nursing’s social policy statementnursing’s social policy statement the essence of the profession...

Nursing’s Social PolicyStatementthe Essence of the Profession

2010 Edition

American Nurses AssociationSilver Spring, Maryland2010

Nursing’sSocial PolicyStatementthe Essence of the Profession

© 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.

2010 Edition

http://www.nursesbooks.org


Library of Congress Cataloging-in-Publication data

American Nurses Association. Nursing’s social policy statement : the essence of the profession / American NursesAssociation. — 3rd ed. p. ; cm.Includes bibliographical references and index. ISBN-13: 978-1-55810-286-6 (e-publication, single user) ISBN-10: 1-55810-286-8 (e-publication, single user) ISBN-13: 978-1-55810-294-1 (e-publication, multiple users) ISBN-10: 1-55810-294-9 (e-publication, multiple users) 1. Nursing. 2. Nursing—Philosophy. 3. Nursing—Practice. 4. Nursing—Social aspects. I. Title. [DNLM: 1. Philosophy, Nursing—Guideline. 2. Nurse’s Role—Guideline. 3. Nursing—standards—Guide-line. 4. Social Responsibility—Guideline. WY 86 A512n 2010] RT82.A59 2010 610.73—dc22 2010019423

The American Nurses Association (ANA) is a national professional association. This ANA publication—Nursing’s Social Policy Statement: The Essence of the Profession—reflects the thinking of the nursing profession on various issues and should be reviewed in conjunction with state board of nursing policies and practices. State law, rules, and regulations govern the practice of nursing, while Nursing’s Social Policy Statement: The Essence of the Profession guides nurses in the application of their professional skills and responsibilities.

Published by Nursesbooks.orgThe Publishing Program of ANAwww.Nursesbooks.org

American Nurses Association8515 Georgia Avenue, Suite 400Silver Spring, MD 20910-34921-800-274-4ANAwww.NursingWorld.org

design and typesetting: David Fox, AURAS Design, Silver Spring, MDprinting: McArdle Printing, Upper Marlboro, MDeditorial services: Grammarians, Inc, Washington, DC: Francis Taylor (copyediting); Kelly Saxton (proofreading); Gina Wiatrowski (indexing)


ISBN-13: 978-1-55810-286-6

First eBook publication August 2010. (First paper publication July 2010.)

http://www.nursesbooks.orghttp://www.nursingworld.org


iii

Contents

Contributors v

Nursing’s Social Policy Statement: An Overview 1

Social Context of Nursing 3TheSocialConcernsinHealthCareandNursing 4TheAuthorityforPracticeforNurses 5TheElementsofNursing’sSocialContract 6ProfessionalCollaborationinHealthCare 7

Definition of Nursing 9HumanResponses 10TheoryApplication 10NursingActions 11Outcomes 11

Knowledge Base for Nursing Practice 13

Scope of Nursing Practice 15SpecializationinNursingPractice 17AdvancedNursingPractice 18

AdvancedPracticeRegisteredNurses(APRNs) 18AdditionalSpecializedAdvancedNursingRoles 19

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iv Nursing’s Social Policy Statement

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iv

Standards of Professional Nursing Practice 21DefinitionandFunctionofStandards 21DevelopmentofStandards 22StandardsofProfessionalNursingPractice 23

StandardsofPractice 23StandardsofProfessionalPerformance 23

ApplicationofScopeandStandards 24CodeofEthicsforNurses 24AutonomyandCompetentPractice 25

Regulation of Professional Nursing 27ProfessionalRegulation 28LegalRegulation 29InstitutionalPoliciesandProcedures 29Self-Regulation 29

Application of Nursing’s Social Policy Statement 33

Conclusion 35

References 37

Glossary 39

Appendix A. 43ConsensusModelforAPRNRegulation:Licensure,Accreditation,Certification,andEducation(2008)

Appendix B. 87Nursing’sSocialPolicyStatement,2ndEdition(2003)

Appendix C. 105Nursing’sSocialPolicyStatement(1995)

Appendix D. 133Nursing:ASocialPolicyStatement(1980)

Appendix E. 169TheDevelopmentofFoundationalNursingDocumentsandProfessionalNursing:ATimeline

Index 173

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v

Revision of the Social Policy Statement Workgroup, 2009–2010Catherine E. Neuman, MSN, RN, NEA-BC – Co-ChairJohn F. Dixon, MSN, RN, NE-BC – Co-Chair

Bette K. Idemoto, PhD, RN, CCRN, ACNS-BCPamela A. Kulbok, DNSc, RN, PHCNS-BCJackie R. Pfeifer, MSN, RN, APRN, CCNSCheryl-Ann Resha, EdD, MSN, RNSue Sendelbach, PhD, RN, CCNS, FAANAnn O’Sullivan, MSN, RN, NE-BC, CNEKathleen M. White, PhD, RN, CNAA-BC

ANA Staff, 2009–2010Carol J. Bickford, PhD, RN-BC – Content editorKatherine C. Brewer, MSN, RN – Content editorMaureen E. Cones, Esq. – Legal counselYvonne Humes, MSA – Project coordinatorEric Wurzbacher – Project editor

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vi Nursing’s Social Policy Statement

Contributors


Congress on Nursing Practice and Economics, 2008–2010

Chair

Kathleen M. White, PhD, RN, CNAA-BC

ViCE-Chair

Ann M. O’Sullivan, MSN, RN, NE-BC, CNE

Susan A. Albrecht, PhD, RN, FAAN

Mary L. Behrens, MSN, RN, FNP-C

Carolyn Baird, MBA, MEd, RN-BC, CARN-AP, CCDP-D-DiplomateInternational Nurses Society on Addictions (INSA)

Carola M. Bruflat, RNC, MSN, WHNP-BC/FNP-BCAssociation of Women’s Health, Obstetrics and Neonatal Nurses (AWHONN)

Garry Brydges, MSN, ACNP-BS, CRNA

Stephanie Davis Burnett, MSN, RN, ACNSpBC, CRRNAssociation of Rehabilitation Nurses (ARN)

Mary Eileen Callan, MS, RN, FNP-BC

Myra C. Carmon, EdD, RN, CPNP

Robin Chard, PhD, RN, CNORAssociation of periOperative Registered Nurses (AORN)

Thomas Coe, PhD, RN, NEA-BC, FACHE

John F. Dixon, MSN, RN, NE-BCAmerican Association of Critical-Care Nurses (AACN)

William R. Donovan, MA, RN

Merilyn Douglass, ARNP, MSN

Bette M. Ferree, MSN, RN, FNP-BC

Susan Foster, MSN, RN, FNP-BC

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Nursing’s Social Policy Statement vii


Lisa A. Gorski, MS, HHCNS-BC, CRNI, FAANInfusion Nurses Society (INS)

Janet Y. Harris, MSN, RN, CNAA-BC

Kimberly A. Hickey, MSN, APRN-BC

Debra Hobbins, MSN, APRN

Patricia L. Holloman, RN, BSN, CNOR

Patricia K. Howard, PhD, RN, CENEmergency Nurses Association (ENA)

Sally Burrows-Hudson, MS, RN, CNNAmerican Nephrology Nurses Association (ANNA)

Bette K. Idemoto, PhD, RN, CCRN, ACNS-BC

Sandra Gracia Jones, PhD, ARNP, CS-C, ACRN, FAAN

Beverly Jorgenson, RNC, MSN, NNP

David M. Keepnews, PhD, JD, RN, FAAN

Patricia L. Keller, MSN, RN, NE-BC

Patrick E. Kenny, EdD, RN-BC, ACRN, APRN-PMH, NE-CAssociation of Nurses in AIDS Care (ANAC)

Linda Riazi-Kermani, RN, BSN, CEN

Robin R. Potter-Kimball, MS, RN, CNS-BC

Jane Kirschling, DNS, RNAmerican Association of Colleges of Nursing (AACN)

Pamela A. Kulbok, DNSc, RN, PHCNS-BC

Kathleen G. Lawrence, MSN, RN, CWOCNWound Ostomy and Continence Nurses Society (WOCN)

Carla A. B. Lee, PhD, ARNP-BC, CNAA, FAAN

Lori Lioce, MSN, FNP-BC

Jennifer H. Matthews, PhD, ACNS-BC

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viii Nursing’s Social Policy Statement

Contributors


Sara A. McCumber, RN, CNP, CNS

Peter T. Mitchell, MSN, RN, CNP, APRN-BC

Karen Leone-Natale, RN, BSN

Pamela Sue Neal, MSN-NA, RN, FNP, APRN-BC

Catherine E. Neuman, MSN, RN, NEA-BC

Linda L. Olson, PhD, RN, NEA-BC

Jackie R. Pfeifer, MSN, APRN, RN, CCNS

Theresa A. Posani, MS, RN, CNS, APRN-BC, CCRN, CNE

Elizabeth Poster, PhD, RN, FAAN

Susan E. Reinarz, MSN, RN, NNP-BCNational Association of Neonatal Nurses (NANN)

Cheryl-Ann Resha, EdD, MSN, RNNational Association of School Nurses (NASN)

Patricia Schlosser, RN, BSN

Cheryl K. Schmidt, PhD, RN, CNE, ANEF

Sue Sendelbach, PhD, RN, CCNSNational Association of Clinical Nurse Specialists (NACNS)

Nancy Shirley, PhD, RN

Joanna Sikkema, MSN, ARNP, FAHAPreventive Cardiovascular Nurses Association (PCNA)

Elaine L. Smith, MSN, MBA, RN, CNAANational Nursing Staff Development Organization (NNSDO)

Karen J. Stanley, MSN, RN, AOCN, FAANOncology Nursing Society (ONS)

Thomas E. Stenvig, PhD, RN, MPH, CNAA

Mary Mason Wyckoff, PhD, MSN, ACNP-BC, FNP-BC, NNP, CCNS, CCRN

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Nursing’s Social Policy Statement ix


About the Workgroup

John F. Dixon, MSN, RN, NE-BCDirector, The Center for Nursing Education and Research, Baylor UniversityMedical Center, Dallas TX

Mr. Dixon has over 25 years of nursing experience in critical care, education,management, administration, quality, innovation, and research in hospitalpractice, academic, and industry settings. Recent activities include nurs-ing research and the development professional nursing practice models andtheir integration into clinical practice and operations. He has served on theAmerican Association of Critical-Care Nurses’ national board, and been theAACCN organizational liaison representative to ANA.

Bette K. Idemoto, PhD, RN, CCRN, ACNS-BCCardiovascular Clinical Nurse Specialist, University Hospitals Case MedicalCenter, Cleveland, OH

An experienced CNS, Dr. Idemoto has almost 40 years of nursing in acute andcritical care, and has been educator, mentor, and presenter on a wide rangeof clinical topics. Her area of study includes delirium in the critically ill. Shehas encouraged participation among staff nurses in research scholarship, pro-moting nursing research through the coordination of evidence-based practiceconferences, project development, and a nursing research internship program.Dr. Idemoto has served at the local, state and national levels of the ANA andother nursing organizations.

Pamela A. Kulbok, DNSc, RN, PHCNS-BCAssociate Professor of Nursing and Public Health Sciences; Coordinatorof Community/Public Health Leadership, University of Virginia, School ofNursing, Charlottesville, VA

Dr. Kulbok’s nursing career has included the U.S. Navy, a visiting nurse service,directing a hospital-based home health agency, and teaching undergraduateand graduate courses in public health nursing, health promotion research, andnursing knowledge development. She is the Principle Investigator of an inter-professional, cross-institution, community-based research project in substanceuse prevention. An active ANA member, she has held leadership roles in twopublic health nursing organizations.

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x Nursing’s Social Policy Statement


Contributors

Catherine E. Neuman, MSN, RN, NEA-BCNurse Consultant, Marion, IL

With over 30 years of practice as a chief nursing executive, Ms. Neuman hasbeen director of nursing education, an infection control nurse, and a staffnurse in acute care hospitals. She has been a leader in and an active memberof ANA and the Illinois Nurses Association; her state-level work includesnurse representative to the hospital licensing board. She is involved in boththe ANCC Magnet Nursing Recognition Program as an appraiser and mentor,and in ANCC’s Pathway to Excellence Program as a reviewer. She is presentlya nurse consultant and an active parish nurse and staff nurse at a free clinic.

Jackie R. Pfeifer, MSN, RN, CCNS, APRNAdvance Practice Registered Nurse, Interventional Radiology, MarshfieldClinic, Marshfield, WI

As a clinical nurse specialist, Mrs. Pfeifer has over 10 years of experience inpatient care, which has included specialty practice in medical–cardiology,surgical intensive care, and ambulatory care. She is an active member ofthe Wisconsin Nurses Association and American Association of Critical CareNurses. She currently sits on the board as a Director-at-Large for the Centerfor American Nurses. Mrs. Pfeifer has a passion for the promoting accessand the improvement in the quality of care provided at all levels of care.

Cheryl-Ann Resha, EdD, MSN, RNDirector, School Health and Nutrition Programs, Connecticut Department ofEducation; Adjunct Professor, University of Hartford; College of Education,Nursing and Health Professions

A nurse administrator and nurse educator working in the field of public policyand pediatric health and wellness, Dr. Resha has over 30 years experience ofclinical practice, administration, and education aimed at improving the healthand well-being of children and their families. Her more recent work in the stategovernment involves advocating for school health programs, safe and healthyschool environments, and such school nursing practice issues as competencyand the roles of school nurses in public health and community nursing. Inthis role, she works with many state and national professional organizations.

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Nursing’s Social Policy Statement xi


Contributors

Sue Sendelbach, PhD, RN, CCNS, FAHADirector of Nursing Research and Clinical Nurse Specialist at AbbottNorthwestern Hospital, Minneapolis, MN

Dr. Sendelbach is a nurse researcher and a clinical nurse specialist in criticalcare with 34 years of nursing experience. She has worked in the area of cogni-tion of cardiovascular patients and delirium of hospitalized patients, and is anadvocate for evidence-based practice in patient care. She is past president ofthe National Association of Clinical Nurse Specialists and the book editor forClinical Nurse Specialist: The Journal for Advanced Nursing Practice.

Ann O’Sullivan, MSN, RN, NE-BC, CNEAssistant Dean, Associate Professor, Blessing-Rieman College of Nursing,Quincy, IL

With over 35 years experience as a nurse educator and nurse administra-tor, with current certification as Nurse Educator and Nurse Executive, Ms.O’Sullivan has long been active in nursing and health care at the national andstate level. Her national-level work includes Sigma Theta Tau and numerouscontributions to developing and advocating for ANA’s standards and guidelines.In addition to roles in such Illinois Nurses Association efforts as workforceadvocacy and health policy, she has served on state-level groups on nursingresources and safety, and is now the nurse representative on its board of health.

Kathleen M. White, PhD, RN, NEA-BC, FAANAssociate Professor, Johns Hopkins School of Nursing, Department of HealthSystems and Outcomes; Director, Doctor of Nursing (DNP) Program

Dr. White has been involved at many levels with graduate nursing educationthe Johns Hopkins University School of Nursing. As a clinical nurse specialistat the Johns Hopkins Hospital, she is a member of the collaborative SON/JHHteam that has developed nursing evidence-based practice model and guide-lines. She also maintains a faculty practice appointment at Howard CountyGeneral Hospital as nurse research liaison focusing on EBP initiatives. Herpractice leadership roles include such Maryland state-level issues as hospitalperformance evaluation and patient safety, and nationally, including leadershipand other roles in ANA’s standards and guidelines work.

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xii Nursing’s Social Policy Statement


Contributors

About the American Nurses AssociationThe American Nurses Association (ANA) is the only full-service professionalorganization representing the interests of the nation’s 3.1 million registerednurses through its constituent member nurses associations, its organizationalaffiliates, and the Center for American Nurses. The ANA advances the nurs-ing profession by fostering high standards of nursing practice, promoting therights of nurses in the workplace, projecting a positive and realistic view ofnursing, and by lobbying the Congress and regulatory agencies on health careissues affecting nurses and the public.

About Nursesbooks.org, The Publishing Program of ANANursesbooks.org publishes books on ANA core issues and programs, includingethics, leadership, quality, specialty practice, advanced practice, and the pro-fession’s enduring legacy. Best known for the foundational documents of theprofession on nursing ethics, scope and standards of practice, and social policy,Nursesbooks.org is the publisher for the professional, career-oriented nurse,reaching and serving nurse educators, administrators, managers, and research-ers as well as staff nurses in the course of their professional development.

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“Nursing is the pivotal health care profession, highly valued for its specialized knowledge, skill, and caring in improving the health status of the public and ensuring safe, effective, quality care.”

(ANA, 2003)

This revision of Nursing’s Social Policy Statement is the culmination of anextensive review process that also included a long public comment period. Itbuilds on previous editions, especially the original 1980 document. The workdescribes the essence of the profession by discussing nursing as a professionthat is both valued within a society and uniquely accountable to that society.The definition of nursing follows and describes contemporary nursing prac-tice. A more detailed discussion of practice is presented in the sections aboutthe scope and standards of practice and professional performance. A briefcommentary about regulation provides an overview of professional, legal, andself-regulation expectations. This foundational ANA publication remains a keyresource for nurses both to conceptualize the framework of nursing practiceand to provide direction to nursing educators, administrators, and research-ers. This publication also can inform other health professionals, legislatorsand other regulators, those who work in funding bodies, and members of thegeneral public.

Nursing’s Social Policy Statement: An Overview

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“Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.”

(ANA, 2002)

Nursing, like other professions, is an essential part of the society out of which itgrew and within which it continues to evolve. Nursing is responsible to societyin the sense that nursing’s professional interest must be perceived as servingthe interests of society. The mutually beneficial relationship between societyand the nursing profession has been expressed as follows:

Professions acquire recognition and relevance primarily in terms ofneeds, conditions, and traditions of particular societies and their mem-bers. It is societies (and often vested interests within them) that deter-mine, in accord with their different technological and economic levels ofdevelopment and their socioeconomic, political, and cultural conditionsand values, what professional skills and knowledge they most need anddesire. By various financial means, institutions will then emerge to train[educate] interested individuals to supply those needs.

Logically, then, the professions open to individuals of any particularsociety are the property not of the individual, but of the society. What

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individuals acquire through training [education] is professional knowl-edge and skill, not a profession or even part ownership of one. (Page,1975, p. 7)

The Social Concerns in Health Care and NursingHealth care continues to be a major focus of attention in the United States andworldwide. Many other societal concerns garner extensive attention and sub-sequent action by the nursing profession and its nurse constituency. Nursinghas an active and enduring leadership role in public and political determina-tions about the following six key areas of health care:

u Organization, delivery, and financing of quality health careQuality health care is a human right for all (ANA, 2008b). To improvethe quality of care, healthcare professionals must address these complexissues: increasing costs of care; health disparities; and the lack of safe,accessible, and available healthcare services and resources.

u Provision for the public’s healthIncreasing responsibility for basic self-help measures by the individual,family, group, community, or population complements the use of healthpromotion, disease prevention, and environmental measures.

u Expansion of nursing and healthcare knowledge and appropriate application of technologyIncorporation of research and evidence into practice helps inform theselection, implementation, and evaluation processes associated with thegeneration and application of knowledge and technology to healthcareoutcomes.

u Expansion of healthcare resources and health policyExpanded facilities and workforce capacity for personal care and com-munity health services are needed to support and enhance the capacityfor self-help and self-care of individuals, families, groups, communities,and populations.

u Definitive planning for health policy and regulationCollaborative planning is responsive to consumer needs and provides forbest resource use in the provision of health care for all.

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u Duties under extreme conditionsHealth professionals will weigh their duty to provide care with obligationsto their own health and that of their families during disasters, pandem-ics, and other extreme emergencies.

Of increasing importance, healthcare regulatory bodies set institutional stan-dards for mandated quality of care, and other healthcare entities provide guide-lines and protocols to attain quality care and better outcomes. The goals toprovide quality while addressing the costs and quantity of available healthcareservices will continue to be social and political priorities for nursing action.

The Authority for Nursing Practice for Nurses The authority for nursing, as for other professions, is based on social respon-sibility, which in turn derives from a complex social base and a social contract.

There is a social contract between society and the profession. Under itsterms, society grants the professions authority over functions vital toitself and permits them considerable autonomy in the conduct of theirown affairs. In return, the professions are expected to act responsibly,always mindful of the public trust. Self-regulation to assure quality andperformance is at the heart of this relationship. It is the authentic hall-mark of the mature profession. (Donabedian, 1976)

Nursing’s social contract reflects the profession’s long-standing core valuesand ethics, which provide grounding for health care in society. It is easy tooverlook this social contract underlying the nursing profession when faced withcertain facets of contemporary society, including depersonalization, apathy,disconnectedness, and growing globalization. But upon closer examination,we see that society validates the existence of the profession through licensure,public affirmation, and legal and legislative parameters. Nursing’s response isto provide care to all who are in need, regardless of their cultural, social, oreconomic standing.

The nursing profession fulfills society’s need for qualified and appropriatelyprepared individuals who embrace, and act according to, a strong code ofethics, especially when entrusted with the health care of individuals, families,groups, communities, and populations. The public ranks nurses among thetop-few most trusted professionals. In turn, the nursing profession’s trustedposition in society imposes a responsibility to provide the very best health

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care. The provision of such health care relies on well-educated and clinicallyastute nurses and a professional association, comprising these same nurses,that establishes a code of ethics, standards of care and practice, educationaland practice requirements, and policies that govern the profession.

The American Nurses Association (ANA) is the professional organizationthat performs an essential function in articulating, maintaining, and strength-ening the social contract that exists between nursing and society, upon whichthe authority to practice nursing is based. That social contract is evident inANA’s most enduring and influential work, which is derived from the collec-tive expertise of its constituent member associations, individual members, andaffiliate member organizations. Such work includes:

u Developing and maintaining nursing’s code of ethics;

u Developing and maintaining the scope andstandards of nursing practice;

u Supporting the development of nursing theory and researchto explain observations and guide nursing practice;

u Establishing the educational requirements of professional practice;

u Defining professional role competence; and

u Developing programs and resources to establish andarticulate nursing’s accountability to society, includingpractice policy work and governmental advocacy.

The Elements of Nursing’s Social Contract The following statements undergird professional nursing’s social contractwith society:

u Humans manifest an essential unity of mind, body, and spirit.

u Human experience is contextually and culturally defined.

u Health and illness are human experiences. The presence of illnessdoes not preclude health, nor does optimal health preclude illness.

u The relationship between the nurse and patient occurs withinthe context of the values and beliefs of the patient and nurse.

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u Public policy and the healthcare delivery system influence thehealth and well-being of society and professional nursing.

u Individual responsibility and interprofessionalinvolvement are essential.

These values and assumptions apply whether the recipient of professionalnursing care is an individual, family, group, community, or population.

Professional Collaboration in Health CareThe nursing profession is particularly focused on establishing effective work-ing relationships and collaborative efforts essential to accomplish its health-oriented mission. Multiple factors combine to intensify the importance ofdirect human interactions, communication, and professional collaboration: thecomplexity, size, and culture of the healthcare system and its transitional anddynamic state; increasing public involvement in health policy; and a nationalfocus on health.

Collaboration means true partnership, valuing expertise, power, and respecton all sides and recognizing and accepting separate and combined spheres ofactivity and responsibility. Collaboration includes mutual safeguarding of thelegitimate interests of each party and a commonality of goals that is recognizedby all parties. The parties base their relationship upon trust and the recogni-tion that each one’s contribution is richer and more truly real because of thestrength and uniqueness of the others.

Successful collaboration requires that nursing and its members respond todiversity by recognizing, assessing, and adapting the nature of working rela-tionships with individuals, populations, and other health professionals andhealth workers. These efforts also extend to relationships within nursing andbetween nursing and representatives of the public in all environments wherenursing practice may occur.Co

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9


Definitions of nursing have evolved to reflect the essential features of profes-sional nursing:

u Provision of a caring relationship that facilitates health and healing

u Attention to the range of human experiences and responses tohealth and illness within the physical and social environments

u Integration of assessment data with knowledge gainedfrom an appreciation of the patient or the group

u Application of scientific knowledge to the processes of diagnosisand treatment through the use of judgment and critical thinking

u Advancement of professional nursing knowledge throughscholarly inquiry

u Influence on social and public policy to promote social justice

u Assurance of safe, quality, and evidence-based practice

In her Notes on Nursing: What It Is and What It Is Not, published in 1859,Florence Nightingale defined nursing as having “charge of the personal healthof somebody . . . , and what nursing has to do . . . is to put the patient in thebest condition for nature to act upon him.”

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A century later, Virginia Henderson (1961) defined the purpose of nursingas “to assist the individual, sick or well, in the performance of those activitiescontributing to health or its recovery (or to a peaceful death) that he wouldperform unaided if he had the necessary strength, will or knowledge. And todo this in such a way as to help him gain independence as rapidly as possible.”

In the original Nursing: A Social Policy Statement (ANA, 1980), nursingwas defined as “the diagnosis and treatment of human responses to actual orpotential health problems.”

In 2001, ANA’s Code of Ethics With Interpretive Statements stated that“nursing encompassed the prevention of illness, the alleviation of suffering, andthe protection, promotion and restoration of health in the care of individuals,families, groups, and communities.”

The definition for nursing remains unchanged from the 2003 edition ofNursing’s Social Policy Statement:

Nursing is the protection, promotion, and optimization of health andabilities, prevention of illness and injury, alleviation of suffering throughthe diagnosis and treatment of human response, and advocacy in thecare of individuals, families, communities, and populations.

This definition encompasses four essential characteristics of nursing: humanresponses or phenomena, theory application, nursing actions or interventions,and outcomes.

Human ResponsesThese are the responses of individuals to actual or potential health problems,and which are the phenomena of concern to nurses. Human responses includeany observable need, concern, condition, event, or fact of interest to nursesthat may be the target of evidence-based nursing practice.

Theory ApplicationIn nursing, theory is a set of interrelated concepts, definitions, or propositionsused to systematically describe, explain, predict, or control human responsesor phenomena of interest to nurses. Understanding theories of nursing andother disciplines precedes, and serves as a basis for, theory application throughevidence-based nursing actions.

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Nursing Actions The aims of nursing actions (also nursing interventions) are to protect, pro-mote, and optimize health; to prevent illness and injury; to alleviate suffer-ing; and to advocate for individuals, families, communities, and populations.Nursing actions are theoretically derived, evidence-based, and require well-developed intellectual competencies.

Outcomes The purpose of nursing actions is to produce beneficial outcomes in relationto identified human responses. Evaluation of outcomes of nursing actionsdetermines whether the actions have been effective. Findings from nursingresearch provide rigorous scientific evidence of beneficial outcomes of specificnursing actions.

Figure 1 depicts the intertwined relationships of human responses, theoryapplication, nursing actions, and outcomes.

Figure 1. Defining CharaCteristiCs of nursing PraCtiCe

*EBP - Evidence-Based Practice

HumanResponses

(Phenomena)

TheoryApplication

(Science)

NursingActions(EBP)*

Outcomes(Eects)

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13

Knowledge Base for Nursing Practice

Nursing is a profession and is both a science and an art. The knowledge basefor professional nursing practice includes nursing science, philosophy, and eth-ics; biology and psychology; and the social, physical, economic, organizational,and technological sciences. To refine and expand nursing’s knowledge base,nurses use theories that fit with professional nursing’s values of health andhealth care and that are relevant to professional nursing practice. Nurses applyresearch findings and implement the best evidence into their practice basedon applicability to the individual, family, group, community, population, orsystem of care. These efforts generate knowledge and advance nursing science.

Nurses are concerned with human experiences and responses across the lifespan. Nurses partner with individuals, families, communities, and populationsto address issues such as the following:

u Promotion of health and wellness

u Promotion of safety and quality of care

u Care, self-care processes, and care coordination

u Physical, emotional, and spiritual comfort, discomfort, and pain

u Adaptation to physiological and pathophysiological processes

u Emotions related to the experience of birth, growth anddevelopment, health, illness, disease, and death

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u Meanings ascribed to health, illness, and other concepts

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u Health literacy

u Decision making and the ability to make choices

u Relationships, role performance, and change processeswithin relationships

u Social policies and their effects on health

u Healthcare systems and their relationships to access, cost, andquality of health care

u The environment and the prevention of disease and injury

Nurses use their theoretical and evidence-based knowledge of these humanexperiences and responses to collaborate with patients and others to assess,diagnose, plan, implement, evaluate care, and identify outcomes. Nursinginterventions aim to produce beneficial effects, contribute to quality outcomes,and—above all—do no harm. Nurses use the process that is evidence-basedpractice as a foundation of quality patient care to evaluate the effectiveness ofcare in relationship to identified outcomes.

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15

Scope of Nursing Practice

Professional nursing has a single scope of practice that encompasses the rangeof activities from those of the beginning registered nurse through those ofthe most advanced level of nursing practice. The scope of practice statement(ANA, 2010) describes the who, what, where, when, why, and how of nursingpractice. Although a single scope of professional nursing practice exists, thedepth and breadth to which individual nurses engage in the total scope ofprofessional nursing practice are dependent on their educational preparationand self-development, their experience, their role, the setting, and the natureof the populations they serve.

Further, all nurses are responsible for practicing in accordance with rec-ognized standards of professional nursing practice and the recognized profes-sional code of ethics. Note that the lower level and foundation of the pyramidin Figure 2 (see next page) includes the scope of professional practice, standardsof practice, and the code of ethics.

Each nurse remains accountable for the quality of care within his or herscope of nursing practice. The level of application of standards varies withthe education, experience, and skills of the individual nurse, who must relyon self-determination and self-regulation as the final level of professionalaccountability.

Professional nursing’s scope of practice is dynamic and continually evolv-ing, characterized by a flexible boundary responsive to the changing needsof society and the expanding knowledge base of applicable theoretical and

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scientific domains. This scope of practice thus overlaps those of other profes-sions involved in health care, whose boundaries are also constantly evolving.Members of any profession collaborate in various ways, such as:

u Sharing knowledge, techniques, and ideas about how todeliver and evaluate quality and outcomes in health care

u Sharing some functions and a common focus on the sameoverall mission

u Recognizing the expertise of others within and outside theprofession, referring patients to other providers when appropriate

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