Legal and Ethical Application of Differentiated Essential Competencies (DECs)

Introduction

The practice of nursing in Texas requires nurses to be licensed based on their educational levels from vocational nurse to registered nurse. The nurses are expected to have skills and obey the rules of the Differentiated Essential Competencies (DECs). DECs is the third generation of the TBON education competencies which have a variation based on the results of the levels of the nursing education curricula. DECs offer guidance to nursing education programs for preparing graduates to offer safe and competent care

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The analysis aims to describe the ethical and legal applications of DECs in a case study involving an elderly patient who fractured the left femur when been transferred from a wheelchair to a hospital bed. The structure of the paper entails a background of DECs and its role, followed by its application in a case scenario, and finally identifying the legal and ethical applications of the DECs.

Background of Differentiated Essential Competencies (DECs)

On January 20th, 2000, the Advisory Committee on Education (ACE) was trusted to assess and revise the original competency document, the Essential Competencies of Texas Graduates of Education Programs in Nursing, by the Board of Nurse Examiners (BNE). The BNE and ACE conducted a survey on the vocational programs to evaluate and revise the vocational nurse competencies. A subcommittee of nurses from Diploma, ADN, and BSN curriculum together with members of Texas Organization of Nurse Executives (TONE), and Texas League for Nursing (TLN) was selected. The committee analyzed the Educational Competencies for Graduates of Associate Degree Nursing Programs and the Essentials of Baccalaureate Education. They found that the fourteen competencies in the Texas documents were consistent with their requirements. They revised the competencies including the statements of course objectives and outcomes. The revised version was later permitted in 2002.

Later, on July 2008, the Texas Board of Nursing (TBON) selected the ACE to review the 2002 Differentiated Entry Level Competencies (DELC). The ACE selected VN, Diploma, ADN, and BSN members within the DELC group. The amendment process took over 20 months, and the group changed the DELC name to Differentiated Essential Competencies (DECs). The suggested DECs nursing roles included being an advocate for patient safety, member of the profession, an affiliate of the health care team, and the provider of patient-centered care.

The Texas Board of Nursing (TBON) has proficiencies values for a vocational nurse (VN), diploma/associate degree nurse (DIP/ADN), and baccalaureate degree nurse (BSN) graduates to ensure their competences is consistent with the evolving healthcare environment. Each nursing curricula program varies, and the results of the learning levels will dictate the DECs of the graduates. The expected behaviors progress across the learning programs from VN to BSN whereby the proficiencies of each level is built from the preceding one. The DECs not only explains and improves uniformity to educational outcomes, but they also provide nurse employers, educators, and community a comprehensive understanding of the role of the TBON in safeguarding the well-being of the society (Texas Board of Nursing, 2012).

Application of the DECs

Steps to be Taken by ADN and BSN Nurse from the Case Scenario

When the patient falls, the nurses should first assess the fracture for associated symptoms. A comprehensive assessment including checking for vital signs such as radial and apical pulses is necessary. The assessment should include checking the airway, breathing, circulation, disability, and exposure. Additionally, the nurses should check the skin for abrasion, bruises, and pallor, check cranial nerve, a central nervous system for movement and sensation, assess the level of consciousness, and look for cognitive changes. The body should be immobilized since adequate splinting prevents the fractured femur from moving. In case the patient experienced an open fracture, it should be assessed to reduce the risks of tetanus, and osteomyelitis (Belleza, 2016). A closed fracture is analyzed to ensure that there is no opening at the femur. The assessments will help the nurses to diagnose the patient with acute pain, the risk of infection, and impaired physical mobility associated with the femur fracture.

Competencies of an ADN Nurse

As a provider of patient care, the nurse was expected to determine the physical and fitness of the patient from the findings on the medical history of the patient. This would have helped the nurse to be mindful of the elderly patient and take the right precautions. The nurse should use clinical reasoning and knowledge from the study and use evidence-based practice outcomes to decide on the steps to take to evaluate the patient. Additionally, the nurse needed to provide safe, comprehensive, and compassionate nursing care to the elderly patient who would have prevented the fall leading to fracturing of the left femur.

As a member of the healthcare team, the ADN nurse should communicate with the patient to plan the patient-centered care to offer. In this case, the nurse would have been mindful of the patient ability to move to the hospital bed safely. Additionally, the nurse should assign nurse care to another member of the team after first analyzing the patient. This would help with transportation as they would know how to handle the elderly patient. The nurse serves as an advocate for the team by promoting and monitoring quality and access to care for patients.

Competencies of a BSN Nurse

As a provider of patient care, a BSN nurse should synthesize comprehensive assessment of data to identify problems. The BSN will direct on the patient care to be given to the elderly patient without the directives of a doctor. As the two nurses test the patient femur fracture through checking for signs such as swelling, the BSN nurse can go an extra mile to do additional tests such as checking the patient's chart for any predispositions to prepare a thorough report for the doctor. As a member of the healthcare team, a BSN nurse in managerial position can delegate nursing care to the ADN nurse. This can include conducting some tests on the patient before the doctor arrives.

Legal and Ethical Application of DECs

Mortality rates from falls increase with age. Most cases of falls in hospitals occur when nurses fail to follow the policy and failure to raise bedrails. The DECs require nurses to obey the legal roles such as being the provider of service. The nurse must ensure that a patient receives safe, competent, and holistic care. Additionally, the nurses must act as a patient safety advocate. The DECs emphasizes on nurses to execute practices that enhance safe environment for patients. The nurses should have ensured that the wheelchair was placed in such a place that there was no room between it and the bed for the patient to fall and fracture the hip.

Additionally, all nurses must obtain supervision and training that are necessary for implementing the nursing practices. The ADN nurse failed to obtain proper instruction which led to injuring the patient. Their focus was on their issues other than concentrating on the patient to ensure that the transfer to the hospital bed was successful. DECs also requires the nurses to accept and make assignments that are considerate of the patient safety. The ADN nurse also failed to demonstrate the Texas Nursing Practise Act (NPA) and the Texas Board of Nursing Rules that emphasized the need to ensure patient safety (Yoost & Crawford, 2015). The nurse failed to take an appropriate precaution which is legal negligence in nursing. Altruism is a concern for the welfare of other people.

Conclusion

The nursing code of ethics is the minimal appropriate standards within the legal parameters that a nurse owes to the patient and colleagues. Thus, it is a requirement for all nurses to comply with the requirements of the Texas NPA. Nurses are expected to be committed to altruism through compassion, caring, and commitment. Additionally, nurse as providers of patient-centered care should implement aspects of care that are within the ethical and legal parameters and considers the patient factors.

References

Belleza, M. (2016, November 25). Fracture-Nursing Care Management: Study Guide. Retrieved from https://nurseslabs.com/fracture/

Texas Board of Nursing (2012). Differentiated Essential Competencies of Graduates of Texas Nursing Programs. Retrieved from https://www.bon.texas.gov/pdfs/differentiated_essential_competencies-2010.pdf

Yoost, B. L., & Crawford, L. R. (2015). Fundamentals of Nursing-E-Book: Active Learning for Collaborative Practice. Elsevier Health Sciences.