If a patient received an esophagogastroduodenoscopy EGD at 1

If a patient received an esophagogastroduodenoscopy (EGD) at 1200 but did not receive her 0900 drugs due to an order of NPO (nothing by mouth), what factors should a nurse consider when deciding which of the 0900 oral drugs should be administered at this time?

Solution

There are four standards, each with accompanying indicators, that describe factors should a nurse consider when deciding which of the 0900 oral drugs should be administered :-

Indicators

The nurse meets the standard by:-

having sufficient knowledge, skill and judgment to determine the appropriateness of performing the procedure at a given time for a particular client, considering the:

client’s overall condition,

risks and benefits (e.g., predictability and severity of possible outcomes, risk of harm arising from performing or not performing the procedure),

available resources to support the performance of the procedure (e.g., emergency equipment, cardiac arrest team) and manage outcomes;

advocating for the appropriate health care provider to perform the procedure

ensuring that the rationale for performing the procedure is based on achieving the best outcomes for the client

determining whether the procedure fits within a professional nursing role (e.g., requires nursing assessment, health teaching, counselling, discharge planning)

ensuring that practice setting policies support the nurse in performing the procedure

declining to perform the procedure when it does not support safe and ethical client care

ensuring that informed consent includes the information that a nurse is performing the procedure.

1. Appropriate health care provider

Nurses must consider each situation to determine if the performance of the procedure promotes safe client care, and if it is appropriate for a nurse to perform the procedure

In addition, the nurse in an administrative role meets the standard by:-

using knowledge, best evidence, skill and judgment to determine whether a nurse is the appropriate practitioner to perform the procedure after considering the:

specialized knowledge required and whether nurses can develop the necessary knowledge, skill and judgment to perform the procedure safely,

qualifications required (e.g., the category6 and class of nursing registration [NP, RN or RPN]), education and related experience,

overall care needs of the client population,

risks and benefits (e.g., predictability of outcomes, risk of harm arising from performing or not performing the procedure),

whether the rationale for a nurse to perform the procedure supports timely access to care, continuity of care and client care that focuses on the whole person;

ensuring that sufficient nursing resources are available to incorporate the procedure into the practice (e.g., if nurses take on the procedure, considering how workload is affected and planning to offset additional responsibilities)

mobilizing sufficient resources to support the safe performance of the procedure

providing educational resources to support nurses learning to perform the procedure safely;

evaluating client outcomes in relation to nurses performing the procedure.

2. Authority

Nurses ensure that they have the appropriate authority before performing procedures. Indicators The nurse meets the standard by:

knowing the scope of practice of nursing, the legislated authority and what the practice setting has approved as a nurse’s role and responsibilities;

knowing when additional authority is required in the form of delegation7, and proceeding with delegation according to regulation;

knowing when specific direction for client care is required in the form of orders, directives, protocols or recommendations;

obtaining direct client orders or implementing directives appropriately;

ensuring that client records reflect the procedures that were performed;

initiating the performance of controlled act procedures within the boundaries of legislation, competence and agency policy; and

ensuring that client records reflect the initiated procedures.

In addition, the nurse in an administrative role meets the standard by ensuring that:

a functional conflict-resolution mechanism exists for nurses to resolve issues/disagreements regarding performing procedures

quality assurance mechanisms monitor the impact of the authorizing mechanism on client care and ensure that required changes are made in a timely manner,

documentation of authorizing mechanisms are maintained.

3. Competence

Nurses ensure that they are competent in both the cognitive and technical aspects of a procedure prior to performing it.

The nurse meets the standard by:

demonstrating cognitive and technical competence to perform the procedures;

declining to perform procedures that she/he is not competent to perform;

determining the appropriateness of the procedure for the specific client in a specific situation;

demonstrating knowledge of the following components of procedures: purpose (assessment or treatment), indications,

contraindications,

risk to the client,

expected outcomes,

actions to take if complications occur, and

health teaching and decision support;

applying knowledge, best evidence, skill, judgment and appropriate authority to make and act on decisions required during the procedure

consulting when she/he reaches the limits of her/ his knowledge, skill and judgment;

communicating with other health care team members as necessary for safe, effective and ethical client care.

reflecting on and continuously improving knowledge, skill and judgment in relation to practice.

In addition, the nurse in an administrative role meets the standard by:

ensuring that resources support the delivery of initial and ongoing education to support nurses in attaining and maintaining competence.

4. Managing outcomes

Prior to performing procedures, nurses ensure that they are able to identify the potential outcomes of procedures, have the authority and competence to manage the outcomes, or have the resources available to manage those outcomes.

Indicators

The nurse meets the standard by:

identifying the potential risks and outcomes related to performing a procedure;

determining whether the management of the possible outcomes is within her/his knowledge, skill, judgment and authority;

identifying the required resources (present and future) to manage outcomes before performing a procedure;

managing outcomes independently within her/his abilities and authority;

advocating for and accessing required resources;

declining to perform procedures when she/he cannot manage the outcomes or does not have the required resources available to manage the outcomes and communicating that decision appropriately.

In addition, the nurse in an administrative role meets the standard by:

ensuring that the required resources are available to manage outcomes at all times when the procedure is performed;

supporting a nurse when she/he declines to perform procedures for which she/he does not have the knowledge or skill to manage the outcomes and/or does not have the required available resources.