Standards of Neuroscience Nursing Practice
The standards published herein may be used as evidence of the standard of care, with the understanding that application of the standards is context dependent. The standards are subject to change with the dynamics of the nursing profession, as new patterns of professional practice are developed and accepted by the nursing profession and the public. In addition, specific conditions and clinical circumstances may also affect the application of the standards at a given time (e.g., during a natural disaster). The standards are subject to formal periodic review and revision.
The competencies that accompany each standard may serve as evidence of compliance with the corresponding standard. The list of competencies is not exhaustive. Whether a particular standard or competency applies depends upon the context.
Standards of Practice for Neuroscience Nursing
Standard 1. Assessment
The neuroscience registered nurse collects comprehensive data pertinent to the patient’s health and/or the situation.
COMPETENCIES
The neuroscience registered nurse:
Collects comprehensive data, including but not limited to physical, functional, psychosocial, emotional, cognitive, sexual, cultural, age-related, environmental, spiritual/transpersonal, and economic assessments, in a systematic and ongoing process while honoring the uniqueness of the individual.
Elicits the patient’s values, preferences, expressed needs, and knowledge of the healthcare situation.
Involves the patient, family, and other healthcare providers as appropriate, in holistic data collection.
Identifies barriers (e.g., psychosocial, literacy, financial, cultural) to effective communication and makes appropriate adaptations.
Recognizes the impact of personal attitudes, values, and beliefs.
Assesses family dynamics and impact on patient health and wellness.
Prioritizes data collection based on the patient’s immediate condition, or the anticipated needs of the patient or situation.
Uses appropriate evidence-based assessment techniques, instruments, and tools.
Synthesizes available data, information, and knowledge relevant to the situation to identify patterns and variances.
Applies ethical, legal, and privacy guidelines and policies to the collection, maintenance, use, and dissemination of data and information.
Recognizes the patient as the authority on his or her own health by honoring the patient’s care preferences.
Documents relevant assessment data in a confidential, accessible, and retrievable format.
ADDITIONAL COMPETENCIES FOR THE NEUROSCIENCE ADVANCED PRACTICE REGISTERED NURSE
The neuroscience advanced practice registered nurse:
Utilizes advanced assessment techniques, incorporating technological data and diagnostic information where appropriate.
Initiates and interprets diagnostic tests and procedures relevant to the patient’s current status.
Identifies system and personnel needs in the clinical environment that influence patient outcomes.
Assesses the effect of interactions among individuals, family, community, and social systems on health and illness.
Standard 2. Diagnosis
The neuroscience registered nurse analyzes assessment data in determining diagnoses or issues.
COMPETENCIES
The neuroscience registered nurse:
Derives diagnoses or issues from assessment data.
Validates the diagnoses or issues with the patient, family, and other healthcare providers when possible and appropriate.
Identifies actual or potential risks to the patient’s health and safety or barriers to health, which may include, but are not limited to, interpersonal, systematic, or environmental circumstances.
Uses standardized classification systems and clinical decision support tools, when available, in identifying diagnoses.
Documents diagnoses or issues in a manner that facilitates determination of the expected outcomes and plan.
ADDITIONAL COMPETENCIES FOR THE NEUROSCIENCE ADVANCED PRACTICE REGISTERED NURSE
The neuroscience advanced practice registered nurse:
Systematically compares and contrasts clinical findings with normal and abnormal variations and developmental events in formulating a differential diagnosis.
Utilizes complex data and information obtained during interview, examination, and diagnostic processes in identifying diagnoses.
Assists staff in developing and maintaining competence in the diagnostic process.
Documents diagnoses in a manner that facilitates communication among the interprofessional team.
Standard 3. Outcomes Identification
The neuroscience registered nurse identifies expected outcomes for a plan individualized to the patient.
COMPETENCIES
The neuroscience registered nurse:
Considers associated risks, benefits, costs, expected trajectory of the condition, and clinical expertise when formulating expected outcomes.
Derives culturally appropriate expected outcomes from the diagnoses.
Modifies outcomes in response to changing needs or condition of the patient.
Ensures that outcomes are measurable, provide direction for continuity of care, and include an appropriate time frame for achievement.
Formulates outcomes in collaboration with the patient, family, and interdisciplinary healthcare team, when possible and appropriate.
Ensures that outcomes are realistic and attainable within the patient’s available resources, cultural influences, and present and potential capabilities.
Documents expected outcomes as measurable goals.
ADDITIONAL COMPETENCIES FOR THE NEUROSCIENCE ADVANCED PRACTICE REGISTERED NURSE
The neuroscience advanced practice registered nurse:
Identifies expected outcomes that incorporate scientific evidence and are achievable through implementation of evidence-based practices.
Identifies expected outcomes that incorporate cost and clinical effectiveness, patient satisfaction, and continuity and consistency among providers.
Identifies factors that hinder achievement of outcomes for patients, families, nurses, or systems.
Differentiates outcomes that require care process interventions from those that require system-level interventions.
Standard 4. Planning
The neuroscience registered nurse develops a plan of care that prescribes strategies and alternatives to attain expected outcomes.
COMPETENCIES
The neuroscience registered nurse:
Develops an individualized plan in partnership with the person, family, and others considering the person’s characteristics or situation, including, but not limited to, neurologic status, values, beliefs, spiritual and health practices, preferences, choices, developmental level, coping style, culture and environment, and available technology.
Establishes the plan priorities with the patient, family, and others as appropriate.
Includes strategies in the plan that address each of the identified diagnoses or issues. These strategies may include, but are not limited to, strategies for promotion and restoration of health; prevention of illness, injury, and disease; alleviation of suffering; and supportive care for those who are dying.
Includes strategies for health and wholeness across the lifespan.
Provides for continuity in the plan.
Incorporates an implementation pathway or timeline in the plan.
Considers the economic impact of the plan on the patient, family, caregivers, or other affected parties.
Integrates current scientific evidence, trends, and research in developing the plan of care.
Utilizes the plan to provide direction to other members of the healthcare team.
Defines the plan to reflect current statutes, rules and regulations, and standards.
Modifies the plan according to the ongoing assessment of the patient’s response and other outcome indicators.
Explores suggested, potential, and alternative options to the plan of care with the patient in a safe time and place.
Documents the plan in a manner that uses standardized language or recognized terminology.
ADDITIONAL COMPETENCIES FOR THE NEUROSCIENCE ADVANCED PRACTICE REGISTERED NURSE
The neuroscience advanced practice registered nurse:
Identifies assessment strategies, diagnostic strategies, and therapeutic interventions that reflect current evidence, including data, research, literature, and expert clinical knowledge.
Selects or designs strategies to meet the multifaceted needs of complex patients.
Includes a synthesis of the patient’s values and beliefs regarding nursing and medical therapies in the plan.
Leads the design and development of interprofessional processes to address the identified diagnosis or issue.
Actively participates in the development and continuous improvement of systems that support the planning process.
Standard 5. Implementation
The neuroscience registered nurse implements the identified plan.
COMPETENCIES
The neuroscience registered nurse:
Partners with the person, family, significant others, and caregivers as appropriate to implement the plan in a safe, realistic, and timely manner.
Demonstrates caring behaviors toward patients, significant others, and groups of people receiving care.
Utilizes technology to measure, record, and retrieve patient data; implement the nursing process; and enhance nursing practice.
Utilizes evidence-based interventions and treatments specific to the diagnosis or problem.
Provides holistic care that addresses the needs of diverse populations across the lifespan.
Advocates for healthcare that is sensitive to the needs of patients, with particular emphasis on the needs of diverse populations.
Applies appropriate knowledge of major health problems and cultural diversity in implementing the plan of care.
Applies available healthcare technologies to maximize access and optimize outcomes for patients.
Utilizes community resources and systems to implement the plan.
Collaborates with healthcare providers from diverse backgrounds to implement and integrate the plan.
Accommodates different styles of communication used by patients, families, and healthcare providers.
Integrates traditional and complementary healthcare practices as appropriate.
Implements the plan in a timely manner in accordance with patient safety goals.
Promotes the patient’s capacity for the optimal level of participation and problem-solving.
Documents implementation and any modifications, including changes or omissions, of the identified plan.
ADDITIONAL COMPETENCIES FOR THE NEUROSCIENCE ADVANCED PRACTICE REGISTERED NURSE
The neuroscience advanced practice registered nurse:
Facilitates utilization of systems, organizations, and community resources to implement the plan.
Supports collaboration with nursing and other colleagues to implement the plan.
Incorporates new knowledge and strategies to initiate change in nursing care practices if desired outcomes are not achieved.
Assumes responsibility for safe and efficient implementation of the plan.
Utilizes advanced communication skills to promote relationships between nurses and patients, to provide a context for open discussion of the patient’s experiences, and to improve patient outcomes.
Actively participates in the development and continuous improvement of systems that support implementation of the plan.
Standard 5A. Coordination of Care
The neuroscience registered nurse coordinates care delivery.
COMPETENCIES
The neuroscience registered nurse:
Organizes the components of the plan.
Manages a patient’s care in a way that maximizes independence and quality of life.
Assists the patient to identify options for alternative care.
Communicates with the patient, family, and system during transitions in care.
Advocates for the delivery of dignified and humane care by the interprofessional team.
Documents the coordination of care.
ADDITIONAL COMPETENCIES FOR THE NEUROSCIENCE ADVANCED PRACTICE REGISTERED NURSE
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