Mr. Gold is a patient in your rural ICU and for the past 4 months. He is on a vent and is paralyzed from ALS. The only real movement is that he can blink his eyes. At times when you are caring for him he appears to be crying and it is disturbing to you because he cannot readily communicate.  His wife comes in daily and asks many questions about how he is doing and has a hard time not crying. The physician orders many daily tests. You wonder why since Mr. Gold certainly will not recover from this devastating disease. One day the wife comes in demanding to have Mr. Gold removed from the vent. The Pulmonologist orders a ‘weaning trial’; which Mr. Gold fails. You attempt to log into the computer to  review his data, however the computer system is down.  Without access to the computer system containing Mr. Golds information, you are concerned as you need it to understand what is going on.


Address one of the following questions regarding this case and provide evidence to support it from our course materials or outside readings in your main post.


1. How could you apply one or more aspects of the Scope and Standards of Practice, Code of ethics for Nurses with Interpretive Statements and patient advocacy to Mr. Gold’s case.


Module 12 notes


Nursing practice is guided by professional standards.


Functioning in interprofessional teams we must be aware of the standards developed by organizations, such as the the American Nurses Association (ANA), because these principles are used to help us to conceptualize practice, solve problems, make ethical decisions and positively influence patient-care outcomes.


For example, all registered nurses (RN), regardless of their specialty, are bound to function within the ANA Scope and Standards of Practice (2015). The ANA publishes a number of standards and each may be applied to RN practice regardless of the setting. The ANA has scopes and standards of practice for Informatics as well ( see list below).


When we work in healthcare, we see the connection and importance with informatics inclusive of essentials in ANA (2015) Scope and Standards of Practice including the Code of Ethics for Nurses with Interpretive Statements. In addition, linking policy to practice, the ANA publishes position statements, or their view and ruling on particular issues. 


According to the National Council of State Boards of Nursing (n.d.) nursing practice is governed be individual states nurse practice acts. Each state defines practice requirements that a RN license holder must abide by.


These came about more than 100 years ago by state governments enacting laws which protect the publics health and welfare by overseeing and ensuring the safe practice of nursing. All states and territories have enacted a nurse practice act (NPA). and each state’s Nurses Practice Act is enacted by the state’s legislature” (National Council of State Boards of Nursing, n.d., para. 4).



As a review to refresh the importance of these topics to your professional practice this module explains selected ANA standards and positions statements and how each influences nursing practice. The relationship between the nurse practice act and conditions placing the nurse at risk for professional negligence are explained.


What are standards and how do they impact delivery of nursing care? 


Standards are considered rules, expectations, level of quality required, set by those in authority positions, and can be measured.



The American Nurses Association has standards for nursing practice.


The nursing profession describes the responsibilities for which its practitioners are accountable (ANA, 2015)


Standards reflect values and priorities of the nursing profession.


They may change over time, reflecting the diverse needs of patients and the health care delivery system.


Standards provide direction for professional practice and a framework for the evaluation of professional practice. To do tthis, standards are written in measurable terms that define how the nurse will be accountable to the public.


ANA has several published resources to inform nurses’ thinking and decision-making and guide their practice. The two below are the Scope and Standards of Practice and the Social Policy Statement.  

  • Nursing’s Social Policy Statement: The Essence of the Profession, defines nursing, conceptualizes nursing practice, and describes the social context of nursing.
  • Nursing Scope and Standards of Practice, states the RN’s scope of practice and presents standards and competencies that outline the professional role of the RN.



Additionally, others include the Code of Ethics for Nurses with Interpretive Statements, establishing the ethical framework for RNs across all roles, levels, and settings along with the Scope and Standards of Informatics.



Scope & Standards of Practice apply to all registered nurses. The overarching principles of the ANA Scope & Standards of Practice


  • The patient includes the individual, family, groups, communities, and populations;
  • Cultural, racial, and ethical diversity of the patient must always be considered when providing care and,
  • They apply to all professional registered nurses engaged in practice, regardless of clinical or functional specialty, practice setting, or educational preparation.

The ANA Scope & Standards of Practice are also composed of Standards of Practice and Standards of Professional Performance. They apply directly to the Scope and Standards of Informatics:


Image transcription text

Addresses the Who What When Where Haw Why Standards of
Professional Performance Standards of Practice with
Competencies 1 Assessment- The registered nurse




Take a look at the similarities between the the ANA Scope and Standards of Practice for Informatics and the ANA Scope & Standards of Practice are also composed of Standards of Practice and Standards of Professional Performance .  


2014 Scope Informatics (1).jpg

Image transcription text

I Nursing Informatics: Scope and Standards of Practice, Second
Edition AER Nursing informatics (NI) is the specialty that
integrates nursing science with multiple information

The practice of nursing requires specific knowledge, application of the knowledge, and decisions that are independent.

As nurses are critical in caring for individuals, there is risk of harm to the public if not appropriately prepared, therefore, there are regulations and laws specific to protect the public from harm.

State Legislatures are involved in much of the delegation of laws and regulations.

Each State/Territory has a Nurse Practice Act with a Board of Nursing that administers specific regulations, laws, and rules.

Though there may be some variations all include:

  • Authority, power, and composition of a board of nursing
  • Education program standards
  • Standards and scopes of nursing practice
  • Types of titles and licenses
  • Requirements for licensure
  • Grounds for disciplinary action, other violations, and possible remedies


In Maryland the Board of Nursing has what is called COMAR or code of Maryland Regulations.

There are numerous standards applied to registered nursing practice such as:

  • – multiple definitions
  •–  standards of care
  • – standards of performance

For more information you can visits Maryland Division of State Documents at

There you can search for statutes directly or nursing practice.

And the ANA Scope and Standards of Practice are incorporated for the expectations of nursing practice per state law.

Legally nurses are bound by laws and regulations.  Passing NCLEX (National Council of Licensing Examinations) indicates meeting specific criteria and competencies to practice safely and thus, practice is expected to meet standards of care. 

Problems with standard of care can involve harm. Terms we need to know about include:

  • Negligence– failure to use such care as a reasonably prudent person would use under similar circumstances (Hurley & Berghahn, 2010). Negligence is a Tort Law (, n.d). This is an act of an injury or a wrong caused by one person towards another. Most negligence lawsuits are civil, not criminal cases. A person can be found negligent even though they did not actually intend to harm to an injured party, because negligent conduct is the behavior which results in unintended harm.
  • Malpractice—is negligence committed by a health care professional. Professional negligence is related to malpractice where a “healthcare professional acts negligently when they fail to exercise ordinary care, the level of care that a reasonable healthcare professional would use in a similar situation” (Hurley & Berghahn, 2010, p. 41). Deviating from the standard of care and scope of practice is, most often, the basis for most malpractice claims (Hurley & Berghahn, 2010, p. 41).


For there to be malpractice four elements must be present.

  • the defendant owed the plaintiff a duty of reasonable care;
  • the defendant breached her duty;
  • the plaintiff incurred an injury, loss or harm and,
  • the defendant’s acts or omissions caused the plaintiff’s injury, loss or harm.