The following Domains of Nursing Practice and associated activities are based on a practice analysis of medical-surgical nursing.
Select a Domain to learn more about its associated activities.
1. Helping Role
- Maintain an environment in which patient confidentiality is assured.
- Assess patient's level of comfort/pain.
- Act as an advocate to help patient meet needs/goals.
- Acknowledge, respect, and support emotional state of patient and/or family as they experience and/or express their emotions.
- Assist patients to achieve optimal level of comfort, using an interdisciplinary approach.
- Modify plan of care to achieve patient's optimal level of comfort, i.e., pharmacological interventions, heat, cold, massage, positioning, touch, etc.
- Provide a therapeutic environment, considering privacy, noise, light, visitors'/providers' interaction with patients.
- Provide culturally competent patient care, including education.
- Support family involvement in accordance with patient's wishes regarding caregiving and decision making.
- Assess for potential for self-harm.
- Identify need of patient/family for support systems/resources and make appropriate referrals.
- Work on behalf of patient/family to help resolve ethical and clinical concerns.
- Coordinate care across multiple settings.
- Identify, acknowledge, support, and facilitate patient/family decisions regarding end-of-life care.
- Identify signs of domestic or intimate partner violence.
- Assess and provide for spiritual needs of patients and families.
- Identify ethical issues in clinical practice and facilitate a resolution with patient, family, and staff.
2. Teaching/Coaching Function
- Assess the patient's and family's readiness and ability to learn.
- Identify barriers to learning.
- Prepare/educate patient for transition in care, e.g., discharge to home or other facility.
- Provide information and rationales related to diagnosis, procedures, self-care, prognosis, wellness, and modifiable risk factors.
- Utilize opportunities for spontaneous education.
- Encourage patient's and family's participation in establishing educational goals.
- Develop and implement an individualized teaching plan for patient and/or family.
- Evaluate and modify teaching plan based on achievement of pre-established and ongoing learning needs.
- Assist staff in identifying educational needs of patients and their families.
- Assist staff in selecting/developing educational materials appropriate for intended learner(s).
- Teach patient and family about available community resources.
3. Diagnostic and Patient Monitoring
- Conduct and document a comprehensive baseline assessment.
- Anticipate patient's response to treatment and monitor for potential problems.
- Reassess patient based on established standards of care at appropriate intervals.
- Interpret results of laboratory and diagnostic studies and take appropriate action.
- Use invasive and non-invasive methods to collect data.
- Analyze all patient data in formulating a plan of care.
- Participate in medication reconciliation at transitions of care.
- Anticipate the patient's response and needs related to physiological, psychosocial sexual, spiritual, and cultural aspects of his/her illness.
- Prioritize identified problems and modify the plan of care to achieve the best possible outcomes.
- Develop an individualized plan of care congruent with patient goals.
- Identify purpose and appropriateness of diagnostic studies.
4. Administering and Monitoring Nursing Interventions
- Administer medications accurately and safely.
- Identify subtle changes in patient's assessment to prevent deterioration of patient status.
- Assess patient's level of consciousness.
- Monitor patients for therapeutic responses, reactions, untoward effects, toxicity, and incompatibilities of administered medications.
- Implement measures to ensure adequate oxygenation and gas exchange.
- Monitor and implement measures to prevent alterations in skin integrity.
- Initiate, maintain, and monitor intravenous therapy.
- Identify, document, and report deviations from expected findings.
- Monitor for signs and symptoms of complications of disease processes.
- Implement measures to address threats to patient safety, e.g., falls, seizures.
- Maintain patent airway.
- Maintain integrity and prevent infection of invasive drainage systems, e.g., catheters, percutaneous drains.
- Implement measures to maintain adequate hydration and electrolyte balance.
- Provide care to patients on continuous cardiac monitoring.
- Use adaptive/assistive devices for mobility, immobility, positioning, and comfort.
- Interpret cardiac rhythm strips.
- Monitor for complications of musculoskeletal trauma and surgical procedures.
- Perform a neurovascular assessment, e.g., extremities, flaps, grafts.
- Provide optimum nutrition during hospitalization, allowing for cultural and individual preferences.
- Identify and implement transmission-based precautions based on patient's history and symptoms.
- Monitor effectiveness of nutritional interventions.
- Develop and implement a wound management strategy.
- Care for patient receiving IV patient-controlled analgesia
- Perform central line dressing change.
- Administer heparin drip
- Apply and/or monitor devices used to immobilize affected area, e.g., cast, splint, collar, etc.
- Care for patient receiving epidural analgesia
- Provide care for patients who have chest drainage systems.
5. Effective Management of Rapidly Changing Situations
- Recognize signs that a patient’s condition is deteriorating and take appropriate action.
- Obtain appropriate orders to address a change in the patient’s condition,
- Determine priorities in rapidly changing situations.
- Use existing guidelines/protocols/policies to respond to changing patient situations, e.g., hypoglycemia, wound dehiscence.
- Use existing guidelines/protocols/policies to respond to urgent and emergent situations, e.g., acute chest pain, stroke.
- Initiate basic life support.
6. Monitoring/Ensuring Quality Health Care Practices
- Communicate effectively to the healthcare team.
- Question/clarify orders as appropriate.
- Incorporate evidence-based practice into the patient's plan of care.
- Coordinate and/or participate in interdisciplinary activities to ensure consistent patient outcomes, e.g., core measures.
- Report system failures, e.g., chain of command, equipment, safety, medication administration, computer systems.
- Assist nursing staff in incorporating evidence-based practice and quality improvement into practice.
- Participate in quality improvement activities.
- Identify clinical problems for further investigation.
7. Organizational and Work-Role Competencies
- Practice in accordance with the rules and regulations of the state board of nursing in state(s) of licensure.
- Adhere to the Scope and Standards of Medical-Surgical Nursing Practice.
- Utilize electronic/computer resources to optimize patient care.
- Set priorities based on assignment, unit, and institutional needs.
- Act as a professional role model.
- Participate as an active member of the interdisciplinary healthcare team.
- Delegate patient care assignments based on competency levels and scope of practice of healthcare team members.
- Act as a resource for other nurses on the unit.
- Provide collaborative, interdisciplinary, coordinated care.
- Incorporate strategies that support effective team dynamics in a caring and nurturing environment.
- Evaluate own practice based on established standards of care.
- Evaluate nursing care based on outcome criteria.
- Recognize unsafe work practices (nurse/patient ratio, ergonomics, standard precautions, etc.) and intervene appropriately.
- Identify, develop, and implement strategies to reduce readmissions.
- Use the chain of command appropriately.
- Serve as consultant to nursing staff and other disciplines.
- Coordinate and/or participate in interdisciplinary activities to ensure consistent patient outcomes, e.g., core measures.
- Identify, develop, and implement strategies to decrease length of stay while improving patient/family/staff satisfaction and patient care.
- Provide expert support to unit educators, preceptors, and nurse managers.
- Follow institutional policies and procedures in response to an internal or external crisis or event.
- Serve as preceptor/mentor for students and staff.
- Assist with data collection (e.g., patient outcomes, nurse-sensitive indicators).
