A nursing conceptual model is used to set a guideline and is based on a concept.  Nursing theory

describes the knowledge used to support nursing practice and is based on evidence.

In Florence Nightingales Environmental Theory, she states that the nurse can utilize the patient’s

environment to help optimize their healing. This can be done by making sure certain environmental factors

are present such as:

– clean water

-fresh air,

-sunlight

-cleanliness of the environment

-and appropriate drainage

This practice is still used today to aid is patients healing. Although we no longer need to worry about

things such as appropriate drainage, we still maintain a cleanly environment, make sure the patient has fresh

clean water to drink if allowed. In the hospital setting we turn on lights and open blinds during the day and

turn off lights and close the blinds at night.  We fill out the “white boards” to help the patient stay oriented to

date and day as well as who their providers are and the goal for the day. In the hospital where I work, we

have what is called “Quiet Time” It is a 2-hour block during the day from 1430-1630 where the hallway lights

are turned down, the staff is expected to be quieter in their work and no over head paging is allowed. This is

used to decrease stimulation and promote healing in the hospital patients. Signs are posted all around the

hospital notifying staff and visitors of quiet time hours.

 

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The dictionary defines accountability as : the quality or state of being accountableespecially: an obligation or willingness to accept responsibility or to account for one’s actions (Merriam-webster.com, 2019)

Nurses have a responsibility to their patients to be accountable. One of the tools to help and guide nurses are the Nurses Code of Professional Conduct. The nurses Code of Professional conduct or Code of ethics,” is a compilation of ethical rules designed to guide the nurse in making the correct decision in difficult patient-care situations. The Code contains nine provisions, each dealing with a different area of patient care. Nurses must adhere to the Code throughout all interactions with patients, colleagues and other health-care providers.” (Work.chron.com, 2019)

Under Provision 4 int the Code of Ethics it states, “The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes actions consistent with the obligation to promote health and to provide optimal care.” (ANA, 2019)

In caring for a patient, a nurse can demonstrate professional accountability by only rendering care he/she is competent to do. An example of this would be a nurse with no tele experience or training hired to work on a med surge floor being floated or pulled to work on telemetry unit. If that nurse accepted the assignment without having passed a tele competency he/she would be working outside their scope of practice and would be breaking the code of conduct. they would not be showing accountability in their actions to the patients or their practice and could put the patient and nursing license in jeopardy. They could also be charged with misconduct. A Nurse who refused said assignment and bumped up the issue to a supervisor would be holding themselves accountable for the safety of the patients and the integrity of their license.  

The reason we use clinical expertise along with EBP to make decisions is because we as health care providers cannot know everything. Even if we have years of clinical experience and expertise. In that sense it is important to bring clinical expertise together with EBP to bring forward the best care for our patients and by incorporating both we are being fully accountable to our practice and for our patients.

 

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Accountability is defined as the concept of being responsible for one’s actions. This means being accountable for our work practice, environment and patient safety. The American Nursing Association’s (ANA) code of Ethics defines professional accountability as being “answerable to oneself and others for one’s actions.” In 2016 the Gallup poll rated Nursing as one of the most trusted profession in the United States for 15 consecutive years. It is of vital importance that we maintain this level of trust with each patient encounter. As nurses our patient’s healthcare depend on the decisions and actions we make. Sometimes our actions make a difference between life and death. As nurses we face daily time challenges as well as work demands. We often have to deal with staff shortages and the acuity of our patients. Even with all these road blocks, it is our responsibility to maintain certain ethical standards in order to obtain better outcomes. The ANA code of Ethics for Nurses was developed as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession. It was created to help nurses “navigate ethical and value conflicts, and life and death decisions, many of which are common to everyday practice” (Ethics and Human Rights, 2018). It states that, “the nurse is responsible and accountable for nursing practice and determines the appropriate delegation tasks consistent with the nurse’s obligation to provide optimum patent care” (Code of Ethics for Nurses with Interpretive Statements, 2010)

 

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When nurses advocate for patients, stand up for patients’ rights, or work to meet their need for care, that nurse is actively assuming the role of patient advocate. The nurse is using knowledge to care for the patient and to coordinate care for the patient (Dynamics in Nursing 2018). This is important because the nurse communicates what he/she believes to be the best methods of care for the patient based off the data in all forms.  This is then communicated by the nurse across all levels of care of the patient to ensure the best possible outcomes for the patient.

A situation I recall in my time of patient care in the Emergency Room to where I advocated for a patient was realizing that based off the data I collected when caring for a patient I suggested to the doctor to perform a CT scan that wasn’t previously done and hadn’t been ordered yet.  The patient was feeling a bit short of breath and was on oxygen and on the cardiac monitor with a slightly elevated heart rate.  We had already performed a chest x-ray and labs right away and cardiac monitoring.  Because I was the nurse caring for the patient and monitoring the results in all forms, my concern was that the patient had a Pulmonary Embolism and because the doctor hadn’t actually made it bedside to see the patient yet, my advance knowledge and awareness prompted me to relay to the doctor what I believed we needed to do.  Sure enough the patient did in fact have a Pulmonary Embolism and we were able to proceed faster with care and get the patient admitted and to the floor faster as well.  Had I not advocated for the patient the outcomes could have went in many directions but mostly would have delayed prompt patient care and potential adverse outcomes.

 

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