on patient’s body can be reduced to minimum. However, the issue that
was faced by nurse is that patient was a non-Caucasian man and had a bit of language barrier
as well. Hence, it was getting difficult for nurse to ascertain the feeling of Mr. X.
In case of language barrier, it is important for the staff to take actions considering cultural
sensitivity in mind. Providing effective and sensitive nursing care requires empathy,
commitment and flexibility. There are certain nursing interventions that can be followed by
them in case of Mr. X. Some of them are listed as below:
 Each patient carries a unique outlook. However, the case become more sensitive if he / she
belongs to entirely different culture with diverse language as well. Hence, it becomes
important to treat and educate before making any type of assumption regarding Mr. X.
 Finding a translator when a patient struggles in speaking a particular language can also
help in sorting out the issue. It will help in developing a better understanding of the
condition of Mr. X.
 Due to extensive loss of blood, it becomes important for the nurse to address patient’s
signs and symptoms as well as try to understand condition with help of his posture and
body movement (Hur and Roh, 2013). Any type of redness, tenderness and increased ooze
could be a sign of infection. The health care professional must be informed regarding
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condition for better treatment practices.
 The nurse must document drainage in every hour so as to attain its consistency and
amount. In case of heavy flow of material from body, it becomes important to perform
blood culture to ascertain that if there is any infection in the body or not (Jeon and et.al.,
2016).
 Due to presence of culture barrier, it is difficult to assess the level of pain that Mr. X is
facing. In such cases, understanding through irregular movement in the body and try
connecting with the patient through listening, asking questions, seeking it to understand
and following through it with bit of understanding gathered by the nurse.
 Increasing clinic diversity among clinicians can help in dealing with issue where nurses
can meet requirements of patients without facing any type of problem that can create
problems for the patient (Doenges, Moorhouse and Murr, 2014).
 Having cultural differences in patients due to barrier in language, it becomes difficult for
the nurse to understand that what they are feeling. In such scenario, translator can help in
building understanding. Moreover, appropriate knowledge of patient’s laboratory reports
can help the nurse in dealing with issue. Further, adoption of effective pain management
techniques can also help in finding appropriate solution for Mr. X.
STANDARD 2: Engaging in therapeutic and professional relationships
A therapeutic relationship in between nurse and patient can be defined as the helping relation
which is totally based on respect and mutual trust. A nurse must be able to nurture the
relationship with hope and faith with being sensitive to other’s feelings. This type of care
relationship helps in bringing patients close to the nurse and they are able to share their,
physical, emotional and spiritual needs. One of the important aspects that is related to
therapeutic relationship is that there must be effective verbal and nonverbal communication in
between patient and nurse. It enables providing care in format where patient becomes an equal
part of achieving wellness at the end.
Trust, intimacy and respect are the other factors that are related to therapeutic relationship.
With the same, nurse gets power to act in the best interest of patient and take all decisions
based on it (Allen, 2016). All verdicts taken by nurse for patient’s health have high
dependence on cultural, psychological, spiritual and physical requirements of patient. The key
component of therapeutic relationship is trust. It is critical to be maintained in a professional
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relationship. It will help patient to understand knowledge and attitude carried out by the nurse
during treatment. Another aspect is directly linked to respect and professional intimacy
between the two. It is important that the nurse respects dignity of client. The nurse must not be
judgemental and professional during overall care tenure. Empathy is also important to be kept
by the nurse. Hence, he / she must be able to extend understanding with maintenance of
adequate emotional distance as well (Seo and et.al., 2012). It helps the nurse in performing
his / her duties without compromising with objective of professionalism. Another vital aspect
that is directly linked to power hold by the nurse is working under a specific position. They
have the right to make decision for patients on behalf of their clients in such a manner that it
can promote wellness. The power must be used by nurse only for good of patient and no undue
advantage must be taken out of it.
The warmth, friendliness, genuine interest and empathy facilitates to support. It helps in
developing interpersonal relationships between the patient and nurses. It improves the overall
satisfaction level of the patient that has been received. Adherence to quality, decreased level of
anxiety, decreased health care cost and improved quality of life is directly initiated by the
nurse in the therapeutic relationship with the patients. research states that there are various
terms used to describe this type of relationship, such as, purposeful relationship, helping
relationship, nurse-client relationship or therapeutic alliances. In a patient centred care, a level
of relationship is kept at the centre (Hong and Lee, 2014). It plays a vital role in eliciting
patient’s true wish and also help in concerning to both their needs and emotional concerns. It
is a constructive clinician – patient experience and achieve the output in case of requirement of
acute care setting as well. There are certain methods that can be adopted by the nurse so as to
initiate effective care and therapeutic relation with the patient are:
 The nurses must introduce themselves and use patient’s name while talking to him. It helps
in developing personal relationship. It helps in development of trust and respect between
each other.
 The patient must feel privacy when nurse is providing care to the patient. It must be
ensured that basic needs and requirements of the patient are met in case of reliving
ongoing pain or any kind of discomfort (Xiu-fang, 2012).
 Nurse must effectively listen to the patient and restating the interpretation he / she has
made out of the patient’s statements. It helps in keeping a connection to the patient. The
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nurse must reflect his / her real side while communicating with the patient. Not restating
too much in the conversation is perceived that one is not listening appropriately to what
has been said.
 Smiling, nodding and maintaining eye contact are few ways based on which it can be
ascertained that the two are engaged in the communication. The voice must be calm, slow
and polite.
 It is also important for the nurse to maintain a professional boundary while communicating
with the patient. In one culture it may be appropriate to touch and hug. However, it may
not be appropriate in the other one (Hong and Lee, 2014).
 Therapeutic relationship can help in achieving harmony in mind, body and spirit and
ensure that the nurse will be able to incorporate good caring behaviour towards the patient.
It can be a win-win situation in which patient and nurse can share growth experience to
each other.
Adopting the same in case of Mr. X, it can be stated that adoption of therapeutic relationship
when the patient is already in a bad condition can help in dealing with the issue in the most
effective manner. Giving emotional support to the patient can help in getting effective
treatment and responding to it.
STANDARD 6: Providing safe, appropriate and responsive quality nursing
practice
It is important that the nursing practices adopted by the nurse vary with the condition of the
patient. One may require extensive care from the side of nurse and other may get to have any
type of assessment once in a while. These changes are the result of requirement that may vary
from each other can help in developing effective environment in the health care centre. The
quality care practices of the nurse help in determining the wellness and health patients from
the hospital. Capability of maintaining such practices can be beneficial to the patients and
health care centre both. It is important for the nurse to maintain safe, appropriate and
responsive type of quality care to the patient in the patient centric environment.
Patient safety is considered to be a cornerstone of extending high quality health care facilities
to the patients. The main focus of safety is to cope up with the negative outcomes that can lead
the patient to mortality and morbidity. Nurses are kept at constant surveillance and
coordination so that incidences of adverse outcomes can be reduced to the minimum. It is the
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duty od nurse to ensure that the environment is face for patients and healthy surroundings can
be provided to them. Management gets to involved in developing interventions and strategies
that can help in providing quality outcomes to the patients (Shi-chang, 2013).
The nurse patient ratio must be appropriate enough so that the requirements of the patient can
be effectively fulfilled in such a manner that best possible results can be attained out of it. All
the norms and values that are being mentioned in the standard are required to be followed in
such a manner that the best possible strategies are adopted for the purpose of nursing
interventions. A responsive environment in the method through which the requirements of the
patients are fulfilled as and when they arise. It helps in showing the responsiveness of the
nurse for particular action.
Another important aspect that is related to quality care is continuous assessment of the patient
condition and ascertaining that whether it is deteriorating or improving. It can be done through
laboratory tests is specific duration. Blood pressure monitoring and other tests that are related
to the disease top which an individual is suffering from. The relevant standards, in such cases
can help in assessing that if the patient is responding to a particular treatment given by
healthcare professional or not. If not, then it must be communicated to the health care
professional so as to bring adequate changes in the treatment line of the patient. The
framework of re testing is generally given by the health care professional and then it is carried
out by nurses on the set durations. Physical assessment of the patient through palpation can
also be initiated by the nurse so as to ascertain any kind of issue that can be faced by the
patient’s body (Gentles, Gellman and Gadaleta, 2015).
Observation and continuous monitoring is another major role that is generally played by the
nurse while treating patients. It helps in ensuring that the patient is in good condition and is not
facing any kind of allergy or infection through the treatment line extended by health care
professionals. Assessing the case of Mr. X it can be stated that he is already issues in his body
due top inserted redon tube. Hence, constant evaluation from the side of nurse can help in
addressing the situation faced by Mr. X. It can also help in addressing any kind of allergy if
any, that can be faced by the patient due to blockage of redon tube in the initial phase. It can
help in extending quality practices to the patient and bring his condition back to normal.
STANDARD 7: Evaluation of outcomes to inform practice
The three standards mentioned above helped in developing deeper understanding regarding
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nursing practices, therapeutic relationship with the patient and quality practices to be adopted
for effective treatment to the patients. evaluation the outcomes from the above standard, it can
be ascertained in the following manner that: STANDARD 1: Analysis of Nursing practice: Nursing practices are the important
measure to be adopted by the nurses so as to extend effective treatment to the patients in
nursing care. Hence, in case of Mr. X it s important for the nurse to analyse his condition
and communicate the same to health care professionals. It also helps in ascertaining that
what kind of treatment is required by the patient in this condition and state of his body
after the operation has already been performed and redon tubes is trying to suction all the
waste blood and puss to come out of the body son as to prevent any kind of infection or
allergy in it. Hence, it is important to opt for effective nursing practice that are appropriate
enough to be adopted by the nurses and must be altered as per the condition and
requirements of the patient (Yang and Hwang, 2014). STANDARD 2: Engaging in therapeutic and professional relationships: It is sometimes
important for the nurse to indulge in therapeutic yet professional relationship with the
patient so as to build a connection where patient trust his treatment. As and when a patient
arrives at the hospital, he is already in the bad health that it develops the requirement of
getting an emotional support in the care that they can build connection to. It also helps in
ensuring that empathy, trust and belief is developed to an extent that patient can share his
problems with the nurse. The deepening of the relationship may vary asper the nature of
patient. However, in case of Mr. X, the process is a bit difficult because, he belongs to
culturally different background. Language barrier also exists between the two which makes
it even more difficult for the nurse and patient to develop that therapeutic relationship.
However, talking in signs and understanding the body language can help in solving this
issue.
 STANDARD 6: Providing safe, appropriate and responsive quality nursing practice: the
third standard discusses regarding providing quality nursing practices to the patients in
such a manner that he can be effectively treated. Since, Mr. X faces the problem which
makes it difficult for the nurse to understand the issue faced by him, it becomes important
to opt for assessment based analysis, where the report of patient condition can be prepared
with the help of certain laboratory tests and through palpating his body. Moreover, amount
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of withdrawal of material through redon tube can also help in ascertaining the condition of
his body to the maximum possible extent (The importance of a therapeutic relationship,
2018). Blood pressure monitoring and other tests that are related to the disease to which
an individual is suffering from. The relevant standards, in such cases can help in assessing
that if the patient is responding to a particular treatment given by healthcare professional or
not.
Hence, it can be stated in the end, that following the above-mentioned standard plays an
important role in evaluating the condition of the patient in such a manner that best possible
medical health practices can be adopted by the staff in the health care set up. Since,
dependence of patient on the nurse is quite higher in comparison to any other type of staff in
health care set up. In such case, it is the duty of nurse to ensure that proper treatment is
extended to the patient according to the type of disease he / she is suffering from.
REFERENCES
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account for healthcare quality improvement: Nursing work and patient status at a
glance white boards. Journal of health organization and management. 30(4). pp.672-
689.
Doenges, M. E., Moorhouse, M. F. and Murr, A.C., 2014. Nursing care plans: guidelines for
individualizing client care across the life span. FA Davis.
Gentles, C., Gellman, L. and Gadaleta, D., 2015. The effects of best practice models on 30-day
readmission rates at a comprehensive center performing laparoscopic adjustable gastric
banding, laparoscopic sleeve gastrectomy and roux-en-Y gastric bypass. Surgery for
Obesity and Related Diseases. 11(6). pp.S62-S63.
Hong, S. J. and Lee, E., 2014. Effect of evidence-based postoperative pain guidelines via web
for patients undergoing abdominal surgery in South Korea. Asian nursing
research. 8(2). pp.135-142.
Hong, S. J. and Lee, E., 2014. Use of web-based evidence-based clinical practice guidelines
for patients following gastrectomy: effects on body temperature, shivering, perceived
thermal comfort, and satisfaction with temperature management. Journal of Korean
Academy of Fundamentals of Nursing. 21(2). pp.112-122.
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Hur, H. K. and Roh, Y. S., 2013. Effects of a simulation based clinical reasoning practice
program on clinical competence in nursing students. Korean Journal of Adult
Nursing. 25(5). pp.574-584.
Jeon, B. H. and et.al., 2016. Relationships between gastrointestinal symptoms, uncertainty, and
perceived recovery in patients with gastric cancer after gastrectomy. Nursing & health
sciences. 18(1). pp.23-29.
Kohno, S. and et.al., 2013. Clinical practice guidelines for nursing-and healthcare-associated
pneumonia (NHCAP)[complete translation]. Respiratory investigation. 51(2). pp.103-
126.
Seo, H. S. and et.al., 2012. The impact of an increased application of critical pathway for
gastrectomy on the length of stay and cost. Journal of gastric cancer. 12(2). pp.126-
131.
Shi-chang, S. U. N., 2013. The effects of nursing intervention on the mood and complications
of postoperative patients with stomach cancer [J]. Chinese Journal of Clinical
Oncology and Rehabilitation. 5. p.051.
Xiu-fang, L .I. U., 2012. Related factors for incision infections after gastric cancer surgery
[J]. Chinese Journal of Nosocomiology. 16. p.043.
Yang, H. M. and Hwang, S. Y., 2014. Development of Clinical Scenarios and Rubrics for a
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Online
The importance of a therapeutic relationship. 2018. [Online]. Available through <
https://lifelabs.psychologies.co.uk/users/36378-katarina-gadjanski/posts/16766-the-
importance-of-a-therapeutic-relationship-in-psychotherapy-and-beyond>
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