Domains of Medical-Surgical Nursing Practice

Helping Role

1. Use a culturally-sensitive and age-specific instrument to assess patient's level of comfort (e.g., pain, fatigue, nausea, dyspnea, anxiety, depression, dementia, etc.).
2. Assist patient to achieve optimal level of comfort using a multidisciplinary approach.
3. Modify plan of care to achieve patient's optimal level of comfort (e.g., pharmacologic interventions, heat, cold, massage, positioning, touch, etc.).
4. Act as an advocate to help patient meet needs/goals, giving consideration to patient's rights.
5. Work on behalf of patient/family to identify and help resolve ethical and clinical concerns.
6. Provide a therapeutic environment, considering privacy, noise, light, visitors'/providers' patterns of interaction with patient, incorporation of pet therapy/music therapy, etc.
7. Recognize and incorporate diversity in the provision of patient care (e.g., ethnicity, gender, disability, spirituality, lifestyle, socioeconomic and education level, etc.).
8. Support family involvement, in accordance with patient's wishes, regarding caregiving and decision making.
9. Maintain an environment in which patient confidentiality is assured.
10. Acknowledge, respect, and support the emotional state of patient and/or family as they experience and/or express their emotions.
11. Identify need of patient/family for support systems/resources and make appropriate referrals.
12. Identify, acknowledge, support, and facilitate patient/family decisions regarding end-of-life care.

Teaching/Coaching Function

1. Assess the patient's and family's readiness and ability to learn.
2. Identify barriers to learning.
3. Encourage the patient's and family's participation in establishing educational goals.
4. Develop and implement an individualized teaching plan for patient and/or family.
5. Evaluate and modify teaching plan based on achievement of pre-established and ongoing learning needs.
6. Utilize opportunities for spontaneous education.
7. Teach patient and family about available community resources that they may need post-discharge.
8. Provide information and rationale related to diagnosis, procedures, self-care, prognosis, wellness, and modifiable risk factors.
9. Provide information in a sensitive manner to make culturally-avoided aspects of illness approachable and understandable.

Diagnostic and Patient Monitoring Function

1. Conduct and document a comprehensive assessment to obtain individual baseline data.
2. Reassess patient based on established standards and at appropriate intervals, using clinical judgment.
3. Use invasive and non-invasive methods to collect data.
4. Analyze all patient data in formulating a plan of care.
5. Develop an individualized plan of care.
6. Prioritize identified problems and modify the plan of care to achieve the best possible outcome.
7. Anticipate patient's responses and needs related to physiologic, psychosocial, spiritual, and cultural aspects of his/her illness.
8. Anticipate patient's response to treatment and monitor for potential problems.
9. Identify subtle changes in patient assessment to prevent deterioration of patient status.
10. Identify, document, and report deviations from expected findings.

Administering and Monitoring Therapeutic Interventions

1. Administer medications using appropriate routes accurately and safely.
2. Monitor patient for therapeutic responses, reactions, untoward effects, toxicity, and incompatibilities of administered medications.
3. Maintain patent airway.
4. Take measures to ensure adequate oxygenation and gas exchange (e.g., suctioning, oxygen delivery, tracheostomy care, chest physical therapy, etc.).
5. Maintain effectiveness and patency of chest drainage systems.
6. Create and implement a wound management strategy that fosters healing, comfort, and appropriate drainage.
7. Monitor for signs and symptoms of infections and other complications.
8. Monitor and take measures to prevent alteration in skin integrity, including peristomal skin.
9. Maintain integrity and prevent infection of invasive drainage systems (e.g., catheters, percutaneous drains, etc.).
10. Appropriately and correctly use adaptive/assistive devices for mobility, immobility, positioning, and comfort.
11. Assess and monitor the effectiveness of adaptive/assistive devices.
12. Apply and/or monitor devices used to immobilize affected area (e.g., cast, splint, collar, etc.).
13. Perform neurovascular assessment of compromised extremity or other area.
14. Provide optimum nutrition during hospitalization, allowing for cultural and individual preferences.
15. Monitor effectiveness of nutritional interventions.
16. Initiate, maintain, and monitor intravenous therapy appropriately and correctly to minimize risks and prevent complications.
17. Maintain a safe environment.
18. Take measures to maintain adequate hydration and electrolyte balance.
19. Use existing guidelines/protocols/policies to respond to changing patient situations

Effective Management of Rapidly Changing Situations

1. Coordinate complex situations by rapidly assessing priorities and delegating responsibilities to meet the needs of the patient and family.
2. Identify and manage a patient crisis.
3. Rapidly match demands and resources in emergency situations.
4. Initiate basic life support.
5. Use existing guidelines/protocols/policies to respond to urgent and emergent situations.

Monitoring/Ensuring Quality Health Care Practices

1. Participate in quality improvement activities.
2. Collect and report data regarding system failures (e.g., safety, medication administration, chain of command, equipment, computer system, environment--loss of power, outlet failure, etc.).
3. Incorporate evidence-based practice into the patient's plan of care.
4. Question/clarify orders as appropriate.
5. Communicate clearly and concisely with health care team members to meet patient care needs.

Organizational and Work-Role Competencies

1. Question/evaluate own practice based on established standards of care, review of the literature, research, and education.
2. Set priorities based on assignment, unit, and institutional needs.
3. Delegate patient care assignments based on competency levels and scope of practice of ealth care team members.
4. Follow institutional policies and procedures in response to an internal or external crisis or event.
5. Adhere to the Scope and Standards of Medical-Surgical Nursing Practice.
6. Practice in accordance with the rules and regulations of state board of nursing in state(s) of licensure
7. Use the chain of command appropriately in own work setting.
8. Recognize unsafe work practices (e.g., nurse/patient ratio; ergonomics, standard precautions, etc.) and appropriately intervene.
9. Incorporate strategies that support effective team dynamics in a caring and nurturing environment.
10. Participate in health-related community and activities, e.g., health fairs, voting, and walks.