Domains of Medical-Surgical Nursing Practice

Helping Role

1. Assess patient’s level of comfort/pain.
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, i.e., pharmacologic and non-pharmacologic interventions.
4. Act as an advocate to help patient meet needs/goals.
5. Work on behalf of patient/family to help resolve ethical and clinical concerns.
6. Provide a therapeutic environment, e.g., privacy, noise, light, visitors’/providers’ patterns of interaction with patient, music therapy, etc.
7. Provide culturally competent patient care.
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.
8. Provide information and rationale related to diagnosis, procedures, self-care, prognosis, wellness, and modifiable risk factors.
9. Provide information in a manner that makes culturally sensitive aspects of illness approachable and understandable.

Diagnostic and Patient Monitoring Function

1. Conduct and document a comprehensive baseline assessment.
2. Identify risk factors for illness and complications of illness.
3. Reassess patient based on established standards of care at appropriate intervals.
4. Use invasive and non-invasive methods to collect data.
5. Analyze all patient data in formulating a plan of care.
6. Develop an individualized plan of care.
7. Prioritize identified problems and modify the plan of care to achieve the best possible outcome.
8. Anticipate patient’s responses and needs related to physiologic, psychosocial, spiritual, and cultural aspects of his/her illness.
9. Anticipate patient’s response to treatment and monitor for potential problems.
10. Identify subtle changes in patient assessment to prevent deterioration of patient status.
11. Identify, document, and report deviations from expected findings.
12. Identify selected cardiac rhythms, i.e., sinus bradycardia, ventricular tachycardia, ventricular fibrillation.

Administering and Monitoring Therapeutic Interventions

1. Administer medications accurately and safely.
2. Monitor patient for therapeutic responses, reactions, untoward effects, toxicity, and incompatibilities of administered medications.
3. Maintain patent airway.
4. Implement measures to ensure adequate oxygenation and gas exchange.
5. Provide care to patients who have chest drainage systems.
6. Develop a wound management strategy.
7. Monitor for signs and symptoms of complications of disease processes.
8. Monitor and implement measures to prevent alteration in skin integrity.
9. Maintain integrity and prevent infection of invasive drainage systems, e.g., catheters, percutaneous drains.
10. Use adaptive/assistive devices for mobility, immobility, positioning, and comfort.
11. Monitor for complications of musculoskeletal trauma and surgical procedures.
12. Apply and/or monitor devices used to immobilize affected area, e.g., cast, splint, collar, etc.
13. Perform neurovascular assessment, e.g., extremities, flaps, grafts.
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.
17. Take measures to prevent and treat infection.
18. Provide care to patients on continuous cardiac monitoring.
19. Implement measures to maintain adequate hydration and electrolyte balance.
20. Use existing guidelines/protocols/policies to respond to changing patient situations, e.g., hypoglycemia, wound dehiscence.
21. Monitor for changes in patient’s level of consciousness.

Effective Management of Rapidly Changing Situations

1. Determine priorities in rapidly changing situations.
2. Rapidly match demands and resources in emergency situations.
3. Initiate basic life support.
4. Use existing guidelines/protocols/policies to respond to urgent and emergent situations, e.g., acute chest pain, stroke.

Monitoring/Ensuring Quality Health Care Practices

1. Participate in quality improvement activities.
2. Collect and report data regarding system failures, e.g., chain of command, equipment, safety, medication administration, computer systems.
3. Incorporate evidence-based practice into the patient’s plan of care, e.g., Core Measure Sets.
4. Question/clarify orders as appropriate.
5. Communicate effectively to the healthcare team.

Organizational and Work-Role Competencies

1. Evaluate own practice based on established standards of care.
2. Set priorities based on assignment, unit, and institutional needs.
3. Delegate patient care assignments based on competency levels and scope of practice of healthcare 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 (nurse/patient ratio; ergonomics, standard precautions, etc.) and intervene appropriately.
9. Incorporate strategies that support effective team dynamics in a caring and nurturing environment.
10. Act as a role model.
11. Provide collaborative, multidisciplinary, coordinated care.
12. Evaluate nursing care based on outcome criteria, e.g., National Database of Nursing Quality Indicators.
13. Coordinate and/or participate in interdisciplinary activities to ensure consistent patient outcomes, e.g., Core Measure Sets.
14. Integrate clinical and management skills with professional and financial accountability.
15. Identify, develop, and implement strategies to decrease length of stay while improving patient/family/staff satisfaction and patient care.
16. Serve as a preceptor/mentor for students and staff.