Standards of Cardiovascular Nursing Practice
Significance of Standards
The Standards of Professional Nursing Practice are authoritative statements of the duties that all registered nurses, regardless of role, population, or specialty, are expected to perform competently. The standards published herein may be utilized 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 be evidence of compliance with the corresponding standard. The list of competencies is not exhaustive. Whether a particular standard or competency applies depends upon the circumstances.
Standards of Practice for Cardiovascular Nursing
Standard 1. Assessment
The cardiovascular registered nurse collects comprehensive data pertinent to the patient’s health and/or the situation.
COMPETENCIES
The cardiovascular 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 person regardless of age and across all settings.
Applies appropriate cardiovascular expertise and knowledge to data collection in caring for patients with cardiovascular disease.
Elicits the patient’s values, preferences, expressed needs, and knowledge of the healthcare situation.
Involves the patients, family, and other healthcare providers, as appropriate, in holistic data collection.
Identifies barriers (e.g., psychosocial, literacy, financial, cultural) to effective communication and education and makes appropriate adaptations.
Recognizes the impact of personal attitudes, values, and beliefs on the performance of nursing care.
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 data in a retrievable format.
ADDITIONAL COMPETENCIES FOR THE APRN
The advanced practice registered nurse:
Initiates and interprets diagnostic tests and procedures relevant to the patient’s current status.
Assesses the effect of interactions among individuals, family, community, and social systems on health and illness.
Standard 2. Diagnosis
The cardiovascular registered nurse analyzes the assessment data to determine the diagnoses or the issues.
COMPETENCIES
The cardiovascular registered nurse:
Derives the 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 education or 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 the determination of the expected outcomes and plan.
ADDITIONAL COMPETENCIES FOR THE APRN
The advanced practice registered nurse:
Systematically compares and contrasts clinical findings with normal and abnormal variations and developmental events in formulating a differential diagnosis.
Applies appropriate advanced cardiovascular knowledge and expertise to the diagnostic process when caring for patients with cardiovascular disease.
Utilizes complex data and information obtained during interview, examination, and diagnostic processes in identifying diagnoses.
Facilitates staff development and maintenance of competence in the diagnostic process for cardiovascular disease.
Standard 3. Outcomes Identification
The cardiovascular registered nurse identifies expected outcomes for a plan individualized to the patient and the situation.
COMPETENCIES
The cardiovascular registered nurse:
Involves the patients, family, healthcare providers, and others in formulating expected outcomes when possible and appropriate.
Derives culturally appropriate expected outcomes from the diagnoses.
Considers associated current scientific evidence, risks, benefits, costs, expected trajectory of the condition, and clinical expertise when formulating expected outcomes.
Derives outcomes that enhance self-care as appropriate for the patient and/or family.
Defines expected outcomes in terms of the patient’s preferences, culture, values, and ethical values.
Includes a time estimate for the attainment of expected outcomes.
Develops expected outcomes that facilitate continuity of care.
Modifies expected outcomes according to changes in the status of the patient or evaluation of the situation.
Documents expected outcomes as measurable goals.
ADDITIONAL COMPETENCIES FOR THE APRN
The 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 across providers and care settings.
Differentiates outcomes that require care process interventions from those that require system-level interventions.
Standard 4. Planning
The cardiovascular registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes.
COMPETENCIES
The cardiovascular registered nurse:
Develops an individualized plan, in partnership with the patient, family, and others, that considers the patient’s characteristics or situation, including, but not limited to, values, beliefs, spiritual and health practices, preferences, choices, developmental level, coping style, culture and environment, and available technology.
Establishes plan priorities with the patient, family, and others as appropriate.
Applies cardiovascular expertise and knowledge in the planning of care for patients with cardiovascular disease.
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,
The alleviation of suffering, and
Supportive care for those who are dying.
Includes strategies for health and wholeness across the life span.
Provides for continuity in the plan so that transitions in the care continuum are safe and effective.
Incorporates an implementation pathway or timeline in the plan.
Considers the economic impact of the plan on the patient, family, caregivers, or others.
Integrates current scientific evidence, trends, and research.
Utilizes the plan to provide direction to other members of the healthcare team.
Explores practice settings and safe space and time for the nurse and the patient to explore suggested, potential, and alternative options.
Defines the plan to reflect current statutes, rules and regulations, and standards.
Modifies the plan according to ongoing assessment of the patient’s response and other outcome indicators.
Documents the plan in a manner that uses standardized language or recognized terminology.
ADDITIONAL COMPETENCIES FOR THE APRN
The 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 the synthesis of patients’ 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 cardiovascular registered nurse implements the identified plan.
COMPETENCIES
The cardiovascular registered nurse:
Partners with the healthcare consumer, 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 life span.
Advocates for health care that is sensitive to the needs of culturally diverse populations.
Applies appropriate cardiovascular expertise and knowledge in caring for healthcare consumers with major health problems 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 nursing colleagues and other healthcare providers from diverse professional backgrounds to implement and integrate the plan.
Accommodates different styles of learning and 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 in self-care and problem solving.
Documents implementation and any modifications, including changes or omissions, of the identified plan.
ADDITIONAL COMPETENCIES FOR THE APRN
The 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 changes in nursing care practices if desired outcomes are not achieved.
Assumes responsibility for safe and efficient implementation of the plan.
Use 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 cardiovascular registered nurse coordinates care delivery.
COMPETENCIES
The cardiovascular registered nurse:
Organizes the components of the plan.
Manages a patient’s cardiovascular care so as to maximize independence and quality of life.
Assists the patient to identify options for alternative care.
Communicates with the patient, family, and healthcare system, including referring clinicians and community resources, 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 APRN
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