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Nursing Manual Nursing Services Direct Nursing Services For the purpose of this manual, "direct nursing services" will be the term used to describe the provision of nursing care, or "duty of care". A nurse may provide direct nursing services to one or more individuals living in a community setting.In the nursing care of the person with developmental disabilities, long-term, complex health problems are prevalent. To complicate matters, the person may be unable to provide a health history, and may not have a complete written history available. In addition, the person may not be able to help coordinate their own health care, and may be cared for by many different (and frequently changing) staff. It is extremely important, therefore, for the nurse involved, to provide an all-inclusive, holistic approach. For the RN providing direct, holistic nursing services, there are certain expectations (see OSBN "Standards of Practice for the Licensed Practical Nurse and Registered Nurse"). The RN is expected to complete a nursing assessment, including direct assessment and health history, prior to providing care, or staff training. From the annual nursing assessment, the nurse will construct a complete health care plan/nursing care plan, (and/or review the health support plan), and write the necessary protocols, procedures, and other instructions as needed, in a format that staff can easily understand and follow. The duties of a nurse who provides direct, holistic nursing services include the following:
Sometimes an RN may be involved in an aspect of care, for example, a home health RN providing limited ostomy care and staff training for a person with a new colostomy. These RNs provide direct nursing services and would be expected to follow the same standard of nursing practice as an RN providing holistic care. An assessment would be necessary, prior to providing care or staff training. It might be somewhat limited in focus, depending on what nursing services were needed. The nurse also develops a care plan specific to the health concern followed. It is extremely important that when a program arranges for direct nursing services that it is clear to both the agency and the RN whether the services are holistic or limited. The residential program will need to provide a health care plan that addresses the health issues not covered by the RN providing limited services. The person (house manager, program manager) writing the health care plan will need to confer with the RN providing the limited care to make sure that all aspects of the care coordinate. Occasionally an RN may be employed by an agency to help the agency with issues that are neither person specific nor prescribed by a physician. Some duties that an RN may do under this role are:
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