{"id":64,"date":"2019-10-20T00:00:29","date_gmt":"2019-10-20T00:00:29","guid":{"rendered":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/chapter\/2-2-ethical-and-professional-foundations-of-safe-medication-administration-by-nurses\/"},"modified":"2021-12-07T10:52:01","modified_gmt":"2021-12-07T10:52:01","slug":"2-2-ethical-and-professional-foundations-of-safe-medication-administration-by-nurses","status":"publish","type":"chapter","link":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/chapter\/2-2-ethical-and-professional-foundations-of-safe-medication-administration-by-nurses\/","title":{"raw":"2.2 Ethical and Professional Foundations of Safe Medication Administration by Nurses","rendered":"2.2 Ethical and Professional Foundations of Safe Medication Administration by Nurses"},"content":{"raw":"<h2>ANA Code of Ethics for Nurses<\/h2>\nThe <a class=\"rId7\" href=\"https:\/\/www.nursingworld.org\/ana\/about-ana\/\" target=\"_blank\" rel=\"noopener noreferrer\">American Nurses Association (ANA)<\/a> is a professional organization that represents the interests of the nation's 4 million registered nurses and is at the forefront of improving the quality of health care for all.<sup>[footnote]American Nurses Association. (2019). About ANA. <a href=\"https:\/\/www.nursingworld.org\/ana\/about-ana\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/ana\/about-ana<\/a>\/.[\/footnote] <\/sup>The ANA developed the <a class=\"rId8\" href=\"https:\/\/www.nursingworld.org\/coe-view-only\" target=\"_blank\" rel=\"noopener noreferrer\">Code of Ethics for Nurses<\/a> as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.<sup>[footnote]American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. <a href=\"https:\/\/www.nursingworld.org\/coe-view-only\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/coe-view-only<\/a>[\/footnote]<\/sup>Several provisions from the Code of Ethics impact how nurses should administer medication in an ethical manner. A summary of each provision from the Code of Ethics and how it affects medication administration is outlined below.\n<ul>\n \t<li><strong>Provision 1<\/strong> focuses on respect for human dignity and the right for self-determination: \"The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.\"<\/li>\n \t<li><strong>Provision 2<\/strong> states, \"The nurse's primary commitment is to the patient\u2026\" <sup>[footnote]American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. <a href=\"https:\/\/www.nursingworld.org\/coe-view-only\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/coe-view-only<\/a>[\/footnote]<\/sup> In health care settings, nurses often experience several competing loyalties, such as to their employer, to the doctor(s), to their supervisor, or to others on the health care team. However, the patient should always receive the primary commitment of the nurse. Additionally, the patient has the right to accept, refuse, or terminate any treatment, including medications.<\/li>\n \t<li><strong>Provision 3<\/strong> states, \"The nurse promotes, advocates for, and protects the rights, health, and safety of the patient...\"<sup>[footnote]American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. <a href=\"https:\/\/www.nursingworld.org\/coe-view-only\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/coe-view-only<\/a>[\/footnote]<\/sup>This provision includes a nurse's responsibility to promote a culture of safety for patients. If errors occur, they must be reported, and nurses should ensure responsible disclosure of errors to patients. This also includes proper disclosure of questionable practices, such as <strong>[pb_glossary id=\"1060\"]drug diversion[\/pb_glossary]<\/strong> or impaired practice by any professional.<\/li>\n \t<li><strong>Provision 4<\/strong> involves authority, accountability, and responsibility by a nurse to follow legal requirements, such state practice acts and professional standards of care.<\/li>\n \t<li><strong>Provision 5<\/strong> includes the responsibility of the nurse to promote health and safety.<\/li>\n \t<li><strong>Provision 6<\/strong> focuses on virtues that make a nurse a morally good person. For example, nurses are held accountable to use their clinical judgment to avoid causing harm to patients (<strong>[pb_glossary id=\"1061\"]maleficence[\/pb_glossary]<\/strong>) and to do good (<strong>[pb_glossary id=\"1062\"]beneficence[\/pb_glossary]<\/strong>). When administering medications, nurses should validate the medication is doing more \"good\" than \"harm\" (adverse or side effects).<\/li>\n \t<li><strong>Provision 7<\/strong> focuses on a nurse practicing within the professional standards set forth by their <strong>[pb_glossary id=\"1063\"]state nurse practice act[\/pb_glossary]<\/strong>, as well as standards established by professional nursing organizations.<\/li>\n \t<li><strong>Provision 8<\/strong> explains that a nurse must address the <strong>[pb_glossary id=\"1064\"]social determinants of health,[\/pb_glossary]<\/strong> such as poverty, education, safe medication, and healthcare disparities.<sup>[footnote]American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. <a href=\"https:\/\/www.nursingworld.org\/coe-view-only\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/coe-view-only<\/a>[\/footnote]<\/sup><\/li>\n<\/ul>\nWhenever a nurse provides patient care, the ANA Code of Ethics should be kept in mind.\n<div class=\"__UNKNOWN__\">\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\n<h2>Critical Thinking Activity 2.2a\n<img class=\"alignright wp-image-197\" src=\"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-content\/uploads\/sites\/5\/2019\/09\/ORN-Icons_lightbulb-300x300-1.png\" alt=\"Image of a lightbulb inside a circle\" width=\"200\" height=\"200\"><\/h2>\n<\/header>\n<div class=\"textbox__content\" style=\"text-align: left\">\n\nA nurse is preparing to administer medications to a patient. While reviewing the chart, the nurse notices two medications with similar mechanisms of action have been prescribed by two different providers.\n\nWhat is the nurse's best response?\n\nNote: Answers to the Critical Thinking activities can be found in the \"Answer Key\" sections at the end of the book.\n\n<\/div>\n<\/div>\n<\/div>\n<h2>ANA Professional Standards and Scope of Practice<\/h2>\nThe American Nurses Association (ANA) publishes the <a class=\"rId9\" href=\"https:\/\/www.nursingworld.org\/nurses-books\/nursing-scope-and-standards-of-practice-3rd-ed\/\" target=\"_blank\" rel=\"noopener noreferrer\"><em>Nursing: Scope and Standards of Practice<\/em><\/a>. This resource is updated regularly and outlines professional nursing performance according to national standards.<sup>[footnote]American Nurses Association. (2015). <em>Nursing : scope and standards of practice<\/em> (3rd ed.). Available for all Chippewa Valley Technical College students and employees through <a href=\"http:\/\/search.ebscohost.com\/login.aspx?direct=true&amp;db=nlebk&amp;AN=1077002&amp;site=eds-live&amp;scope=site\" target=\"_blank\" rel=\"noopener noreferrer\">OneSearch<\/a>.[\/footnote] <\/sup>The ANA defines <strong>[pb_glossary id=\"1066\"]nursing [\/pb_glossary]<\/strong> as \"the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations.\" A <strong>[pb_glossary id=\"1067\"]registered nurse (RN)[\/pb_glossary]<\/strong>\u00a0is defined as an individual who is educationally prepared and licensed by a state to practice as a registered nurse. Nursing practice is characterized by the following tenets:\n<ul>\n \t<li>Caring and health are central to the practice of the registered nurse.<\/li>\n \t<li>Nursing practice is individualized to the unique needs of the healthcare consumer.<\/li>\n \t<li>Registered nurses use the nursing process to plan and provide individualized care for healthcare consumers.<\/li>\n \t<li>Nurses coordinate care by establishing partnerships to reach a shared goal of delivering safe, quality health care.<sup> [footnote]American Nurses Association. (2015). <em>Nursing : scope and standards of practice<\/em> (3rd ed.). Available for all Chippewa Valley Technical College students and employees through <a href=\"http:\/\/search.ebscohost.com\/login.aspx?direct=true&amp;db=nlebk&amp;AN=1077002&amp;site=eds-live&amp;scope=site\" target=\"_blank\" rel=\"noopener noreferrer\">OneSearch<\/a>.[\/footnote]<\/sup><\/li>\n<\/ul>\nState nurse practice acts further define the scope of practice of RNs and Licensed Practical Nurses (LPNs) within each state. The Wisconsin Nurse Practice Act is further discussed in the \"Legal Foundations\" section.\n<h2>ANA Standards of Practice<\/h2>\nANA Standards of Practice are authoritative statements of duties that all registered nurses, regardless of role, population, or specialty, are expected to perform competently. <strong>[pb_glossary id=\"1069\"]Standards of Practice[\/pb_glossary]<\/strong> include assessment, diagnosis, outcome identification, planning, implementation, and evaluation (ADOPIE) components of providing patient care. Implementation also includes the components of health promotion and health teaching. Medication administration should include all components of ADOPIE.\n<h3>Health Promotion and Patient Teaching<\/h3>\nThe ANA standards for patient teaching state, \"The registered nurse employs strategies to promote health and a safe environment.\"<sup>[footnote]American Nurses Association. (2015). <em>Nursing : scope and standards of practice<\/em> (3rd ed.). Available for all Chippewa Valley Technical College students and employees through <a href=\"http:\/\/search.ebscohost.com\/login.aspx?direct=true&amp;db=nlebk&amp;AN=1077002&amp;site=eds-live&amp;scope=site\" target=\"_blank\" rel=\"noopener noreferrer\">OneSearch<\/a>.[\/footnote] <\/sup>Specific behaviors related to patient teaching about medication include:\n<ul>\n \t<li>Use health promotion and health teaching methods in collaboration with the patient's values, beliefs, health practices, developmental level, learning needs, readiness and ability to learn, language preference, spirituality, culture, and socioeconomic status.<\/li>\n \t<li>Provide patients with information about intended effects and potential adverse effects of the plan of care.<\/li>\n \t<li>Provide anticipatory guidance to patients to promote health and prevent or reduce the risk of negative health outcomes.<sup>[footnote]American Nurses Association. (2015). <em>Nursing : scope and standards of practice<\/em> (3rd ed.). Available for all Chippewa Valley Technical College students and employees through <a href=\"http:\/\/search.ebscohost.com\/login.aspx?direct=true&amp;db=nlebk&amp;AN=1077002&amp;site=eds-live&amp;scope=site\" target=\"_blank\" rel=\"noopener noreferrer\">OneSearch<\/a>.[\/footnote]<\/sup><\/li>\n<\/ul>\nIn the book <em>Preventing Medication Errors<\/em> by the Institute of Medicine (2007), additional key actions to include when teaching patients about safe use of their medications are:\n<ul>\n \t<li>Patients should maintain an active list of all prescription drugs, over-the-counter (OTC) drugs, and dietary supplements they are taking, the reasons for taking them, and any known drug allergies. Every provider involved in the medication-use process for a patient should have access to this list.<\/li>\n \t<li>Patients should be provided information about side effects, contraindications, methods for handling adverse reactions, and sources for obtaining additional objective, high-quality information.<sup>[footnote]Institute of Medicine. (2007). <em>Preventing medication errors.<\/em> The National Academies Press. <a href=\"https:\/\/doi.org\/10.17226\/11623\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/doi.org\/10.17226\/11623<\/a>[\/footnote]<\/sup><\/li>\n<\/ul>\n<h3>ANA Standards of Professional Performance<\/h3>\nANA Standards of Professional Performance\u00a0describe a competent level of behavior in the professional role, including activities related to ethics, culturally congruent practice, communication, collaboration, leadership, education, evidence-based practice, and quality of practice.<sup style=\"text-align: initial\">[footnote<\/sup><sup style=\"text-align: initial\">]<\/sup>American Nurses Association. (2015). <em>Nursing : scope and standards of practice<\/em> (3rd ed.). Available for all Chippewa Valley Technical College students and employees through <a href=\"http:\/\/search.ebscohost.com\/login.aspx?direct=true&amp;db=nlebk&amp;AN=1077002&amp;site=eds-live&amp;scope=site\" target=\"_blank\" rel=\"noopener noreferrer\">OneSearch<\/a>.<sup style=\"text-align: initial\">[\/footnote]<\/sup>\n<h4>Cultural Congruent Practice<\/h4>\nThe ANA defines <strong>[pb_glossary id=\"1071\"]culturally congruent practice[\/pb_glossary]<\/strong> as the application of evidence-based nursing that is in agreement with the preferred cultural values, beliefs, worldview, and practices of the healthcare consumer and other stakeholders. <strong>[pb_glossary id=\"1151\"]Cultural competence[\/pb_glossary]<\/strong> represents the process by which nurses demonstrate culturally congruent practice. Nurses must assess the cultural beliefs and practices of their patients and implement culturally congruent interventions when administering medications and teaching about them. Additional information about cultural implications for medication administration is further discussed in the \"Cultural and Social Determinants Related to Medication Administration\" section later in this chapter.\n<div class=\"__UNKNOWN__\">\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\n<h2>Critical Thinking Activity 2.2b\n<img class=\"alignright wp-image-197\" src=\"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-content\/uploads\/sites\/5\/2019\/09\/ORN-Icons_lightbulb-300x300-1.png\" alt=\"Image of a lightbulb inside a circle\" width=\"200\" height=\"200\"><\/h2>\n<\/header>\n<div class=\"textbox__content\" style=\"text-align: left\">\n\nA nurse is preparing to administer metoprolol, a cardiac medication, to a patient and implements the nursing process:\n\n<strong>ASSESSES<\/strong> the vital signs prior to administration and discovers the heart rate is 48.\n\n<strong>DIAGNOSES<\/strong> that the heart rate is too low to safely administer the medication per the parameters provided.\u00a0 Establishes the <strong>OUTCOME<\/strong> to keep the patient's heart rate within normal range of 60-100.\n\n<strong>PLANS<\/strong> to call the physician, as well as report this incident in the shift handoff report.\n\nImplements <strong>INTERVENTIONS<\/strong> by withholding the metoprolol at this time, documenting the incident that the medication is withheld, and notifying the provider.\n\nContinues to <strong>EVALUATE<\/strong> the patient status throughout the shift after not receiving the metoprolol.\n\nThe nurse is providing patient teaching to a patient about the medication before discharge. The nurse provides a handout with instructions, as well as a list of the current medications.\n\nWhat other information should be provided to the patient?\n\nNote: Answers to the Critical Thinking activities can be found in the \"Answer Key\" sections at the end of the book.\n\n<\/div>\n<\/div>\n<\/div>\n\n[caption id=\"\" align=\"aligncenter\" width=\"903\"]<img class=\"\" title=\"&quot;Nursing\u202f: Scope and Standards of Practice&quot; image retrieved from http:\/\/search.ebscohost.com\/login.aspx?direct=true&amp;db=nlebk&amp;AN=1077002&amp;site=eds-live&amp;scope=site \" src=\"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-content\/uploads\/sites\/5\/2019\/10\/image8-2.png\" alt=\"Image showing American Nursing Association Model of Professional Nursing Practice Regulation\" width=\"903\" height=\"926\"> Fig 2.1 ANA Model of Professional Nursing Practice Regulation[\/caption]\n\nFigure 2.1 is an image from <em>Nursing: Scope and Standards of Practice<\/em> by the ANA (2015). [footnote]American Nurses Association. (2015). <em>Nursing : scope and standards of practice<\/em> (3rd ed.) Available for all Chippewa Valley Technical College students and employees through <a href=\"http:\/\/search.ebscohost.com\/login.aspx?direct=true&amp;db=nlebk&amp;AN=1077002&amp;site=eds-live&amp;scope=site\" target=\"_blank\" rel=\"noopener noreferrer\">OneSearch<\/a>.<sup>[\/footnote]<\/sup> It explains how professional scope of practice, standards, and code of ethics are the \"base\" of nursing practice. Nursing practice is further defined by the State's Nurse Practice Act, rules and regulations, institutional policies and procedures, and self-determination by the individual nurse. All these components are required to provide quality, safe patient care that is evidence-based.","rendered":"<h2>ANA Code of Ethics for Nurses<\/h2>\n<p>The <a class=\"rId7\" href=\"https:\/\/www.nursingworld.org\/ana\/about-ana\/\" target=\"_blank\" rel=\"noopener noreferrer\">American Nurses Association (ANA)<\/a> is a professional organization that represents the interests of the nation&#8217;s 4 million registered nurses and is at the forefront of improving the quality of health care for all.<sup><a class=\"footnote\" title=\"American Nurses Association. (2019). About ANA. https:\/\/www.nursingworld.org\/ana\/about-ana\/.\" id=\"return-footnote-64-1\" href=\"#footnote-64-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a> <\/sup>The ANA developed the <a class=\"rId8\" href=\"https:\/\/www.nursingworld.org\/coe-view-only\" target=\"_blank\" rel=\"noopener noreferrer\">Code of Ethics for Nurses<\/a> as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.<sup><a class=\"footnote\" title=\"American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. https:\/\/www.nursingworld.org\/coe-view-only\" id=\"return-footnote-64-2\" href=\"#footnote-64-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a><\/sup>Several provisions from the Code of Ethics impact how nurses should administer medication in an ethical manner. A summary of each provision from the Code of Ethics and how it affects medication administration is outlined below.<\/p>\n<ul>\n<li><strong>Provision 1<\/strong> focuses on respect for human dignity and the right for self-determination: &#8220;The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.&#8221;<\/li>\n<li><strong>Provision 2<\/strong> states, &#8220;The nurse&#8217;s primary commitment is to the patient\u2026&#8221; <sup><a class=\"footnote\" title=\"American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. https:\/\/www.nursingworld.org\/coe-view-only\" id=\"return-footnote-64-3\" href=\"#footnote-64-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a><\/sup> In health care settings, nurses often experience several competing loyalties, such as to their employer, to the doctor(s), to their supervisor, or to others on the health care team. However, the patient should always receive the primary commitment of the nurse. Additionally, the patient has the right to accept, refuse, or terminate any treatment, including medications.<\/li>\n<li><strong>Provision 3<\/strong> states, &#8220;The nurse promotes, advocates for, and protects the rights, health, and safety of the patient&#8230;&#8221;<sup><a class=\"footnote\" title=\"American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. https:\/\/www.nursingworld.org\/coe-view-only\" id=\"return-footnote-64-4\" href=\"#footnote-64-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a><\/sup>This provision includes a nurse&#8217;s responsibility to promote a culture of safety for patients. If errors occur, they must be reported, and nurses should ensure responsible disclosure of errors to patients. This also includes proper disclosure of questionable practices, such as <strong>drug diversion<\/strong> or impaired practice by any professional.<\/li>\n<li><strong>Provision 4<\/strong> involves authority, accountability, and responsibility by a nurse to follow legal requirements, such state practice acts and professional standards of care.<\/li>\n<li><strong>Provision 5<\/strong> includes the responsibility of the nurse to promote health and safety.<\/li>\n<li><strong>Provision 6<\/strong> focuses on virtues that make a nurse a morally good person. For example, nurses are held accountable to use their clinical judgment to avoid causing harm to patients (<strong>maleficence<\/strong>) and to do good (<strong>beneficence<\/strong>). When administering medications, nurses should validate the medication is doing more &#8220;good&#8221; than &#8220;harm&#8221; (adverse or side effects).<\/li>\n<li><strong>Provision 7<\/strong> focuses on a nurse practicing within the professional standards set forth by their <strong>state nurse practice act<\/strong>, as well as standards established by professional nursing organizations.<\/li>\n<li><strong>Provision 8<\/strong> explains that a nurse must address the <strong>social determinants of health,<\/strong> such as poverty, education, safe medication, and healthcare disparities.<sup><a class=\"footnote\" title=\"American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. https:\/\/www.nursingworld.org\/coe-view-only\" id=\"return-footnote-64-5\" href=\"#footnote-64-5\" aria-label=\"Footnote 5\"><sup class=\"footnote\">[5]<\/sup><\/a><\/sup><\/li>\n<\/ul>\n<p>Whenever a nurse provides patient care, the ANA Code of Ethics should be kept in mind.<\/p>\n<div class=\"__UNKNOWN__\">\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h2>Critical Thinking Activity 2.2a<br \/>\n<img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-197\" src=\"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-content\/uploads\/sites\/5\/2019\/09\/ORN-Icons_lightbulb-300x300-1.png\" alt=\"Image of a lightbulb inside a circle\" width=\"200\" height=\"200\" \/><\/h2>\n<\/header>\n<div class=\"textbox__content\" style=\"text-align: left\">\n<p>A nurse is preparing to administer medications to a patient. While reviewing the chart, the nurse notices two medications with similar mechanisms of action have been prescribed by two different providers.<\/p>\n<p>What is the nurse&#8217;s best response?<\/p>\n<p>Note: Answers to the Critical Thinking activities can be found in the &#8220;Answer Key&#8221; sections at the end of the book.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h2>ANA Professional Standards and Scope of Practice<\/h2>\n<p>The American Nurses Association (ANA) publishes the <a class=\"rId9\" href=\"https:\/\/www.nursingworld.org\/nurses-books\/nursing-scope-and-standards-of-practice-3rd-ed\/\" target=\"_blank\" rel=\"noopener noreferrer\"><em>Nursing: Scope and Standards of Practice<\/em><\/a>. This resource is updated regularly and outlines professional nursing performance according to national standards.<sup><a class=\"footnote\" title=\"American Nurses Association. (2015). Nursing : scope and standards of practice (3rd ed.). Available for all Chippewa Valley Technical College students and employees through OneSearch.\" id=\"return-footnote-64-6\" href=\"#footnote-64-6\" aria-label=\"Footnote 6\"><sup class=\"footnote\">[6]<\/sup><\/a> <\/sup>The ANA defines <strong>nursing <\/strong> as &#8220;the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations.&#8221; A <strong>registered nurse (RN)<\/strong>\u00a0is defined as an individual who is educationally prepared and licensed by a state to practice as a registered nurse. Nursing practice is characterized by the following tenets:<\/p>\n<ul>\n<li>Caring and health are central to the practice of the registered nurse.<\/li>\n<li>Nursing practice is individualized to the unique needs of the healthcare consumer.<\/li>\n<li>Registered nurses use the nursing process to plan and provide individualized care for healthcare consumers.<\/li>\n<li>Nurses coordinate care by establishing partnerships to reach a shared goal of delivering safe, quality health care.<sup> <a class=\"footnote\" title=\"American Nurses Association. (2015). Nursing : scope and standards of practice (3rd ed.). Available for all Chippewa Valley Technical College students and employees through OneSearch.\" id=\"return-footnote-64-7\" href=\"#footnote-64-7\" aria-label=\"Footnote 7\"><sup class=\"footnote\">[7]<\/sup><\/a><\/sup><\/li>\n<\/ul>\n<p>State nurse practice acts further define the scope of practice of RNs and Licensed Practical Nurses (LPNs) within each state. The Wisconsin Nurse Practice Act is further discussed in the &#8220;Legal Foundations&#8221; section.<\/p>\n<h2>ANA Standards of Practice<\/h2>\n<p>ANA Standards of Practice are authoritative statements of duties that all registered nurses, regardless of role, population, or specialty, are expected to perform competently. <strong>Standards of Practice<\/strong> include assessment, diagnosis, outcome identification, planning, implementation, and evaluation (ADOPIE) components of providing patient care. Implementation also includes the components of health promotion and health teaching. Medication administration should include all components of ADOPIE.<\/p>\n<h3>Health Promotion and Patient Teaching<\/h3>\n<p>The ANA standards for patient teaching state, &#8220;The registered nurse employs strategies to promote health and a safe environment.&#8221;<sup><a class=\"footnote\" title=\"American Nurses Association. (2015). Nursing : scope and standards of practice (3rd ed.). Available for all Chippewa Valley Technical College students and employees through OneSearch.\" id=\"return-footnote-64-8\" href=\"#footnote-64-8\" aria-label=\"Footnote 8\"><sup class=\"footnote\">[8]<\/sup><\/a> <\/sup>Specific behaviors related to patient teaching about medication include:<\/p>\n<ul>\n<li>Use health promotion and health teaching methods in collaboration with the patient&#8217;s values, beliefs, health practices, developmental level, learning needs, readiness and ability to learn, language preference, spirituality, culture, and socioeconomic status.<\/li>\n<li>Provide patients with information about intended effects and potential adverse effects of the plan of care.<\/li>\n<li>Provide anticipatory guidance to patients to promote health and prevent or reduce the risk of negative health outcomes.<sup><a class=\"footnote\" title=\"American Nurses Association. (2015). Nursing : scope and standards of practice (3rd ed.). Available for all Chippewa Valley Technical College students and employees through OneSearch.\" id=\"return-footnote-64-9\" href=\"#footnote-64-9\" aria-label=\"Footnote 9\"><sup class=\"footnote\">[9]<\/sup><\/a><\/sup><\/li>\n<\/ul>\n<p>In the book <em>Preventing Medication Errors<\/em> by the Institute of Medicine (2007), additional key actions to include when teaching patients about safe use of their medications are:<\/p>\n<ul>\n<li>Patients should maintain an active list of all prescription drugs, over-the-counter (OTC) drugs, and dietary supplements they are taking, the reasons for taking them, and any known drug allergies. Every provider involved in the medication-use process for a patient should have access to this list.<\/li>\n<li>Patients should be provided information about side effects, contraindications, methods for handling adverse reactions, and sources for obtaining additional objective, high-quality information.<sup><a class=\"footnote\" title=\"Institute of Medicine. (2007). Preventing medication errors. The National Academies Press. https:\/\/doi.org\/10.17226\/11623\" id=\"return-footnote-64-10\" href=\"#footnote-64-10\" aria-label=\"Footnote 10\"><sup class=\"footnote\">[10]<\/sup><\/a><\/sup><\/li>\n<\/ul>\n<h3>ANA Standards of Professional Performance<\/h3>\n<p>ANA Standards of Professional Performance\u00a0describe a competent level of behavior in the professional role, including activities related to ethics, culturally congruent practice, communication, collaboration, leadership, education, evidence-based practice, and quality of practice.<sup style=\"text-align: initial\"><a class=\"footnote\" title=\"American Nurses Association. (2015). Nursing : scope and standards of practice (3rd ed.). Available for all Chippewa Valley Technical College students and employees through OneSearch.\" id=\"return-footnote-64-11\" href=\"#footnote-64-11\" aria-label=\"Footnote 11\"><sup class=\"footnote\">[11]<\/sup><\/a><\/sup><\/p>\n<h4>Cultural Congruent Practice<\/h4>\n<p>The ANA defines <strong>culturally congruent practice<\/strong> as the application of evidence-based nursing that is in agreement with the preferred cultural values, beliefs, worldview, and practices of the healthcare consumer and other stakeholders. <strong>Cultural competence<\/strong> represents the process by which nurses demonstrate culturally congruent practice. Nurses must assess the cultural beliefs and practices of their patients and implement culturally congruent interventions when administering medications and teaching about them. Additional information about cultural implications for medication administration is further discussed in the &#8220;Cultural and Social Determinants Related to Medication Administration&#8221; section later in this chapter.<\/p>\n<div class=\"__UNKNOWN__\">\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h2>Critical Thinking Activity 2.2b<br \/>\n<img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-197\" src=\"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-content\/uploads\/sites\/5\/2019\/09\/ORN-Icons_lightbulb-300x300-1.png\" alt=\"Image of a lightbulb inside a circle\" width=\"200\" height=\"200\" \/><\/h2>\n<\/header>\n<div class=\"textbox__content\" style=\"text-align: left\">\n<p>A nurse is preparing to administer metoprolol, a cardiac medication, to a patient and implements the nursing process:<\/p>\n<p><strong>ASSESSES<\/strong> the vital signs prior to administration and discovers the heart rate is 48.<\/p>\n<p><strong>DIAGNOSES<\/strong> that the heart rate is too low to safely administer the medication per the parameters provided.\u00a0 Establishes the <strong>OUTCOME<\/strong> to keep the patient&#8217;s heart rate within normal range of 60-100.<\/p>\n<p><strong>PLANS<\/strong> to call the physician, as well as report this incident in the shift handoff report.<\/p>\n<p>Implements <strong>INTERVENTIONS<\/strong> by withholding the metoprolol at this time, documenting the incident that the medication is withheld, and notifying the provider.<\/p>\n<p>Continues to <strong>EVALUATE<\/strong> the patient status throughout the shift after not receiving the metoprolol.<\/p>\n<p>The nurse is providing patient teaching to a patient about the medication before discharge. The nurse provides a handout with instructions, as well as a list of the current medications.<\/p>\n<p>What other information should be provided to the patient?<\/p>\n<p>Note: Answers to the Critical Thinking activities can be found in the &#8220;Answer Key&#8221; sections at the end of the book.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<figure style=\"width: 903px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"\" title=\"&quot;Nursing\u202f: Scope and Standards of Practice&quot; image retrieved from http:\/\/search.ebscohost.com\/login.aspx?direct=true&amp;db=nlebk&amp;AN=1077002&amp;site=eds-live&amp;scope=site\" src=\"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-content\/uploads\/sites\/5\/2019\/10\/image8-2.png\" alt=\"Image showing American Nursing Association Model of Professional Nursing Practice Regulation\" width=\"903\" height=\"926\" \/><figcaption class=\"wp-caption-text\">Fig 2.1 ANA Model of Professional Nursing Practice Regulation<\/figcaption><\/figure>\n<p>Figure 2.1 is an image from <em>Nursing: Scope and Standards of Practice<\/em> by the ANA (2015). <a class=\"footnote\" title=\"American Nurses Association. (2015). Nursing : scope and standards of practice (3rd ed.) Available for all Chippewa Valley Technical College students and employees through OneSearch.\" id=\"return-footnote-64-12\" href=\"#footnote-64-12\" aria-label=\"Footnote 12\"><sup class=\"footnote\">[12]<\/sup><\/a><\/sup> It explains how professional scope of practice, standards, and code of ethics are the &#8220;base&#8221; of nursing practice. Nursing practice is further defined by the State&#8217;s Nurse Practice Act, rules and regulations, institutional policies and procedures, and self-determination by the individual nurse. All these components are required to provide quality, safe patient care that is evidence-based.<\/p>\n<hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-64-1\">American Nurses Association. (2019). About ANA. <a href=\"https:\/\/www.nursingworld.org\/ana\/about-ana\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/ana\/about-ana<\/a>\/. <a href=\"#return-footnote-64-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-64-2\">American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. <a href=\"https:\/\/www.nursingworld.org\/coe-view-only\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/coe-view-only<\/a> <a href=\"#return-footnote-64-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-64-3\">American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. <a href=\"https:\/\/www.nursingworld.org\/coe-view-only\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/coe-view-only<\/a> <a href=\"#return-footnote-64-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-64-4\">American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. <a href=\"https:\/\/www.nursingworld.org\/coe-view-only\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/coe-view-only<\/a> <a href=\"#return-footnote-64-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><li id=\"footnote-64-5\">American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. <a href=\"https:\/\/www.nursingworld.org\/coe-view-only\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/coe-view-only<\/a> <a href=\"#return-footnote-64-5\" class=\"return-footnote\" aria-label=\"Return to footnote 5\">&crarr;<\/a><\/li><li id=\"footnote-64-6\">American Nurses Association. (2015). <em>Nursing : scope and standards of practice<\/em> (3rd ed.). Available for all Chippewa Valley Technical College students and employees through <a href=\"http:\/\/search.ebscohost.com\/login.aspx?direct=true&amp;db=nlebk&amp;AN=1077002&amp;site=eds-live&amp;scope=site\" target=\"_blank\" rel=\"noopener noreferrer\">OneSearch<\/a>. <a href=\"#return-footnote-64-6\" class=\"return-footnote\" aria-label=\"Return to footnote 6\">&crarr;<\/a><\/li><li id=\"footnote-64-7\">American Nurses Association. (2015). <em>Nursing : scope and standards of practice<\/em> (3rd ed.). Available for all Chippewa Valley Technical College students and employees through <a href=\"http:\/\/search.ebscohost.com\/login.aspx?direct=true&amp;db=nlebk&amp;AN=1077002&amp;site=eds-live&amp;scope=site\" target=\"_blank\" rel=\"noopener noreferrer\">OneSearch<\/a>. <a href=\"#return-footnote-64-7\" class=\"return-footnote\" aria-label=\"Return to footnote 7\">&crarr;<\/a><\/li><li id=\"footnote-64-8\">American Nurses Association. (2015). <em>Nursing : scope and standards of practice<\/em> (3rd ed.). Available for all Chippewa Valley Technical College students and employees through <a href=\"http:\/\/search.ebscohost.com\/login.aspx?direct=true&amp;db=nlebk&amp;AN=1077002&amp;site=eds-live&amp;scope=site\" target=\"_blank\" rel=\"noopener noreferrer\">OneSearch<\/a>. <a href=\"#return-footnote-64-8\" class=\"return-footnote\" aria-label=\"Return to footnote 8\">&crarr;<\/a><\/li><li id=\"footnote-64-9\">American Nurses Association. (2015). <em>Nursing : scope and standards of practice<\/em> (3rd ed.). Available for all Chippewa Valley Technical College students and employees through <a href=\"http:\/\/search.ebscohost.com\/login.aspx?direct=true&amp;db=nlebk&amp;AN=1077002&amp;site=eds-live&amp;scope=site\" target=\"_blank\" rel=\"noopener noreferrer\">OneSearch<\/a>. <a href=\"#return-footnote-64-9\" class=\"return-footnote\" aria-label=\"Return to footnote 9\">&crarr;<\/a><\/li><li id=\"footnote-64-10\">Institute of Medicine. (2007). <em>Preventing medication errors.<\/em> The National Academies Press. <a href=\"https:\/\/doi.org\/10.17226\/11623\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/doi.org\/10.17226\/11623<\/a> <a href=\"#return-footnote-64-10\" class=\"return-footnote\" aria-label=\"Return to footnote 10\">&crarr;<\/a><\/li><li id=\"footnote-64-11\"><\/sup>American Nurses Association. (2015). <em>Nursing : scope and standards of practice<\/em> (3rd ed.). Available for all Chippewa Valley Technical College students and employees through <a href=\"http:\/\/search.ebscohost.com\/login.aspx?direct=true&amp;db=nlebk&amp;AN=1077002&amp;site=eds-live&amp;scope=site\" target=\"_blank\" rel=\"noopener noreferrer\">OneSearch<\/a>.<sup style=\"text-align: initial\"> <a href=\"#return-footnote-64-11\" class=\"return-footnote\" aria-label=\"Return to footnote 11\">&crarr;<\/a><\/li><li id=\"footnote-64-12\">American Nurses Association. (2015). <em>Nursing : scope and standards of practice<\/em> (3rd ed.) Available for all Chippewa Valley Technical College students and employees through <a href=\"http:\/\/search.ebscohost.com\/login.aspx?direct=true&amp;db=nlebk&amp;AN=1077002&amp;site=eds-live&amp;scope=site\" target=\"_blank\" rel=\"noopener noreferrer\">OneSearch<\/a>.<sup> <a href=\"#return-footnote-64-12\" class=\"return-footnote\" aria-label=\"Return to footnote 12\">&crarr;<\/a><\/li><\/ol><\/div><div class=\"glossary\"><span class=\"screen-reader-text\" id=\"definition\">definition<\/span><template id=\"term_64_1060\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_64_1060\"><div tabindex=\"-1\"><\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_64_1061\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_64_1061\"><div tabindex=\"-1\"><\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close 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