Domains of Medical-Surgical Nursing Practice

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

  1. Maintain an environment in which patient confidentiality is assured.
  2. Assess patient's level of comfort/pain.
  3. Act as an advocate to help patient meet needs/goals.
  4. Acknowledge, respect, and support emotional state of patient and/or family as they experience and/or express their emotions.
  5. Assist patients to achieve optimal level of comfort, using an interdisciplinary approach.
  6. Modify plan of care to achieve patient's optimal level of comfort, i.e., pharmacological interventions, heat, cold, massage, positioning, touch, etc.
  7. Provide a therapeutic environment, considering privacy, noise, light, visitors'/providers' interaction with patients.
  8. Provide culturally competent patient care, including education.
  9. Support family involvement in accordance with patient's wishes regarding caregiving and decision making.
  10. Assess for potential for self-harm.
  11. Identify need of patient/family for support systems/resources and make appropriate referrals.
  12. Work on behalf of patient/family to help resolve ethical and clinical concerns.
  13. Coordinate care across multiple settings.
  14. Identify, acknowledge, support, and facilitate patient/family decisions regarding end-of-life care.
  15. Identify signs of domestic or intimate partner violence.
  16. Assess and provide for spiritual needs of patients and families.
  17. Identify ethical issues in clinical practice and facilitate a resolution with patient, family, and staff.

2. Teaching/Coaching Function

  1. Assess the patient's and family's readiness and ability to learn.
  2. Identify barriers to learning.
  3. Prepare/educate patient for transition in care, e.g., discharge to home or other facility.
  4. Provide information and rationales related to diagnosis, procedures, self-care, prognosis, wellness, and modifiable risk factors.
  5. Utilize opportunities for spontaneous education.
  6. Encourage patient's and family's participation in establishing educational goals.
  7. Develop and implement an individualized teaching plan for patient and/or family.
  8. Evaluate and modify teaching plan based on achievement of pre-established and ongoing learning needs.
  9. Assist staff in identifying educational needs of patients and their families.
  10. Assist staff in selecting/developing educational materials appropriate for intended learner(s).
  11. Teach patient and family about available community resources.

3. Diagnostic and Patient Monitoring

  1. Conduct and document a comprehensive baseline assessment.
  2. Anticipate patient's response to treatment and monitor for potential problems.
  3. Reassess patient based on established standards of care at appropriate intervals.
  4. Interpret results of laboratory and diagnostic studies and take appropriate action.
  5. Use invasive and non-invasive methods to collect data.
  6. Analyze all patient data in formulating a plan of care.
  7. Participate in medication reconciliation at transitions of care.
  8. Anticipate the patient's response and needs related to physiological, psychosocial sexual, spiritual, and cultural aspects of his/her illness.
  9. Prioritize identified problems and modify the plan of care to achieve the best possible outcomes.
  10. Develop an individualized plan of care congruent with patient goals.
  11. Identify purpose and appropriateness of diagnostic studies.

4. Administering and Monitoring Nursing Interventions

  1. Administer medications accurately and safely.
  2. Identify subtle changes in patient's assessment to prevent deterioration of patient status.
  3. Assess patient's level of consciousness.
  4. Monitor patients for therapeutic responses, reactions, untoward effects, toxicity, and incompatibilities of administered medications.
  5. Implement measures to ensure adequate oxygenation and gas exchange.
  6. Monitor and implement measures to prevent alterations in skin integrity.
  7. Initiate, maintain, and monitor intravenous therapy.
  8. Identify, document, and report deviations from expected findings.
  9. Monitor for signs and symptoms of complications of disease processes.
  10. Implement measures to address threats to patient safety, e.g., falls, seizures.
  11. Maintain patent airway.
  12. Maintain integrity and prevent infection of invasive drainage systems, e.g., catheters, percutaneous drains.
  13. Implement measures to maintain adequate hydration and electrolyte balance.
  14. Provide care to patients on continuous cardiac monitoring.
  15. Use adaptive/assistive devices for mobility, immobility, positioning, and comfort.
  16. Interpret cardiac rhythm strips.
  17. Monitor for complications of musculoskeletal trauma and surgical procedures.
  18. Perform a neurovascular assessment, e.g., extremities, flaps, grafts.
  19. Provide optimum nutrition during hospitalization, allowing for cultural and individual preferences.
  20. Identify and implement transmission-based precautions based on patient's history and symptoms.
  21. Monitor effectiveness of nutritional interventions.
  22. Develop and implement a wound management strategy.
  23. Care for patient receiving IV patient-controlled analgesia
  24. Perform central line dressing change.
  25. Administer heparin drip
  26. Apply and/or monitor devices used to immobilize affected area, e.g., cast, splint, collar, etc.
  27. Care for patient receiving epidural analgesia
  28. Provide care for patients who have chest drainage systems.

5. Effective Management of Rapidly Changing Situations

  1. Recognize signs that a patient’s condition is deteriorating and take appropriate action.
  2. Obtain appropriate orders to address a change in the patient’s condition,
  3. Determine priorities in rapidly changing situations.
  4. Use existing guidelines/protocols/policies to respond to changing patient situations, e.g., hypoglycemia, wound dehiscence.
  5. Use existing guidelines/protocols/policies to respond to urgent and emergent situations, e.g., acute chest pain, stroke.
  6. Initiate basic life support.

6. Monitoring/Ensuring Quality Health Care Practices

  1. Communicate effectively to the healthcare team.
  2. Question/clarify orders as appropriate.
  3. Incorporate evidence-based practice into the patient's plan of care.
  4. Coordinate and/or participate in interdisciplinary activities to ensure consistent patient outcomes, e.g., core measures.
  5. Report system failures, e.g., chain of command, equipment, safety, medication administration, computer systems.
  6. Assist nursing staff in incorporating evidence-based practice and quality improvement into practice.
  7. Participate in quality improvement activities.
  8. Identify clinical problems for further investigation.

7. Organizational and Work-Role Competencies

  1. Practice in accordance with the rules and regulations of the state board of nursing in state(s) of licensure.
  2. Adhere to the Scope and Standards of Medical-Surgical Nursing Practice.
  3. Utilize electronic/computer resources to optimize patient care.
  4. Set priorities based on assignment, unit, and institutional needs.
  5. Act as a professional role model.
  6. Participate as an active member of the interdisciplinary healthcare team.
  7. Delegate patient care assignments based on competency levels and scope of practice of healthcare team members.
  8. Act as a resource for other nurses on the unit.
  9. Provide collaborative, interdisciplinary, coordinated care.
  10. Incorporate strategies that support effective team dynamics in a caring and nurturing environment.
  11. Evaluate own practice based on established standards of care.
  12. Evaluate nursing care based on outcome criteria.
  13. Recognize unsafe work practices (nurse/patient ratio, ergonomics, standard precautions, etc.) and intervene appropriately.
  14. Identify, develop, and implement strategies to reduce readmissions.
  15. Use the chain of command appropriately.
  16. Serve as consultant to nursing staff and other disciplines.
  17. Coordinate and/or participate in interdisciplinary activities to ensure consistent patient outcomes, e.g., core measures.
  18. Identify, develop, and implement strategies to decrease length of stay while improving patient/family/staff satisfaction and patient care.
  19. Provide expert support to unit educators, preceptors, and nurse managers.
  20. Follow institutional policies and procedures in response to an internal or external crisis or event.
  21. Serve as preceptor/mentor for students and staff.
  22. Assist with data collection (e.g., patient outcomes, nurse-sensitive indicators).

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