 |
|
Nursing Manual
Nursing Standards
and Scope of Practice
Expectations:
It is expected that the registered
nurse and licensed practical nurse who provide professional nursing services
to people within the developmental disabilities services system, do so in
accordance with Oregon Administrative Rules (OARs) Chapter 851, as set forth
by the Oregon State Board of Nursing (OSBN) Oregon Revised Statutes Chapter
678. These rules include:
- DIVISION 45 STANDARDS AND SCOPE
OF PRACTICE FOR THE LICENSED PRACTICAL NURSE AND REGISTERED NURSE, and
- DIVISION 47 STANDARDS FOR REGISTERED
NURSE DELEGATION AND ASSIGMENT OF NURSING CARE TASKS TO UNLICENSED PERSONS.
The Purpose of Standards and
Scope of Practice are:
- To establish acceptable levels
of safe practice for the LPN and RN;
- To serve as a guide for the OSBN
to evaluate safe and effective nursing care as well as to determine when
nursing practice is below the expected standard of care; and,
- To interpret standards and the
scope of practice for the LPN and RN.
The following describes the
application of standards and scope of nursing process to your developmental
disabilities nursing practice.
Nursing Process as Related to
Developmental Disabilities Nursing in Oregon
It is expected that nurses use
the nursing process as described by the OSBN. It is also expected that
all steps of the nursing process be documented.
The following describes the
application of nursing process to developmental disabilities nursing
practice in Oregon.
A comprehensive nursing assessment
should be done annually, prior to a person's annual Individual Support
Plan (ISP) and as the individual's health status changes.
Objective and subjective data
should be collected via observations, physical examination, interviews
and the review of written records concerning the person. Direct care
staff are often good resources for information.
The assessment must be documented
and available in the person's record.
The RN analyzes the assessment
data in determining nursing diagnoses. The origins of all diagnoses are
found documented in the assessment.
A health problem list may be
utilized in place of nursing diagnoses. This is done to make your finished
document easily understood by the rest of the ISP team as well as the
staff who will be a part of implementing the plan.
The RN identifies expected outcomes
individualized to the person. Expected outcomes address needs that are
disclosed via assessment data and are reasonable and measurable.
Outcomes are documented as measurable
goals. For example:
| measurable |
non-measurable |
| "Will
have no more than 6 seizures per month." |
"Seizures
will be well controlled." |
| "Will
use 3 or fewer suppositories a month." |
"Will
be free of constipation." |
The RN develops a health care
plan/nursing care plan that outlines interventions to attain expected
outcomes. It is helpful to identify the person(s) responsible for the
interventions.
The RN authored plan which addresses
health needs care plan may be called a nursing care plan (NCP), a medical
support plan (MSP), or a health care plan (HCP).
The health care plan/nursing
care plan, (HCP/NCP) is written prior to the person's annual ISP and
presented to the entire ISP Team for their review and consensus. The
HCP/NCP will then become the section of the ISP that identifies the persons
health needs and associated supports.
It is important that the entire ISP Team, including the RN, decide how,
when, and what changes to the HCP/NCP the ISP team wants to be notified
of by the RN. Document this decision.
The plan should be written so
that it's easily understood by all.
All staff expected to implement
the plan need to be trained to do so.
Interventions to be implemented
should be contained within the established HCP/NCP and should be implemented
in a safe, timely and appropriate manner.
The RN evaluates the person's
progress toward attainment of outcomes/goals. The evaluation process
looks at the effectiveness of interventions in relation to the person's
outcomes.
New assessment data generated
from the evaluation process should be documented and used to revise diagnoses,
identified outcomes, and the HCP/NCP as needed.
Evaluation of the HCP/NCP should
occur at least monthly in most cases, but a person's changing health
status, or an acute, specific health problem may warrant more frequent
evaluation.
Evaluation of the HCP/NCP must
be documented.
What if I Take Over For Another
Nurse?
When assuming the responsibility
of direct nursing service provision after a previous RN has left, you need
to assess the persons to whom you are responsible to provide care, and determine
if their existing HCP/NCPs are appropriate. This must be done prior to delivering
nursing services and must be documented. You may choose to write a new assessment
and care plan, or you may choose to document on the existing nursing assessment
and HCP/NCP that you concur with documents respective contents and/or amend
accordingly. Sign and date all documented entries.
Examples of the Nursing Assessment
and Health Care Plan/Nursing Care Plan are available in section VI.
|
|
