NURS 4006: Topics in Clinical Nursing

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NURS 4006: Topics in Clinical Nursing

Discussion – Week 1
  • This week discussion I am focusing on the emerging of Nipah Virus infection.
  •    This virus is caused by Nipah virus that originates in fruit bats, it spreads between infected animals to human by way of direct contact. This is a new virus that was discovered in Malaysia in 2018, most physicians and health care workers did not know what this virus was and how it can into existence. The citizen of Malaysia to be treated for the virus with symptoms ranging from mild to severe. Most people who contracted the virus was unaware they had the virus before spreading it to others. About 50-75% of the population that did show symptoms presented with fever, cough, headache, shortness of breathe with confusion. 40% of the those patients went into a coma 1-2 days after complication of brain and seizure activity. CDC and WHO spent months on trying to figure out what and where the source of this virus dived from and where was the first point of contact. Scientist final discovered that the RNA of the virus was in the genus Henipa virus in fruit bats. This was confirmed by lab blood draw from the infected patients that the hospital samples and test results that where summited. NURS 4006: Topics in Clinical Nursing

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  • Treatment: of this virus is supportive care, with no known vaccination or cure. We as Health care professional have to educated the public and patients on avoiding exposure with those that have came into direct contact with bats, sick pigs anther animals and drinking raw palm sap. Because, scientist have not figure out how to prevent and treat this new emerging virus, in 2018, more than 700 human cases have been reported and of those reported cases 75% died. This outbreak resulted in 17 death in the Indian State of Kerala as of this day.
  • What implications does the disease have for nursing practice? It has to be treated as a highly contagious infection that is contact through direct contact with droplet precaution. Patient has to be place in the same room as a TB patient and remain on quarantine ( defined as being restricted to their room without implementation of any isolation precaution) in a single room or cohorts with another patient diagnosed with Nipah and hand washing is a must and head to toe PPE when coming in contact with patient or given patient care. NURS 4005 NURS 4006: Topics in Clinical Nursing
  • How does the emergence of this disease affect your personal practice? This virus is deadly without a vaccine or direction on how to treat or prevention of a cure. This could impact every health care professional and the community of which the patient has come in contact within, If my staff would come in direct contact with this virus and was unaware of they had this virus, can affect my practice of having to close the facility completely down, requiring everyone to be tested for Nippah virus, require staff to staff to seek immediate emergency care if experiencing any symptoms and notification of CDC and IDPH for guidance and visits to the faculty. The time and cost its going to take to educate the staff as well as the community about the virus and if there is an outbreak, reducing the panic amongst other patients and health care professionals in the facility. Having the answers for families, staff and patients when there is no cure no treatment guidance. This will have a huge impact on my personal practice. NURS 4006: Topics in Clinical Nursing
  • Why do you think that this disease is emerging/re-emerging? Because, a group of the population has chosen to eat animals that are not meant for human consummation. Some scientist are collecting sample of this animal to try to determine their history and what disease or virus they house and these virus are given to other animals as experimental and then spread to other population of non-human and/or human.
  • What is the nurse’s role in preventing and managing the impact of infectious diseases both from the patient and nurse perspective? The role of a nurse is to minimize the impact of any infectious disease, through use of hand washing, PPE, reviewing and interpreting lab results, assessments of patient on admission and throughout stay alerting the primary of any changes of that patient and making sure there are no delay in care. Maintaining the safety of the staff and patient by using safe practices throughout the work day.

Reference:

WHO: Emergency and Responce to Nipha (2018). Retrieved from: https://www.who.int/csr/disease/nipah/en/

Tan, C., & Wong, K. (2020). Infections among Contacts of Patients with Nipah Virus, India. Emerging Infectious Diseases, 26(8), 1963. https://dx.doi.org/10.3201/eid2608.190722.

 

 

Discussion – Week 2
COLLAPSE

Initial Post: Genomics

Genomics plays a part in chronic illnesses and other diseases.  Certain genes increase one’s risk of getting illnesses like breast and colon cancers and diabetes (CDC, 2020).  According to the CDC genomics explores how diet, health, and behavior is impacted by genes (2020).  I have firsthand experience on how my genes have impacted my health and my life.  Therefore, this topic has always been fascinating and something that I am always interested in learning more about.

The article “Genomic Competencies for Nursing Practice” discusses the importance of educating nurses in the Veterans Healthcare Administration (VHA) about the benefits of genetic service for veterans (Boyd et al., 2017). The field of genomics is constantly changing, and nurses need to be competent and aware of such changes to provide the resources appropriate for their patients.  Veterans makeup almost 21 million of the healthcare population and only 57% use the benefits available to them at the VHA (Boyd et al., 2017).  In 2011 VHA created an initiative called the Million Veteran Program or “MVP”.  It worked with the veterans to study how genes, behavior, and environment affect health (Boyd et al., 2017).  The Office of Nursing Services (ONS) developed a strategy to establish competencies in genetics and genomics in 2010. This was a four-year plan to establish competencies, evaluate the competencies and make any further recommendations so it can be incorporated into continued education (Boyd et al., 2017).  As a result of this the course “Genomics in Your Nursing Practice” became available to nurses at the VHA via an online platform in 2014 (Boyd et al., 2017).

As nurses we are taught to advocate for our patient and provided the best care.  This includes continuing to educate ourselves on advances that impact our patients.  Genomics is a topic that is continuing to evolve and help create patient specific care that is tailored to the individual.  We must also have the resources to provide to our patients so they can make informed decisions and offer them all possible option so they can make the right choice for them.  Nurses must explore the patients’ family history in greater detail, screening, and understand the role genetics plays in chronic illnesses or the risk it may pose to the patient.  Understand available resources and care coordination is essential to providing patient centered care.

There are considerations when exploring genomics that must be addressed.  Protecting racial/personal discrimination from health insurance or employer is important to providing cost effective care for all.  A person must not be punished for their genetic makeup.  There must be laws and policies that reflect the advancement in medical care specifically related to genomics/genetics.  As nurses we must not make assumptions about our patients health related to their race/ethnic background but must also consider genetics. NURS 4006: Topics in Clinical Nursing

References

Boyd, A., Alt-White, A., Anderson, G., Schaa, K., & Kasper, C. (2017). Genomic Competencies for Nursing Practice: Implications for Nursing Leadership. JONA: The Journal of Nursing Administration, 47(1), 62–67. https://doi-org.ezp.waldenulibrary.org/10.1097/NNA.0000000000000438

Public Health Genomics. (2020, October 01). Retrieved October 21, 2020, from https://www.cdc.gov/genomics/default.htm

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Discussion – Week 3
While working in the long term care unit, there was an incident in which a resident with dementia had been complaining of pain and had become less ambulatory. In a review of the medication administration record, the resident was receiving more pain medication than before. As a nurse manager, the staff was asked questions about the ambulation change, and no reasons for the change were documented. A couple of weeks later, there was a call-out on the 11-7 shift I had to cover as the charge nurse. When speaking with the unit secretary familiar with the resident, we began discussing the decreased mobility and pain concerns. During this conversation, the unit secretary told me,” you did not know?” and I replied, “know what?” A couple of weeks ago, the unit secretary replied that the resident was trying to stand from a sitting position and fell backward. Didn’t the nurse tell you? My response was,” I did not receive any incident report from a witnessed fall.”

At this time, I began to review documentation from the date the resident fell. There were no neurological checks, no vital signs taken, and no mention of any falls in the documentation that a fall occurred. From here, I was responsible for filling out an incident report, notified the physician, family member, and administration.  The physician was made aware of the X-ray recommendation, with findings, noted a lumbar fracture. This finding was reported to the Department of Health as it is a reportable incident. My initial thoughts were, I cannot believe the nurse would not share this information. The nurse working on duty the day of the incident was placed on administrative leave for three days while the case was being investigated. After interviewing multiple staff on all three shifts, the activities director, the maintenance staff, and the Certified nursing assistants, the investigation’s conclusion led to the termination of the Licensed Practical Nurse. As a nursing obligation, I was responsible for reporting neglect/abuse to the local Ombudsmen, Adult Protective Services, and the Department of Health Professionals. This was an unfortunate situation that affected this patient’s overall health, in which he later was admitted to hospice and expired.

The first challenge in this situation is that the patient had dementia and could not verbally express what had happened. Another challenge was that the unit secretary assumed management was aware of the fall. Strategies included interviewing the staff who provided care to the resident and interviewing those who may have had some interaction with the resident during the past couple of weeks.  A second strategy, when the patient initially was given pain medications, an X-ray should have been obtained after a few days of given pain medications.

All employees were required to complete an abuse inservice on the initial hire and yearly. After this incident, we hired a consultant to come into the facility to review abuse training, which was mandatory for all licensed staff members.” Since the knowledge influences awareness of abuse, expertise, and preparedness of caregivers, the care team, and nurses as the first line of treatment is responsible for identifying and reporting mistreatments and supporting vulnerable populations such as the elderly (Saghafi, et al., 2019, para, 7).”

Abuse is something not to take lightly and is a reportable offense in which you can lose your nursing license. I had two takeaways from this situation. The first is being more intuned to the care given to dementia residents. Secondly, some nurses will surprisingly make a poor unethical decision, affecting others’ health outcomes.

Reference:

Saghafi, A., Bahramnezhad, F., Poormollamirza, A., Dadgari, A., & Navab, E. (2019). Examining the ethical challenges in managing elder abuse: a systematic review. Journal of medical ethics and the history of medicine, 12, 7.

 

Week 1: Emerging and Re-emerging Infections Across the Lifespan

Introduction

Infections, if not treated properly, can lead to potentially fatal complications that otherwise could have been prevented. Unfortunately, patients who are sick or recovering from surgery are at greater risk of developing infections. While hospitals and other medical facilities have strict policies about cleanliness and have measures in place to help prevent the spread of infectious organisms, it is not always possible to be 100% effective. There is no firewall protection against viruses and potential infections from occurring in these health care settings. For this reason, it is critical that nurses and other medical workers be aware of potential hazards in order to recognize symptoms of infection.

This week, you will consider the many emerging and re-emerging infections that a patient may contract and examine how the quality of care provided by a nurse might help ameliorate the situation. Nurses have an obligation to learn about potential diseases or infections, their symptoms, and the best course for treatment. You will also review different types of infections and explore how nurses can improve the care provided.

Learning Objectives

Students will:
  • Analyze emerging and re-emerging infectious diseases for nursing practice
  • Analyze emerging and re-emerging infectious diseases in local communities
  • Analyze the role of the nurse in preventing and managing the impact of infectious diseases
  • Develop Fact Sheets on an infectious disease to use as a guide to improve public health

Learning Resources

Required Readings

Gonsalves, G., Staley, P. (2014). Panic, paranoia, and public health—The AIDS epidemic’s lessons for Ebola. New England Journal of Medicine, 371(25), 2348– 2349.

Halm, M. A., & O’Connor, N. (2014). Do system-based interventions affect catheterassociated urinary tract infection? American Journal of Critical Care, 23(6), 505-509. doi:10.4037/ajcc2014689

National Institutes of Health. (2007). Understanding emerging and re-emerging infectious diseases. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK20370/

Petlin, A., Schallom, M., Prentice, D., Sona, C., Mantia, P., McMullen, K., & Landholt, C. (2014). Chlorhexidine gluconate bathing to reduce methicillin-resistant Staphylococcus aureus acquisition. Critical Care Nurse, 34(5), 17–26. doi:10.40377/ccn2014943

Pokrywka, M., Feigel, J., Douglas, B., Grossberger, S., Hensler, A. & Weber, D. (2014). A  bundle strategy including patient hand hygiene to decrease clostridium difficile infections. MedSurg Nursing, 23(3), 145-164.

Smeulers, M., Lucas, C., & Vermeulen, H. (2014). Effectiveness of different nursing handover styles for ensuring continuity of information in hospitalised patients. The Cochrane Database Of Systematic Reviews, (6), CD009979

Centers for Disease Control and Prevention. (2015). Ebola (Ebola virus disease). Retrieved from http://www.cdc.gov/vhf/ebola/hcp/index.html?s_cid=cs_4318

Centers for Disease Control and Prevention. (n.d.). Zika virus. Retrieved August 11, 2016, from http://www.cdc.gov/

Required Media

Laureate Education. (Producer). (2009c). Topics in clinical nursing: Emerging and re-emerging infections across the lifespan [Video file]. Baltimore, MD: Author.

 

Note: The approximate length of this media piece is 9 minutes.

 

 

Discussion: Emerging and Re-emerging Infectious Diseases

As presented in this week’s readings, many individuals acquire infections in the community as well as during treatment in the hospital. As a nurse, it is important to know what is going on in the world. In addition to reading scholarly literature, reading the paper and watching the news helps to keep a nurse aware of what is going on currently. In addition, many organizations like the Centers for Disease Control and Prevention (CDC) track current health trends and post updates on their websites, along with Fact Sheets to help educate, prevent, and treat new and re-emerging diseases. These Fact Sheets are made to be short and easy to read so that health care professionals and patients are more likely to read and understand the information.

For this Discussion, you will examine an emerging or re-emerging disease and the nurse’s role in prevention and management of the disease. Locate an article in a newspaper, in a lay magazine, or on an organizational website that discusses an emerging or re-emerging infectious disease that is currently affecting your community. Reflect on the article you selected and think about how the emerging or re-emerging disease might affect nursing practice.

By Day 3

Respond to the following:

Briefly summarize the article you selected and provide the reference. Then, address the following:

  • What implications does the disease have for nursing practice?
  • How does the emergence of this disease affect your personal practice?
  • Why do you think that this disease is emerging/re-emerging?
  • What is the nurse’s role in preventing and managing the impact of infectious diseases both from the patient and nurse perspective?

Support your response with references from the professional nursing literature.

Note Initial Post: A 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old).

By Day 7

Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).

Respond with a comment that asks for clarification, provides support for, or contributes additional information to two or more of your colleagues’ postings.

Post a Discussion entry on three different days of the week. Refer to the Discussion Rubric found in the Course Information and Grading Criteria area.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 and Respond by Day 7

To participate in this Discussion:

Week 1 Discussion

Assignment: Emerging and Re-emerging Diseases Fact Sheet

Sir Francis Bacon said, “Knowledge is power.” This is most definitely true when it comes to diseases and how to prevent and treat them. As a nurse, you are charged with teaching patients how to prevent infectious diseases and what to do if they become infected. A powerful tool in your arsenal is the Fact Sheet. Usually comprised of one page of easy-to-read content, these leaflets can be distributed easily and can effectively inform your practice.

To prepare for this Assignment:

  • Select one disease that is either emerging or re-emerging in the world today.
  • Research the disease using both scholarly and non-scholarly resources.
  • Determine your audience (patients, other nurses, schools, etc.) that you would want to share the Fact Sheet with.
  • Select pieces of information that are appropriate for your audience.

By Day 7

Submit: A 1- to 2-page Fact Sheet.

  • Indicate the audience on the Fact Sheet.
  • Give a brief history of the disease.
  • What are the implications of the spread of the disease?
  • How does one detect and prevent the spread of this disease?
  • How is this disease treated?

Your Fact Sheet should be visually stimulating, appropriate for your audience, and formatted with bullet points for easy reading.

Support your “facts” with references.

Note: Your Fact Sheet must be supported with at least three scholarly sources of evidence in the literature.

Writing Resources and Program Success Tools

For this Assignment, review the following:

  • AWE Checklist (Level 4000)
  • Assignment Rubric

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

  • Please save your Assignment using the naming convention “WK1Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 1 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 1 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK1Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submit button to complete your submission.
Grading Criteria

To access your rubric:

Week 1 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 1 Assignment draft and review the originality report.

Submit Your Assignment by Day 7

To submit your Assignment:

Week 1 Assignment

Week in Review

This week, you analyzed emerging and re-emerging infectious diseases in local communities and for nursing practice and ways to prevent and manage the impact of them. You also developed a Fact Sheet on an infectious disease as a guide to improving public health.

Next week, you will explore strategies that provide better patient care for those with chronic health problems and how genetics and genomics influence nursing practice.

To go to the next week:

Week 2

Week 2: Chronic Health Problems and the Link to Genetic Nursing Care

Introduction

Disease prevention can easily be considered the best path toward a cure, but there are some diseases to which many people are hereditarily more susceptible. Chronic health problems, many of which have yet to be cured, show up in hospitals and clinics frequently.

As medical research continues to actively search for cures and better treatment options, how can you as a nurse provide the best care possible for your patients? Do you know the risks related to misdiagnosis for a patient who suffers from a chronic disease? What can a nurse do to help the patient live comfortably with chronic diseases?

Health care continues to develop through research efforts that find new treatment options. In addition, advances in genetic and genomic connections to health and illness are influencing nursing practice and becoming a routine part of taking a patient’s family history. When a nurse notices a genetic predisposition to an illness, he or she can take the opportunity to begin educating the patient as well as being more aware of possible signs and symptoms of onset.

This week, you will explore strategies for providing better patient care to patients with chronic health problems and explore how genetics and genomics influence nursing practice.

Learning Objectives

Students will:
  • Analyze genetics and genomics for nursing practice
  • Analyze the role of the nurse in addressing genetics and genomics for nursing practice
  • Analyze the ethical considerations relating to genetics and genomics for nursing practice

Learning Resources

Required Readings

Coleman, B., Calzone, K.A., Jenkins, J., Paniagua, C., Rivera, R., Hong, O.S….Bonham, V. (2014). Multi-ethnic minority nurses’ knowledge and practice of genetics and genomics. Journal of Nursing Scholarship, 46(4), 235-244. doi:10.1111/jnu.12083

Gaskin, D. J., Thorpe, R. J., McGinty, E. E., Bower, K., Rohde, C., Young, J. H., … Dubay, L. (2014). Disparities in diabetes: The nexus of race, poverty, and place. American Journal of Public Health, 104(1), 2147–2155. doi: 10.2105/AJPH.2013.301420

Mehrian-Shai, R., & Reichardt, J. V. (2015). Genomics is changing personal healthcare and medicine: The dawn of IPH (individualized preventive healthcare). Human Genomics, 9, 29. doi:10.1186/s40246-015-0052-0

Plavskin, A. (2016). CNE SERIES. Genetics and Genomics of Pathogens: Fighting infections with genome-sequencing. MEDSURG Nursing, 25(2), 91-96.

Shaw, R. J., McDuffie, J. R., Hendrix, C. C., Edie, A., Lindsey-Davis, L., Nagi, A., … Williams, J. W. (2014). Effects of nurse-managed protocols in the outpatient management of adults with chronic conditions. Annals of Internal Medicine, 161(2), 113–121. doi:10.7326/M13-2567

International Society of Nurses in Genetics. (2015). Retrieved from http://www.isong.org/

American Nurses Association. (2016). Personalized medicine. Retrieved from http://www.nursingworld.org/genetics

Required Media

Altman, R. (2013). Let’s test genetics before prescribing drugs. Retrieved from https://www.youtube.com/watch?v=X1iKibDqtck

Doudna, J. (2015). How CRISPR lets us edit our DNA. Retrieved from https://www.ted.com/talks/jennifer_doudna_we_can_now_edit_our_dna_but_let_s_do_it_wisely?language=en#t-190359

Wax, R. (2012). What’s so funny about mental illness? Retrieved from https://www.ted.com/talks/ruby_wax_what_s_so_funny_about_mental_illness

Discussion: Providing Genetic Nursing Care to Patients With Chronic Illnesses

There are several chronic health problems with genetic/genomic components that plague the population. These health problems are very difficult and challenging diseases to manage. Evidenced-based nursing practice must include genetic and genomic information when planning patient care. Nurses, through their knowledge and support, play an important role in positive patient outcomes when managing the challenges of these genetically linked diseases.

For this Discussion, you will consider applications of various topics to genetics and genomics. Review the Resources focusing on the application of genetics and genomics to nursing

Choose one of the following subtopics:

  • Pharmacogenomics and chronic illnesses
  • Genomics in patient assessment
  • Genetically competent care for those with chronic illnesses

Note: A different subtopic relating to genetics and genomics may be chosen with Instructor approval.

Locate at least one scholarly journal article that discusses your subtopic.

By Day 3

Respond to the following:

  • Identify your subtopic and provide a brief summary of your journal article on how this topic relates to nursing practice.
  • What is the nurse’s role in providing care in relation to your subtopic and the overarching theme of advocacy?
  • What ethical implications should be considered with regard to genetics and genomics for nursing practice? Why?

Support your response with references from the professional nursing literature.

Note Initial Post: A 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old). NURS 4006: Topics in Clinical Nursing

By Day 7

Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).

Respond with a comment that asks for clarification, provides support for, or contributes additional information to two or more of your colleagues’ postings.

Post a Discussion entry on three different days of the week. Refer to the Discussion Rubric found in the Course Information and Grading Criteria area.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 2 Discussion Rubric

Post by Day 3 and Respond by Day 7

To participate in this Discussion:

Week 2 Discussion

Week in Review

This week, you analyzed the role of the nurse, as well as ethical considerations related to genetics and genomics for nursing practice.

Next week, you will explore the leading causes of the psychological implications resulting from illnesses and injuries across the lifespan.

To go to the next week:

Week 3

Week 3: Psychological Implications Resulting From Illnesses and Injuries Across the Lifespan

Introduction

Illnesses and injuries can arise from a variety of different situations and can result in psychological disorders. One psychological disorder that is a common complication of chronic illnesses is depression. Depression has many symptoms that can increase the risk of chronic and acute illnesses. Nurses can play a critical role in the prevention and treatment of depression by using strategies that are more holistic in nature.

Psychological implications can also arise when caring for patients with suspicious injuries or illnesses. Oftentimes, nurses notice signs and symptoms that may indicate physical abuse while conducting a health assessment interview or physical exam. Nurses have a responsibility in situations such as these to be an advocate for patients, ensuring that proper attention is paid not only to the injury or illness, but also to the psychological well-being of the patient.

This week, you will explore the leading causes of psychological implications resulting from injuries and illnesses across the lifespan. You will also examine how depression is manifested in different chronic illnesses. In addition, you will explore strategies nurses might use when advocating for patients with suspicious injuries.

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Learning Objectives

Students will:
  • Analyze patient care challenges in relation to illness or injury resulting from depression
  • Analyze patient care challenges in relation to suspicious illness or injury
  • Analyze strategies that nurses might use to address patient care challenges
  • Analyze nurses’ advocacy for patients in situational contexts
  • Analyze legal and ethical implications related to patient care challenges
  • Analyze mental health across the illness/injury continuum
  • Analyze the role of the nurse in working through mental blocks and depression associated with an illness or injury
  • Analyze medical and non-medical approaches for treating mental health
  • Synthesize aspects of nursing practice related to mental health

Learning Resources

Required Readings

Buijck, B. I., Zuidema, S. U., Spruit-van Eijk, M., Bor, H., Gerritsen, D. L., & Koopmans, R. T. C. M. (2014). Determinants of geriatric patients’ quality of life after stroke rehabilitation. Aging & Mental Health, 18(8), 980–985. doi:10.1080/13607863.2014.899969

Haugan, G., Innstrand, S.T. & Moksnes, U.K. (2013). The effect of nurse-patient interaction on anxiety and depression in cognitively intact nursing home patients. Journal of Clinical Nursing, 22(15–16), 2192-2205. doi:10.1111/jocn.12072

Frazao, S. L., Correia, A.M., Norton, P. & Magalhaes, T. (2015). Physical abuse against  elderly persons in institutional settings. Journal of Forensic and Legal Medicine, 36, 54-60.

Liu, C. H. & Tronick, E. (2013). Rates and predictors of postpartum depression by race and ethnicity: Results from the 2004 to 2007 New York City PRAMS Survey (Pregnancy Risk Assessment Monitoring System). Maternal Child Health Journal, 17, 1599-1610.  doi:10.1007/s10995-012-1171-z

Spilman, S. K., Smith, H. L., Schirmer, L. L., & Tonui, P. M. (2015). Evaluation and treatment of depression in adult trauma patients. Journal of Trauma Nursing, 22(1), 17–22. doi:10.1097/JTN.0000000000000102

United Nations Children’s Fund (UNICEF). (2014). Hidden in plain sight: A statistical analysis of violence against children. New York, NY: Author. Retrieved from http://files.unicef.org/publications/files/Hidden_in_plain_sight_statistical_analysis_EN_3_Sept_2014.pdf

Required Media

Steiner, L. M. (2012). Why domestic violence victims don’t leave. Retrieved from https://www.ted.com/talks/leslie_morgan_steiner_why_domestic_violence_victims_don_t_leave?language=en#t-58672

Discussion: Psychological Complications Resulting From Illnesses and Injuries

The nurse’s role goes far beyond that which is expected. Nurses are the main communicators between patients, doctors, and family, and they care for more than just physical ailments. Often, nurses are presented with difficult situations where being an advocate becomes paramount to the healing of the patient. One of the issues that patients with acute and chronic illnesses or extended hospitalization face is a tendency to become depressed. The nurse’s role in this situation requires more than just attention to the physical problem. Another situation where a nurse may need to shift his or her care is when a patient presents with a suspicious injury or illness. In addition to considering the legal and ethical responsibilities of the nurse, he or she must consider the psychological undertones that may be present.

For this Discussion, you will consider delicate situations that nurses often face and analyze the implications of these situations. Reflect on a patient care situation in which you have encountered one of the following:

  • A suspicious illness or injury
  • Depression resulting from illness or injury

Then, locate at least one scholarly journal article related to your patient care situation that offers strategies for managing the circumstances.

By Day 3

Respond to the following:

  • Explain your patient encounter, highlighting the challenges the situation presented, and briefly summarize the contents of your journal article.
  • What strategies did you employ to help handle the situation? What other strategies could you have used?
  • How did you advocate for the patient in the situation?
  • What are some of the legal and ethical implications that need to be considered when providing care for patients with depression resulting from illnesses or injuries or suspicious illnesses or injuries?

Note: Avoid using personal information (e.g., names, facility name, etc.) in your post.

Support your response with references from the professional nursing literature.

Note Initial Post: A 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old).

By Day 7

Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).

Respond with a comment that asks for clarification, provides support for, or contributes additional information to two or more of your colleagues’ postings.

Post a Discussion entry on three different days of the week. Refer to the Discussion Rubric found in the Course Information and Grading Criteria area.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 3 Discussion Rubric

Post by Day 3 and Respond by Day 7

To participate in this Discussion:

Week 3 Discussion

Assignment: How Illnesses and Injuries Affect the Mind

Health complications can be stressful, especially in more vulnerable populations like young children and the elderly. With stress and loss of function often come depression and other psychological manifestations. As a nurse, part of your job is to recognize and educate patients and caregivers on how to deal with the psychological complications of a health crisis.

In this Assignment, you will educate either a caregiver of an elderly patient or a caregiver of a young child patient on ways to prevent and manage psychological manifestations. Review the Learning Resources dealing with injuries and depression and anxiety.

The Assignment:

Develop a teaching plan for treating the potential psychological issues that may result from health crises in either the elderly or young children. You will use PowerPoint to present your teaching plan. Some considerations to make include:

  • In what ways does mental health need to be considered across the illness/injury continuum?
  • How can nurses help both patients and caregivers work through mental blocks and depression associated with an illness or injury?
  • Although treatment will take place in a medical facility, how can non-medical treatments be used as a supplement?

Support your idea with a minimum of three references from the professional nursing literature in the assigned course readings and other references in the Walden Library. If they are relevant, you may use one or two professional Web sites in addition to the literature references.

Include the main elements of your presentation to a group of parents or elderly or their caregivers. This PowerPoint presentation should include between 8–10 slides. It will be assessed using the Week 3 Assignment. Prior to submitting your Assignment, make sure to review the rubric, which is located in the Course Information area.

Note: Be sure to use the Walden Power Point template included in the Writing Resources and Program Success Tools.

Writing Resources and Program Success Tools

For this Assignment, review the following:

  • AWE Checklist (Level 4000)
  • Writing Resources and Program Success Tools
  • Week 3 Assignment Rubric

By Day 7

Submit your Assignment.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

  • Please save your Assignment using the naming convention “WK3Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 3 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 3 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK3Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submit button to complete your submission.
Grading Criteria

To access your rubric:

Week 3 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 3 Assignment draft and review the originality report.

Submit Your Assignment by Day 7

To submit your Assignment:

Week 3 Assignment

Week in Review

This week, you analyzed various challenges related to illness or injury resulting from depression, including suspicious illness or injury and several strategies that nurses might use to address those challenges and advocate in situational contexts. NURS 4005 NURS 4006: Topics in Clinical Nursing

Next week, you will explore the importance of nurse empowerment in effecting change and how action plans are created based on the results of the NDNQI as presented on a dashboard.

To go to the next week:

Week 4

Week 4: Nurse/Patient Empowerment in Practice

Introduction

As a registered nurse, you have the power to influence change in patient outcomes. An important aspect of influencing change is identifying areas that need improvement. This is done primarily through measurement of data. There are several different measures to gather data within organizations as well as on a national scale. Some of these measurements include core measures, standards, best practices, evidence-based practices, and the National Database of Nursing Quality Indicators (NDNQI). These support mechanisms have also been discussed as a means for helping nurses to deliver quality care and improve patient safety. Each measurement essentially focuses on providing care that is safe, effective, patient-centered, timely, efficient, and equitable.

Although there are several different measurements, NDNQI data is used in the process of attaining Magnet Recognition. Magnet Recognition is the highest honor a health care organization can receive for nursing excellence and high-quality patient care. The nurse-specific measures presented in the NDNQI help inform nursing staffs and their organizations of areas where nursing practices can be improved and where nursing practice efforts are producing positive clinical outcomes. Nurses must be directly involved in developing and implementing action plans based on the data presented by the NDNQI.

This week, you will explore the importance of nurse empowerment in effecting change and how action plans are created based on the results of the NDNQI as presented on a dashboard. You will also consider how nurses advocate for patients’ rights, even when that means supporting a patient whose personal choices may have negative health outcomes.

Learning Objectives

Students will:
  • Evaluate strategies to empower both the nurse and the patient to improve quality of care
  • Analyze the use of National Database of Nursing Quality Indictors for nurse empowerment in practice
  • Analyze nurse empowerment in relation to use of quality improvement data for practice
  • Analyze practice experiences for patient or nurse empowerment
  • Analyze quality improvement dashboards for nursing plans

Note: The Assignment related to these Learning Objectives is introduced this week and submitted in Week 5. NURS 4005 NURS 4006: Topics in Clinical Nursing

Learning Resources

Required Readings

Brown, D. S., Aydin, C. E., & Donaldson, N. (2008). Quartile dashboards: Translating large data sets into performance improvement priorities. Journal of Healthcare Quality, 30(6), 18–30. doi: 10.1111/j.1945-1474.2008.tb01166.x

Typically, references should be within five to seven years of publication. However, this publication is considered a classical research reference pertaining to quality improvement and the use of data sets.

Cole, C., Wellard, S., & Mummery, J. (2014). Problematising autonomy and advocacy in nursing. Nursing Ethics, 21(5), 576–582. doi: 10.1177/0969733013511362

Garrard, L., Boyle, D. K., Simon, M., Dunton, N., & Gajewski, B. (2016). Reliability and validity of the NDNQI® injury falls measure. Western Journal Of Nursing Research, 38(1), 111-128. doi: 10.1177/019394591454281

Giancarlo, C., Comparcini, D., & Simonetti, V. (2014). Workplace empowerment and nurses’ job satisfaction: A systematic literature review. Journal of Nursing Management, 22(7), 855-871. doi: 10.1111/jonm.12028

Guglielmi, C. L., Stratton, M., Healy, G. B., Shapiro, D., Duffy, W. J., Dean, B. L., & Groah, L. K. (2014). The growing role of patient engagement: Relationship-based care in a changing health care system. AORN, 99(4), 517–528. doi: 10.1016/j.aorn.2014.02.007

Rock, M.J. & Hoebeke, R. (2014). Informed consent: Whose duty to inform? MedSurg Nursing, 23(3), 189-194.

American Hospital Association. (2003). The patient care partnership: Understanding expectations, rights and responsibilities. Retrieved from http://www.aha.org/content/00-10/pcp_english_030730.pdf NURS 4005 NURS 4006: Topics in Clinical Nursing

 

Read through this document created by the American Hospital Association. This document was created for inpatient hospital stays. However, it is applicable to other practice settings as well.

Montalvo, I. (2007). The national database of nursing quality indicators. The Online Journal of Issues in Nursing, 12(3). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NursingQualityIndicators.html

Institute for Healthcare Improvement. (2016). Retrieved from http://www.ihi.org/Pages/default.aspx

 

The IHI offers numerous resources for improving nursing practice and patient care. Explore a variety of topics and examine some of the resources available.

National Quality Forum. (2016b). Retrieved from http://www.qualityforum.org/Home.aspx

 

The National Quality Forum (NQF) strives to improve patient safety and reduce medical errors. Explore the NQF’s endorsed standards and consider how they apply to nursing practice.

Document: Dashboard Directions (Word document)

Document: Sample Dashboard (Excel workbook) NURS 4005 NURS 4006: Topics in Clinical Nursing

Required Media

Laureate Education. (Producer). (2009a). Topics in clinical nursing: Accountability and nursing practice [Video file]. Baltimore, MD: Author.

 

Note: The approximate length of this media piece is 15 minutes.

 

 

Discussion: Nurse/Patient Empowerment

As a nurse, you are the individual who has the ability to empower patients in the decision-making process pertaining to their health care. In addition, you are in a unique position to empower your nursing colleagues to improve job satisfaction and use performance indicator data from dashboards to effect social change.

In this week’s Learning Resources, you examined both the National Database of Nursing Quality Indicators (NDNQI) and the key role nurses play as advocates for patient rights. To assist nurses in being better prepared for this role, programs such as Patient Care Partnership provide guidance.

For this Discussion, you will analyze the use of quality improvement data and discuss how this data can help empower both patients and nurses. Review the Patient Care Partnership information presented in this week’s Resources. In addition, reflect on the media presentation and the information shared by Ms. Manna on patients’ rights. NURS 4005 NURS 4006: Topics in Clinical Nursing

By Day 3

Respond to the following:

  • What are the best strategies the nurse can employ to empower patients and support patients’ rights to improve quality of care? (Some considerations to keep in mind may include: providing information on effectiveness, risks, and benefits of alternative treatments.)
  • In what ways can NDNQI data from dashboards or quality improvement data be used to support nurse empowerment in practice?
  • How has your institution empowered the nursing staff through the use of quality improvement data?
  • Provide an example of how you have personally empowered either a patient or a fellow nurse.

Support your response with references from the professional nursing literature.

Note Initial Post: A 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old).

By Day 7

Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).

Respond with a comment that asks for clarification, provides support for, or contributes additional information to two or more of your colleagues’ postings. NURS 4005 NURS 4006: Topics in Clinical Nursing

Post a Discussion entry on three different days of the week. Refer to the Discussion Rubric found in the Course Information and Grading Criteria area.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 4 Discussion Rubric

Post by Day 3 and Respond by Day 7

To participate in this Discussion:

Week 4 Discussion

Assignment: Dashboard Analysis and Nursing Plan

As Dr. Rempher and Ms. Manna discussed this week, data from the NDNQI is used to improve nursing practices and support the strategic outcomes of an organization. This data is also used to create the Dashboard. The Dashboard, then, is used to create an action plan. Correctly interpreting information presented on the Dashboard provides nurses with a better understanding of the goals of the action plan.

To prepare

For this Assignment, use the Dashboard located in this week’s Resources, to interpret the data and frame a nursing plan based on best practices.

  • Review the Week 5 Assignment Rubric, provided in the Course Information area.
  • Review the Week 4 Resources that pertain to the NDNQI and use of dashboards
  • Choose a Nurse-Sensitive Quality Indicator that needs improvement based on the data presented in the Dashboard. Reflect on how you would develop a nursing plan with suggestions on how to improve performance in the chosen area.
  • Develop a nursing plan that outlines suggestions on how to improve performance in the chosen area.
  • Provide at least three best practices from evidenced-based literature to support your nursing plan. NURS 4006: Topics in Clinical Nursing

Assignment

  • Draft a 3- to 4 page paper analyzing areas where there is good performance and areas of opportunity from the sample Dashboard.
  • Analyze the data provided in the Dashboard and select an area of performance that needs improvement. Include information on why this area was chosen.
  • Develop a nursing plan that includes suggestions on how to improve performance on the selected indicator. Be sure to provide at least three best practices from the evidenced-based literature to support your suggested nursing plan.

This Assignment is due on Week 5 Day 7. It will be assessed using the Week 5 Assignment Rubric. Writing Resources and Program Success Tools

For this Assignment, review the following:

  • AWE Checklist (Level 4000)
  • Walden paper template (no abstract or running head required)

Submission and Grading Information

There is no submission this week.

Grading Criteria

To access your rubric:

Week 5 Assignment Rubric

Submit Your Assignment by Day 7 of Week 5

Week in Review

This week, you evaluated strategies and analyzed practice experiences. You also evaluated the use of the National Database of Nursing Quality Indicators to empower both the nurse and patient to improve quality of care, including quality improvement dashboards for nursing plans.

Next week, you will consider the emerging role of nursing in palliative and end-of-life care, including any ethical issues and considerations. NURS 4005 NURS 4006: Topics in Clinical Nursing

To go to the next week:

Week 5

Week 5: Holistic and Patient-Centered Care

Introduction

An important area in nursing practice is in palliative and end-of-life care. Palliative care provides a more holistic approach to patient care and attempts to slow the progression of a disease. Palliative care can include an array of non-pharmaceutical therapies such as massage therapy or yoga. It can also include shorter or smaller treatments aimed at reducing negative side effects.

End-of-life care is about the process of dying. Helping patients and their families through this time can be difficult yet rewarding. Patients deserve respect and quality care through this time as well. Like nurses who practice in palliative care organizations, hospice nurses are moving toward alternative therapies to aid in comforting the terminally ill patient. As more care is being delivered in the home, the role of the nurse in providing palliative and end-of-life care will continue to evolve.

This week, you will consider the emerging role of nursing in palliative and end-of-life care. In addition, the ethical issues nurses face with end-of-life care are examined. Finally, you will complete work on your Dashboard nursing plan Assignment.

Learning Objectives

Students will:
  • Identify challenges related to the nurse’s role in providing alternative therapies for patient care
  • Analyze the use of Complementary and Alternative Medicine approaches in relation to alternative therapies for patient care
  • Evaluate Complementary and Alternative Medicine approaches in teaching plans for nurses
  • Analyze the role of the nurse and patient in developing care plans
  • Analyze quality improvement dashboards for nursing plans

Learning Resources

Required Readings

Aldridge, M. D., Hasselaar, J., Garralda, E., van der Eerden, M., Stevenson, D., McKendrick, K., … Meier, D. E. (2016). Education, implementation, and policy barriers to greater integration of palliative care: A literature review. Palliative Medicine, 30(3), 224–239. doi: 10.71177/0269216315606645

Anderson, J.G.& Taylor, A.G. (2012). Use of complementary therapies for cancer symptom management: Results of the 2007 National Health Interview survey. The Journal of Alternative and Complementary Medicine, 18(3), 235-241

Dabney, B.W. & Tzeng, H.M. (2013). Service quality and patient-centered care. MedSurg Nursing, 22(6), 359-364.

De Jonge, K.E., Jamshed, N., Gilden, D., Kubisiak, J., Bruce, S.R. & Taler, G. (2014).  Effects of home-based primary care on Medicare costs in high-risk elders. Journal of the American Geriatrics Society, 62(10), 1825-1831. doi: 10.1111/jgs.12974

Moir, C., Roberts, R., Martz, K., Perry, J., & Tivis, L. J. (2015). Communicating with patients and their families about palliative and end-of-life care: Comfort and educational needs of nurses. International Journal of Palliative Nursing, 21(3), 109–112. doi: 10.129768/ijpn.2015.21.3.109

National Cancer Institute. (2015). Complementary and alternative medicine for health professionals. Retrieved from http://www.cancer.gov/about-cancer/treatment/cam/hp

American Cancer Society. (2016). Retrieved from http://www.cancer.org/

 

The American Cancer Society’s website provides information regarding the progress of cancer research, support systems for patients with cancer, and survivor stories. Explore current research on non-invasive and alternative treatment options for cancer patients.

Hospice & Palliative Nurses Association. (2016). Retrieved from http://hpna.advancingexpertcare.org/

National Quality Forum. (2016a). Palliative care and end-of-life care. Retrieved from http://www.qualityforum.org/Topics/Palliative_Care_and_End-of-Life_Care.aspx

EthnoMed. (2016). Clinical topics. Retrieved from http://ethnomed.org/clinical

 

The EthnoMed site has great resources regarding cultural diversity and beliefs, patient handouts in different languages, research articles, et cetera. NURS 4005 NURS 4006: Topics in Clinical Nursing

Document: Dashboard Directions (Word document)

Document: Sample Dashboard (Excel workbook)

Required Media

Laureate Education. (Producer). (2009d). Topics in clinical nursing: Future directions of nursing care [Video file]. Baltimore, MD: Author. NURS 4006: Topics in Clinical Nursing

 

Note: The approximate length of this media piece is 15 minutes.

 

 

Discussion: Holistic Care and Treatments

The use of complementary and alternative therapies in the treatment of cancer patients, terminal patients, and many other types of patients is steadily increasing. The Resources also contain much information about the various alternative therapies currently being used.

For this Discussion, you will consider alternative therapies and discuss the challenges associated with them.

To prepare for this Discussion:

  • Review the Resources pertaining to alternative therapies.
  • Select one of the following areas where alternative therapies are being used:
    • Cancer treatment
    • Cancer symptom management
    • End-of-life care
    • Palliative care
  • Find at least one scholarly journal article discussing alternative therapies in your chosen subtopic.

By Day 3

Respond to the following:

  • Identify at least one challenge associated with the nurse’s role in providing alternative therapies for patient care.
  • Explain how the nurse might integrate the use of Complementary and Alternative Medicine (CAM) approaches in your chosen subtopic and discuss the ethical issues nurses may face.
  • What are the main elements you would include in a teaching plan for nurses on the use of CAM in your chosen subtopic?
  • What is the shared role of the nurse and patient in developing care plans?

Support your response with references from the professional nursing literature.

Note Initial Post: A 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old).

By Day 7

Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).

Respond with a comment that asks for clarification, provides support for, or contributes additional information to two or more of your colleagues’ postings.

Post a Discussion entry on three different days of the week. Refer to the Discussion Rubric found in the CourseInformation and Grading Criteria area. NURS 4005 NURS 4006: Topics in Clinical Nursing

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 5 Discussion Rubric

Post by Day 3 and Respond by Day 7

To participate in this Discussion:

Week 5 Discussion

Assignment: Dashboard Analysis and Nursing Plan DUE

By Day 7

This Application Assignment, assigned last week, is due. Prior to submitting your Assignment, make sure to review the Week 5 Assignment Rubric, which is located in the Course Information area.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

  • Please save your Assignment using the naming convention “WK5Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 5 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 5 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK5Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submit button to complete your submission.
  • Due to the nature of this assignment, your instructor may require more than 5 days to provide you with quality feedback.
Grading Criteria

To access your rubric:

Week 5 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 5 Assignment draft and review the originality report.

Submit Your Assignment by Day 7

To submit your Assignment:

Week 5 Assignment

Week in Review

This week, you identified the challenges for nurses in providing alternative therapies for patient care and analyzed the use of Complementary and Alternative Medicine approaches in relation to those therapies. You also analyzed the role of nurse and patient in developing care plans and quality improvement dashboards for nursing plans.

In the final week, you will consider a series of articles that focus on strategies for ensuring safety and quality care for patients. You will also explore how successful and efficient teamwork can help prevent and decrease the likelihood of Never Events occurring.

To go to the next week:

Week 6

Week 6: Accountability for Clinical Outcomes and Promoting Safety and Quality

Introduction

Throughout your education, patient safety and improving the quality of patient care have been examined. Through numerous readings and media pieces, you have heard about Never Events. These are serious and costly medical errors that are preventable, such as wrong-side surgery, medication errors, and hospital-acquired infections. Each of these types of medical errors is preventable. The consequences of such errors are now financial as well as legal and emotional. The Centers for Medicare & Medicaid Services no longer reimburse for medical errors classified as Never Events.

As a nurse, how can you help to prevent these types of medical errors? What is your accountability for clinical outcomes? There are standards and core measures in place that guide nursing practice. In addition, the National Database of Nursing Quality Indicators (NDNQI) examines those components of clinical care that are specific to nursing. The NDNQI quantifies, or assesses, these nurse-sensitive components and provides specific feedback on how well nursing practice is being executed in those areas related to patient care. NURS 4005 NURS 4006: Topics in Clinical Nursing

This week, you will consider a series of articles that focus on strategies for ensuring safety and quality care for patients. You will also explore how successful, efficient teamwork between nurses, nursing leaders, physicians, and other medical personnel can help prevent many of the Never Events from occurring and decrease the likelihood of such events in the future.

Learning Objectives

Students will:
  • Analyze the core measures and standards for nursing practice that promote patient safety and quality of care outcomes
  • Analyze the impact of the nurse’s role in clinical outcomes for organizations
  • Analyze nurse-specific challenges for influencing change in quality improvement
  • Analyze the role of the nurse in supporting the organization’s strategic agenda in improving clinical outcomes

Learning Resources

Prior Knowledge

It is not uncommon for students to be required to complete group projects or to work as part of a team. While obtaining your RN credentials, or at some time in your work career, you have more than likely at some point been part of a unit or a collaborative team. Reflect on that experience of working with others to achieve a common goal. How did the actions of your team members impact your success as a team? Consider how this same philosophy applies within an organization. How might the actions of the individuals influence the success of the organization?

Required Readings

Amin, A.N., Hofmann, H., Owen, M.M. Tran, H., Tucker, S & Kaplan, S.H. (2014). Reduce readmissions with service-based care management. Professional Case Management, 19(6), 255-262. doi: 10.1097/NCM.0000000000000051

Forster, A.J., Dervin, G., Martin, C. & Papp, S. (2012). Improving patient safety through the systematic evaluation of patient outcomes. Canadian Journal of Surgery, 55(6), 419-425.  doi: 10.1503/cjs.007811

Johansen, M.L. (2014). Conflicting priorities: Emergency nurses perceived disconnect between patient satisfaction and the delivery of quality patient care. Journal of Emergency Nursing, 40(1), 13-19.  doi: 10.1016/j.jen.2012.04.013

McDowell, D. S. & McComb, S.A. (2014). Safety checklist briefings: A systematic review of the literature. AORN, 99(1), 125-137. doi: 10.1016/j.orn.2013.11.015

Payne, D. (2014). Elderly care: Reflecting on the ultimate ‘never event’. British Journal of Nursing, 23(13). 702. doi: 10.12968/bjon.2014.23.13.702

Thornlow, D.K. & Merwin, E. (2009). Managing to improve quality: The relationship between accreditation standards, safety practices, and patient outcomes. Health Care Management Review, 34(3), 261-272. doi: 10.1097/HMR.0b013e3181a16bce

American Hospital Association. (2016). Retrieved from http://www.aha.org/

 

Explore the American Hospital Association’s website. Focus on the information on improving patient safety and quality of care.

American Organization of Nurse Executives. (2016). Retrieved from http://www.aone.org

 

“Since 1967, the American Organization of Nurse Executives (AONE) has provided leadership, professional development, advocacy and research to advance nursing practice and patient care, promote nursing leadership excellence and shape public policy for health care nationwide. AONE is a subsidiary of the American Hospital Association” (AONE, 2016). NURS 4005 NURS 4006: Topics in Clinical Nursing

Centers for Medicare & Medicaid Services. (n.d.). Quality of care center. Retrieved August 11, 2016, from http://www.cms.gov/Center/Special-Topic/Quality-of-Care-Center.html?redirect=/center/quality.asp

 

Most health care organizations receive some amount of reimbursement from the Centers for Medicare & Medicaid Services (CMS). Reimbursement continues to be jeopardized and reduced by pay for performance standards. Health care organizations are being held to higher standards by CMS. Explore the standards set to improve patient safety and the quality of care. Consider how they affect acute care providers and nursing practice.

The National Academies of Sciences, Engineering, and Medicine. (2016). Health and Medicine Division. Retrieved from http://www.nationalacademies.org/hmd/

 

The Health and Medicine Division (HMD) promotes policies and best practices in an effort to improve patient safety and delivery of quality care. Review a few of the publications available at this site.

The Joint Commission. (2016). National Quality Forum (NQF) endorsed nursing-sensitive care performance measures. Retrieved from http://www.jointcommission.org/national_quality_forum_nqf_endorsed_nursing-sensitive_care_performance_measures/

 

The Joint Commission (TJC) also accredits health care organizations. Through funding provided by the Robert Wood Johnson Foundation, the Joint Commission developed the Implementation Guide for the National Quality Forum (NQF) Endorsed Nursing-Sensitive Care Performance Measures. Review this guide as you consider how core measures and national guidelines improve nursing practice.

Required Media

Laureate Education. (Producer). (2009b). Topics in clinical nursing: Accountability for clinical outcomes and promoting safety and quality [Video file]. Baltimore, MD: Author.

 

Note: The approximate length of this media piece is 15 minutes.

 

 

Discussion: Promoting Safety and Quality

In the article “Managing to Improve Quality: The Relationship Between Accreditation Standards, Safety Practices, and Patient Outcomes,” the authors discuss the growing trend by medical insurance companies to eliminate reimbursement for Never Events. As these types of mistakes should be easily preventable, hospitals have developed protocols to lessen or extinguish the occurrence of these events. In addition, The Joint Commission (TJC) and the Centers for Medicare & Medicaid Services (CMS) have developed core measures to guide health care providers’ efforts in improving patient safety and the quality of care delivered.

Health care organizations have developed strategic agendas to help meet these standards and reduce the incidence of Never Events. Nurses significantly influence the overall quality of health care provided and play a pivotal role in improving patient outcomes.

For this Discussion, you will consider the standards that are in place for nurses and how they can be used to improve quality of care.

To prepare for this Discussion:

  • Review the information at the Joint Commission and Centers for Medicare & Medicaid Services websites on the core measures and standards presented in this week’s Resources.
  • Consider the nurse’s role in supporting the organization’s strategic agenda as it relates to improving clinical outcomes.
  • Conduct an Internet search for either a Never Event or a core measure, and select one to address in your post.

By Day 3

Respond to the following:

  • How has the emphasis on quality of care, patient safety, and clinical care outcomes been impacted by specific standards emanating from TJC and/or CMS? Cite your selected core measure or Never Event in your response.
  • What is the impact of the nurse’s role in clinical outcomes for the organization?
  • Discuss nurse-specific challenges in influencing change in quality improvement.
  • How does this influence the ability of the organization to achieve its strategic agenda?

Support your response with references from the professional nursing literature.

Note Initial Post: A 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old).

By Day 7

Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).

Respond with a comment that asks for clarification, provides support for, or contributes additional information to two or more of your colleagues’ postings.

Post a Discussion entry on three different days of the week. Refer to the Discussion Rubric found in the Course Information and Grading Criteria area.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 6 Discussion Rubric

Post by Day 3 and Respond by Day 7

To participate in this Discussion:

Week 6 Discussion

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Week in Review

In this final week, you analyzed the core measures and standards for nursing practice that promote patient safety and quality of care outcomes, as well as the impact of the nurse’s role in clinical outcomes. You also analyzed nurse-specific challenges for influencing change in quality improvement and in supporting an organization’s strategic agenda in improving clinical outcomes.

Congratulations! After you have finished all of the assignments for this week, you have completed the course. Please submit your Course Evaluation by Day 7.

Discussion – Week 3

     When patients are newly diagnosed with chronic illness/conditions, they are more likely to experience depressive symtoms. Studies conducted in China and United States, indicates  the prevalence of depression among patients with chronic diseases; and recommended that primary care and healthcare providers be alert and knowledgeable regarding  the signs/symtoms of depression. Patients with chronic conditions may have to adjust their lifestyle, enployment, aspiration, meanwhile many others will grieve about their predicament before they adjust to it; but others have protracted distress and may develop mental disorders especially deppresion and anxiety (H. Li, 2019)

Some few years ago I was working with a young adult (age 45) newly diagnosed with colorectal cancer. It was not only a devastating new to the patient but also his care team. The patient did not want his mom to know about his diagnosis because the he was afraid the mom will not received the information well he was a single dad and the sole provider in the family of three. This was a huge challenge to the whole family as the patient would have to adjust his lifestyle, his enployment and aspiration in order to plan for treatments. The patient was in denial about the diagnosis, there was a lot of grieving and fear that he would loose his life. The strategy I used to handle the situation was to allow allow him to air out his emotions (fears and sadness), while I listern, asked him open ended questions so he could talk more. Rather than being judgemental, I tried to understand the root cause of his fears and other emotions associated with the new diagnosis (S. J. Calloway et el, 2019). In addition, I also made some referrals such as counseling, surgical oncology services and other community resources. Another strategy I could have used was to monitor or screen the patient for depression. NURS 4005 NURS 4006: Topics in Clinical Nursing

Some of the legal and ethical implications that need to be considered when providing care for patients with depression resulting from chronic illnesses include providing consent for treatment, clinical decision making. The patient must collaborate with the physician to make medical care decisions. The information provided by the physician must be sufficient and well understood for the patient to make the best decision possible under the circumstances. But when the patient is suffering from depression because of a chronic illness, consenting or making the right decisions about their care becomes difficult.

When depression is undetected and untreated especially in patients with chronic illnesses, physical and mental health can deteriorate. Thus, as nurses, we can screen and address depression, provide evidence-based education as well as make referrals to mental health specialists and community resources.

References

Hongjin Li, Song G. E., […], & Jacqueline Dumber-Jacob (Jan 10th, 2019). Depression in the context of chronic diseases in the United States and China. Retrieved from https://www.ncbi.nlm.nih.gov

Susan J. Calloway, Rosalinda Jimenez, & Dianne Lavin (Aug. 30th, 2019). Depression and Chronic medical illness in adults. Retrieved from MyAmericanNurse.com. NURS 4006: Topics in Clinical Nursing

Providing Genetic Nursing Care to Patients With Chronic Illnesses

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Providing Genetic Nursing Care to Patients With Chronic Illnesses

Discussion – Week 2
COLLAPSE
Pharmacogenomics and chronic illnesses

 

This article gives a brief history and definition of pharmacogenomics as well as gives some examples of nursing implications as it is translated into clinical practice. According to Cheek et al, “while the terms pharmacogenetics and pharmacogenomics are often used interchangeably, pharmacogenetics is generally used to refer to the role of single genes in drug response while pharmac.ogenomics is the broader term that encompasses the role of the entire genome, including gene-gene interactions in drug response” (2015, para. 2). Expanding on that, pharmacogenomics is defined as “the knowledge of the specific genetic factors that affect drug response”, with the ultimate goal being the ability to adjust drug doses or suggest alternate therapies to avoid toxicities in patients and yield optimal patient outcomes (Cheek et al 2015). There are several chronic illnesses where the patients would benefit tremendously from this concept. For example, according to Cheek et al, “the most common disease that benefits from pharmacogenomics is cancer. Providing Genetic Nursing Care to Patients With Chronic Illnesses Targeting of specific pharmacological therapies will assist in a greater understanding of the molecular causes of cancer” (2015, para. 12). They also note, “the Clinical Pharmacogenetics Implementation Consortium of the National Institute of Health Pharmacogenomics Research Network recommends that pharmacogenomics information be used in adjusting doses of Warfarin…” (2015, para. 13). Warfarin is often used as anticoagulation therapy in patients diagnosed with certain cardiac arrythmias. And also, per Cheek et al, “pharmacogenomics is also utilized in determining drug efficacy with the antiplatelet agent clopidogrel…” (2015, para. 14). Clopidogrel is often used in patients who have coronary artery disease and have undergone cardiac catheterizations with stent placement to maintain stent patency long-term. Pharmacogenomics is also used in the drug management of mental health disorders. Cheek et al notes, “this is the second largest therapeutic area that the FDA has identified with pharmacogenomics biomarkers in drug labeling” (2015, para. 25). In summary, the use of pharmacogenomics gives providers the ability to prescribe the precise drug and dosages for maximum efficacy and patient outcomes and minimizes, if not completely eliminates, the risk for adverse drug reactions.

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The nurse’s role is critical because one of our primary duties is safe medication administration. Advocacy involves advocating for and demanding implementation of all available safe administration practices, including precision drug and dosing practices made possible by pharmacogenomics. Nurses also have a duty to communicate with providers results of genetic testing if/when available. Nurses in certain specialties should also be competent to know when genetic testing is actually indicated before certain drugs are prescribed. For example, HIV+ patients with a certain genetic allele can have an adverse drug reaction to the commonly prescribe antiviral medication abacavir, resulting in fatal multi-organ hypersensitivity (Cheek et al, 2015). Nurses have the responsibility of monitoring, assessing, and advocating for the patients, as well as communicating and collaborating with other members of the health care team for the best possible outcomes for the patients. Nurses should also be educating the patients and their families about information that needs to be passed along to other specialties or providers and just so that the patient is aware and informed of his/her own health care information. We also have a duty to safely administer medications based on the correct patient, drug, dose, route and time. We should be monitoring and reassessing for the patient’s response to the drug. Nurses should be communicating immediately with the provider about any adverse drug reactions and provide interventions as indicated. Nurses also have an ethical responsibility to our patients. We have to first ensure that the patient is aware of genetic testing and understands how that information will be used in their health care. We should also ensure that they agree and are willing to have the testing done prior to the actual testing. This is important because it not only affects the patient, but also their family members who may be genetically predisposed, at risk for or managing some of the same conditions or diseases. Cheek et al notes, Providing Genetic Nursing Care to Patients With Chronic Illnesses

The area of precision medicine is here, and the ability to tailor treatment for a myriad of acute and chronic health problems are vast due to the genomic, pharmacogenomic, and genetic explosion. Genetic testing can have a life-altering impact on patients and families. Nurses need to be prepared to first educate patients and families on the value of genetic testing, and then how the information can be used to help families make decisions about the medical management of family members.. Nurses serve as patient advocates for the best possible health outcomes by educating patients about the role pharmacogenomics play in their treatment plan. (2015, para. 31). NURS 4005 NURS 4006: Topics in Clinical Nursing

Pharmacogenomics provides an opportunity for nurses to safely administer the most effective drug and dosage, based on genetics, ultimately resulting in optimal patient outcomes with a minimized risk of adverse drug reactions.

 

Reference:

Cheek, D., Bashore, L., Brazeau, A. (2015). Pharmacogenomics and implications for nursing practice. Journal of Nursing Scholarship., 47(6), 496-504. Doi: 10.1111/jnu.12168

 

Discussion: Providing Genetic Nursing Care to Patients With Chronic Illnesses
There are several chronic health problems with genetic/genomic components that plague the population. These health problems are very difficult and challenging diseases to manage. Evidenced-based nursing practice must include genetic and genomic information when planning patient care. Nurses, through their knowledge and support, play an important role in positive patient outcomes when managing the challenges of these genetically linked diseases.

For this Discussion, you will consider applications of various topics to genetics and genomics. Review the Resources focusing on the application of genetics and genomics to nursing

Choose one of the following subtopics:

Pharmacogenomics and chronic illnesses
Genomics in patient assessment
Genetically competent care for those with chronic illnesses
Note: A different subtopic relating to genetics and genomics may be chosen with Instructor approval.

Locate at least one scholarly journal article that discusses your subtopic.

By Day 3
Respond to the following:

Identify your subtopic and provide a brief summary of your journal article on how this topic relates to nursing practice.
What is the nurse’s role in providing care in relation to your subtopic and the overarching theme of advocacy?
What ethical implications should be considered with regard to genetics and genomics for nursing practice? Why?
Support your response with references from the professional nursing literature.

Note Initial Post: A 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old).

By Day 7
Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).

Respond with a comment that asks for clarification, provides support for, or contributes additional information to two or more of your colleagues’ postings.

Post a Discussion entry on three different days of the week. Refer to the Discussion Rubric found in the Course Information and Grading Criteria area.

 

Discussion – Week 2
COLLAPSE

This week, I chose the subtopic of genomics in patient assessment, but the journal article also falls under the subtopic of genetically competent care for those with chronic illness. This week’s article focuses on the fact that in 2006, the American Nurses Association (ANA) created important competencies for all RNs, but over half of the nurses in practice receive no pre-licensure education on genetics and genomics (G/G) competencies. The article subsequently describes the current utilization of G/G nursing competencies in the acute setting in hospitals and the nurses’ perceptions of them (Newcomb et al., 2019).

The completion of the Human Genome Project has broadened the opportunities for the prevention, diagnosis and management of many diseases resulting in more demands for genetic services. The increasing demands are utilizing nongenetic health professionals to take family histories, conduct family history assessments, interpret results of genetic tests, provide G/G education, and advocate for patient referrals for genetic evaluations. For non-genetic nurses, mostly staff nurses, keeping up with genetic advancements is difficult partially because of the lack of genomic competencies, skills and confidence in integrating G/G into patient education and assessments. Because of the increasing demands of bedside nursing and the education involved to maintain staff nurse competencies, little attention is paid to G/G assessment competencies and patient education (Talwar, et al., 2017).

Clinical performance for nurses is usually evaluated using competencies that compare nurses’ current work performance with previously established standards of performance. Competencies should reflect the current realities in practice, connecting to performance improvement data and is ever changing. That being said, clinical nurses are expected to master many competencies directly related to their work specific environment, and there are some universal competencies, regardless of practice setting. NURS 4005 NURS 4006: Topics in Clinical Nursing

The ANA created a new set of essential G/G competencies because they usually have a disease or health disorder component. However, most clinical nurses are age 34 and over, with the average age being 48 years old. Many currently practicing nurses who attended nursing school immediately after high school or those who graduated before 2006, received no education about the G/G competencies in their prelicensure programs, but currently, there is very little empirical evidence of that clinical nurses are actually using these competencies. This journal takes a quick look at 10 hospitals over a four -week period and assess in a 38-item questionnaire and direct observation of the EMR to assess for evidence of RN documentation of G/G related care activities (Newcomb, et al., 2019). Providing Genetic Nursing Care to Patients With Chronic Illnesses

While nurses with a graduate degree tended to report more significant competency performance, bedside nurses performed less if any and generally didn’t report any continuing education focusing on G/G. Only six components were performed by most of the respondents in the study with two of them being more concrete activities such as collecting health histories and conducting a physical exam with G/G in mind. Obtaining a family history has been taught as a nursing fundamental for decades, but the ANA suggests going back three generations, which was rarely performed (Newcomb, et al., 2019).

Medical management of chronic illness consumes 75% of money spent on healthcare in the United States making accessible, high quality care a major concern (Shaw, et al., 2014). With the vast amount of ever improving advances in personal monitors, smart phones, watches, and the plethora of data on the internet, many conditions can be identified early, but an ethical issue remains of misuse of information or patients who may manipulate data to get information or push for a diagnosis of an illness that may not actually be appropriate. Genome sequencing is getting more affordable, allowing for the identification of risks that in some cases can be mitigated if not eliminated completely. However sometimes, more information can cause more ethical dilemmas and complicates decision making because genome sequencing is accurate in some case but can be just a predictor in other cases (Mehrian-Shai, et al.,2015).

Yearly competencies added to the multiple online and in person education for nurses both inpatient and outpatient settings, would be a great step towards obtaining pertinent data and increasing nurse confidence related to the education and integration of G/G. Much of this education should include the ethical complications of more advanced G/G testing. Also, a brief understanding of the role genetics plays in the treatment and prevention of disease should be reviewed each year to help bridge the gap for nurses who need a reminder of competencies and those who didn’t receive it in nursing school prior to actual nursing practice.

 

 

 

 

 

 

References

 

Mehrian-Shai, R., & Reichardt, J. K. V. (2015). Genomics is changing personal healthcare and medicine: the dawn of iPH (individualized preventive healthcare). Human Genomics, 9, 29. https://doi-org.ezp.waldenulibrary.org/10.1186/s40246-015-0052-0

 

Newcomb, P., Behand, D., SLEUTEL, M., WALSH, J., BALDWIN, K., & LOCKWOOD, S. (2019). Are genetics/genomics competencies essential for all clinical nurses? Nursing, 49(7), 54–60. https://doi-org.ezp.waldenulibrary.org/10.1097/01.nurse.0000554278.87676.ad NURS 4005 NURS 4006: Topics in Clinical Nursing

 

Shaw, R. J., McDuffie, J. R., Hendrix, C. C., Edie, A., Lindsey-Davis, L., Nagi, A., Kosinski, A. S., & Williams, J. W., Jr. (2014). Effects of nurse-managed protocols in the outpatient management of adults with chronic conditions: a systematic review and meta-analysis. Annals of Internal Medicine, 161(2), 113–121. https://doi-org.ezp.waldenulibrary.org/10.7326/M13-2567

 

Talwar, D., Tseng, T.-S., Foster, M., Xu, L., & Chen, L.-S. (2017). Genetics/genomics education for nongenetic health professionals: a systematic literature review. Genetics in Medicine : Official Journal of the American College of Medical Genetics, 19(7), 725–732. https://doi-org.ezp.waldenulibrary.org/10.1038/gim.2016.156 NURS 4005 NURS 4006: Topics in Clinical Nursing

Assignment: How Illnesses and Injuries Affect the Mind

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Assignment: How Illnesses and Injuries Affect the Mind

Health complications can be stressful, especially in more vulnerable populations like young children and the elderly. With stress and loss of function often come depression and other psychological manifestations. As a nurse, part of your job is to recognize and educate patients and caregivers on how to deal with the psychological complications of a health crisis.

In this Assignment, you will educate either a caregiver of an elderly patient or a caregiver of a young child patient on ways to prevent and manage psychological manifestations. Review the Learning Resources dealing with injuries and depression and anxiety.

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The Assignment:

Develop a teaching plan for treating the potential psychological issues that may result from health crises in either the elderly or young children. Assignment: How Illnesses and Injuries Affect the Mind. You will use PowerPoint to present your teaching plan. Some considerations to make include:

In what ways does mental health need to be considered across the illness/injury continuum?
How can nurses help both patients and caregivers work through mental blocks and depression associated with an illness or injury? Assignment: How Illnesses and Injuries Affect the Mind
Although treatment will take place in a medical facility, how can non-medical treatments be used as a supplement? Assignment: How Illnesses and Injuries Affect the Mind
Support your idea with a minimum of three references from the professional nursing literature in the assigned course readings and other references in the Walden Library. If they are relevant, you may use one or two professional Web sites in addition to the literature references.

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Include the main elements of your presentation to a group of parents or elderly or their caregivers. This PowerPoint presentation should include between 8–10 slides. It will be assessed using the Week 3 Assignment. Prior to submitting your Assignment, make sure to review the rubric, which is located in the Course Information area.

Note: Be sure to use the Walden Power Point template included in the Writing Resources and Program Success Tools. Assignment: How Illnesses and Injuries Affect the Mind

Writing Resources and Program Success Tools

AWE Checklist (Level 4000)
This checklist will help you self-assess your writing to see if it meets academic writing standards for this course.
http://academicguides.waldenu.edu/writingcenter/templates/general
http://academicguides.waldenu.edu/writingcenter/scholarlyvoice
http://academicguides.waldenu.edu/writingcenter/webinars/scholarlywriting#s-lg-box-2773859
http://academicguides.waldenu.edu/writingcenter/apa/citations/commonsources
Walden University. (n.d.). Walden templates: General templates: APA course paper template with advice (6th ed.).
Retrieved May 31, 2019, from https://academicguides.waldenu.edu/ld.php?content_id=45326751
For this Assignment, review the following:

AWE Checklist (Level 4000)
Writing Resources and Program Success Tools
Week 3 Assignment Rubric
By Day 7
Submit your Assignment.

Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK3Assgn+last name+first initial.(extension)” as the name.
Click the Week 3 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 3 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK3Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission. Assignment: How Illnesses and Injuries Affect the Mind

NURS 4005 4006 Discussion: Psychological Complications Resulting From Illnesses and Injuries

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NURS 4005 4006 Discussion: Psychological Complications Resulting From Illnesses and Injuries

NURS 4005 4006 Discussion: Psychological Complications Resulting From Illnesses and Injuries
Discussion – Week 3

          For this week’s post, I will discuss a case from my time working on an inpatient psychiatric unit. A patient had come to the ER after concerned family and friends urged them to do so. During the

assessment, the patient divulged having suicidal ideations and depression related to a terminal cancer diagnosis. The patient was admitted to our unit for these very reasons. The task of providing hope and

helping the patient heal became difficult. How do you discuss the importance of choosing life when you’re faced with death?

          Our treatment team had to think. The psychiatrists and providers on the team decided to treat the depression and provide comfort. Discussions with nursing staff normalized death and touched on the

beautiful aspects of life the patient enjoys. Incorporating music the patient loved and the family that supported them was critical in finding peace for the individual. Psychiatric palliative nursing includes

interventions that form a support system for the patient and their family, affirms life, recognizes death as a normal process, and incorporates spiritual components into coping and treatment (Lindblad et al.,

2019). When offered specific medications to treat anxiety and depression associated with their cancer diagnosis, the patient would relay information about side effects and dissatisfaction with the mediation. As

a nursing staff, it was our job to ensure the patient adhered to a schedule to achieve therapeutic dosing. At the next day’s treatment team, we offered the patient’s medication preference as it comforted the

patient and assured compliance. The patient’s ordering providers well-received this. During shift assessments and follow-ups from the providers, however, the suicidal ideations did not dissipate.

         The patient talked with staff about physician-assisted suicide (PAS), but this was not an option for our treatment team. PAS is illegal in Pennsylvania; however, California, Colorado, District of Columbia,

Hawaii, Maine, New Jersey, Oregon, Vermont, and Washington allow individuals that are deemed mentally competent to make this choice (2020). This decision and process leads to many ethical and legal

questions. Even the providers and psychiatric liaisons involved in PAS have uncertainties about establishing a patient’s competency regarding assisted suicide. 6% of psychiatrists felt they could determine this

competence after a single session with the individual requesting physician-assisted suicide (Kelly & McLoughlin, 2009). NURS 4005 4006 Discussion: Psychological Complications Resulting From Illnesses and Injuries

         While the patient’s chronic suicidal ideations would typically warrant intensive inpatient treatment, the patient’s discharge plan included palliative nursing care orders in the home. The treatment team felt

that inpatient psychiatric admission was furthering anxiety, as the patient felt certain aspects of their life were “passing by.” Through education and collaboration, a discharge plan was made. The patient felt

that with the medication regimen, identified coping skills, and family support, safety and treatment could be carried on at home. This discussion post made me reflect on difficult mental health nursing tasks

and how specialties in the nursing profession cross paths more often than I realized. It also brings thoughts of preparedness and education regarding this special patient situations. In the future, I would like to

have more informed treatment ideas for those suffering mental illness as related to terminal or debilitating illness/injury. NURS 4005 4006 Discussion: Psychological Complications Resulting From Illnesses and Injuries

References:

Kelly, B. D., & McLoughlin, D. M. (2009). Physician-assisted suicide and psychiatry. Psychiatry, 8(7), 276–279. https://doi-org.ezp.waldenulibrary.org/10.1016/j.mppsy.2009.04.011

Lindblad, A., Helgesson, G., & Sjöstrand, M. (2019). Towards a palliative care approach in psychiatry: Do we need a new definition? Journal of Medical Ethics, 45(1), 26.

doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1136/medethics-2018-104944

Resources. (2020, March 17). Retrieved October 27, 2020, from https://www.deathwithdignity.org/learn/ NURS 4005 4006 Discussion: Psychological Complications Resulting From Illnesses and Injuries

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Discussion – Week 3

COLLAPSE

I have an interesting relationship and experience(s) with a patient of mine. When I first graduated nursing school I started working on a Neuro/Stroke unit. I frequently cared for an elderly woman (above the age of 65), who was experiencing a significant number of falls, and subsequently resulting in traumatic brain injuries. This became suspicious to me and the other nurses on my unit due to the number of admissions this patient had over a short period of time. Oddly, once I left the hospital and moved to a private neurosurgery practice, the physician I work for is the same physician who operated on this patient and oversees her outpatient care. It’s interesting as a nurse to have seen her in the acute setting, but also in the outpatient setting as well. Elder abuse is something near and dear to my heart as I believe it is overwhelmingly occurring in the health care world. Elder mistreatment is defined as intentional actions that cause harm or risk of harm (even if unintended), or failure to meet the elder’s basic needs and to protect them from harm (Wangmo, T., Nordstrom, K., Kressig R.W., 2016).

Prior to her first known incident, she was known to have Alzheimer’s Dementia and lived at home with her husband, which she still does at this time. When she was admitted the first time, she had been wandering on the side of a highway and was hit by a truck. While she sustained several locations of brain bleeds, and then in turn Hydrocephalus, you can imagine the number of other injuries sustained as well. One of my first questions upon her admission was “why and how was she out on the main highway at night?” Turns out, this incident occurred while her husband was sleeping, and she escaped their home. So, we thought “no big deal, just a crazy accident.” However, we began to see more and more admissions over the period of 3-6 months. Every admission was something new (UTI’s, unstageable bed sores, gangrene, etc.) she continued to decline cognitively and physically and was every bit related to the care or lack thereof she was receiving at home. I will never forget one incident that resulted in her admission. She was a diabetic that suffered from diabetic neuropathy and was also blind. When she came into the hospital maggots were literally eating her feet. I’ve never seen anything like it.  NURS 4005 4006 Discussion: Psychological Complications Resulting From Illnesses and Injuries

Obviously, at this point in her inpatient care, there were a lot of team members involved such as social work and care management. They were our initial strategy in this situation as it was clear the patient was not being cared for at home. I’m not entirely sure of the intricate details of her situation, but her husband was an attorney and refused to place her in a long-term care facility. I remember discussing with the social worker how much disbelief I was that she was able to return home with him. I tried to advocate for her safety as she was unable to do so for herself. However, as a nurse in an inpatient setting, I felt our voices weren’t heard. Decisions at this level were made by physicians and social work. So then at that point, our focus shifted to educating the husband on her care, seeing if any other family members or friends could assist in the care, and having home health aide in care as well.

Fast forward, she hasn’t had any recent hospitalizations, but we often see her in our clinic. How she is still under the care of her husband is beyond me. Last week when she was in our office for a follow-up, she was pulled out of the back of a van where a newspaper laid underneath her. Her hair was matted, her face from her chin to her eyebrows was covered by her mask, she had obviously not been bathed, and had been sitting in feces. When she arrived at our office, we contacted social services. I am still unaware of what has come of this situation. I expressed my concerns to her husband for her safety, and our physician urged placement in a long- term care facility.  NURS 4005 4006 Discussion: Psychological Complications Resulting From Illnesses and Injuries

According to research, elder mistreatment is defined by five types of abuse/neglect. These consist of physical abuse, emotional/psychological abuse, sexual abuse, financial exploitation, and neglect (Wangmo, T., Nordstrom, K., Kressig R.W., 2016). Shockingly, for every case of elder abuse and neglect (EAN) reported, 24 more cases remain unreported (Wangmo, T., Nordstrom, K., Kressig R.W., 2016). When examing elder abuse further and the statistics correlating with the abuse, 40% of Americans over the age of 65 experience some type of functional limitation (Zeranski, L., Halgin, R.P., 2011). It is also estimated that 13% of older Americans have a diagnosis of Alzheimer’s, and another 20% experience cognitive disabilities without dementia relating to issues such as depression, stroke, diabetes (Zeranski, L., Halgin, R.P., 2011). Research shows that older adults with the conditions as stated about are at much-increased risk of becoming victims of abuse and neglect and in turn, can experience significant issues with depression (Zeranski, L., Halgin, R.P., 2011). So, in examining my patient’s demographics and medical history, she easily falls into more than one of these categories and further explaining her risk of abuse.

In addressing the legal and ethical issues with elder abuse and the reporting of such abuse, there are laws requiring investigation of these reports in all 50 states. However, each state has its own definition of elder abuse, and who is protected by these laws varies as well. (Zeranski, L., Halgin, R.P., 2011). Looking beyond the actual legal implications of elder abuse, there are a lot of ethical issues arising from this as well. Reporting elder abuse is keeping with ethic codes of beneficence and nonmaleficence, and respect for the patient’s rights and their dignity (Zeranski, L., Halgin, R.P., 2011). When looking at my patient’s situation specifically, she lacks the capacity to make her own decisions due to her medical issues. Her Dementia diagnosis alone creates an argument for lack of competency as it relates to her care. It is obvious that she is not being cared for adequately but, a nurse should examine the “cultural beliefs and patterns of adaptation of family members who neglect an elderly person’s personal and environmental health requirements rather than consider it a pathological finding” (Saghafi, A., Bahramnezhad, F., Poormallamizra, A., Dadgari, A., Navab, E., 2019). NURS 4005 4006 Discussion: Psychological Complications Resulting From Illnesses and Injuries

 

References

Wangmo, T., Nordstrom, K., & Kressig, R. W. (2016, December 23). Preventing elder abuse and neglect in geriatric institutions:Solutions from nursing care providers. Elsevier. https://reader.elsevier.com/reader/sd/pii/S0197457216303111?token=5A239EB7C8AAFEFD10A10DFAFE842DE0D5F209EAB9390786083CFF20CE18AD0BE3D7634F6F4A9F77D20FE7EB661EA8DC

Zeranski, L., & Halgin, R. P. (2011). Ethical issues in elder abuse reporting: A professional psychologist’s guide. Professional Psychology: Research and Practice, 42(4), 294–300. https://doi.org/10.1037/a0023625

Saghafi, A., Bahramnezhad, F., Poormollamirza, A., Dadgari, A., & Navab, E. (2019). Examining the ethical challenges in managing elder abuse: a systematic review. Journal of medical ethics and history of medicine, 12, 7.

 

Discussion: Psychological Complications Resulting From Illnesses and Injuries

The nurse’s role goes far beyond that which is expected. Nurses are the main communicators between patients, doctors, and family, and they care for more than just physical ailments. Often, nurses are presented with difficult situations where being an advocate becomes paramount to the healing of the patient. One of the issues that patients with acute and chronic illnesses or extended hospitalization face is a tendency to become depressed. The nurse’s role in this situation requires more than just attention to the physical problem. Another situation where a nurse may need to shift his or her care is when a patient presents with a suspicious injury or illness. In addition to considering the legal and ethical responsibilities of the nurse, he or she must consider the psychological undertones that may be present. NURS 4005 4006 Discussion: Psychological Complications Resulting From Illnesses and Injuries

For this Discussion, you will consider delicate situations that nurses often face and analyze the implications of these situations. Reflect on a patient care situation in which you have encountered one of the following:

  • A suspicious illness or injury
  • Depression resulting from illness or injury

Then, locate at least one scholarly journal article related to your patient care situation that offers strategies for managing the circumstances. NURS 4005 4006 Discussion: Psychological Complications Resulting From Illnesses and Injuries

By Day 3

Respond to the following:

  • Explain your patient encounter, highlighting the challenges the situation presented, and briefly summarize the contents of your journal article.
  • What strategies did you employ to help handle the situation? What other strategies could you have used?
  • How did you advocate for the patient in the situation?
  • What are some of the legal and ethical implications that need to be considered when providing care for patients with depression resulting from illnesses or injuries or suspicious illnesses or injuries? NURS 4005 4006 Discussion: Psychological Complications Resulting From Illnesses and Injuries

Note: Avoid using personal information (e.g., names, facility name, etc.) in your post.

Support your response with references from the professional nursing literature.

Note Initial Post: A 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old).

By Day 7

Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).

Respond with a comment that asks for clarification, provides support for, or contributes additional information to two or more of your colleagues’ postings.

Post a Discussion entry on three different days of the week. Refer to the Discussion Rubric found in the Course Information and Grading Criteria area.

Submission and Grading Information NURS 4005 4006 Discussion: Psychological Complications Resulting From Illnesses and Injuries

N521 – State’s nurse practice act (NPA) advanced practice nurses (CNPs, CRNAs, CNMs, CNSs prescription regulation discussion essays

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N521 – State’s nurse practice act (NPA) advanced practice nurses (CNPs, CRNAs, CNMs, CNSs prescription regulation discussion essays

Discussion 1

Locate your state’s nurse practice act (NPA) and associated regulations governing prescribing by advanced practice nurses (CNPs, CRNAs, CNMs, CNSs). Answer and discuss the following in this forum:

  1. Does your NPA require the APRN to have a collaborative agreement with a physician? Discuss whether you think the NPA should or should not require the APRN to have a collaborative agreement, and explain why/why not.
  2. Does your NPA require the APRN to have a prescribing agreement with a physician? Discuss whether you think the NPA should or should not require the APRN to have a prescribing agreement, and explain why/why not.
  3. Does your NPA permit APRNs to prescribe all classes (schedules) of medications? Discuss whether you think the NPA should or should not permit APRNs to prescribe all classes of medications, and explain why/why not.
  4. Describe collaborative approaches to treating rashes across the lifespan. Should the CNP treat without a collaborator or consultant? Support your statements based upon evidence.

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Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.

Discussion 1

1.     Virginia Law requires licensed nurse practitioners to have collaborative agreement with a physician. After a nurse practitioner has practiced for the equivalent of five years full time, they may be issued a license that states they may practice without a physician agreement (Medical Practice Act of the Code of Virginia, 2020). I do not disagree with this, in fact, I think that it would be beneficial for nurse practitioners to have residencies, like that of care providers.

2.     Virginia Law requires licensed nurse practitioners to have a prescribing agreement with a practice and supervising physician for their first two years of practicing as a nurse practitioner. This was put into law through Executive Order 57, that was signed by the Virginia Governor in April of this year. Previously a nurse practitioner had to have practiced for five years before the requirement to have an electronic agreement with a physician would no longer be necessary (Code of Virginia, 1999). Requiring nurse practitioners to have a prescribing agreement during the first two years of practice is sensible. Medication safety should be major focus of all practitioners. From 2009 to 2012 more than half of Americans were on at least one prescription medication (Arcangelo et al., 2017).

3.     VA laws support the prescribing of schedule II through schedule VI, depending on the electronic practice agreement that the nurse practitioner is in. Per Virginia code, schedule VI “Any compound, mixture, or preparation containing any stimulant or depressant drug exempted from Schedules III, IV or V and designated by the Board as subject to this section” but also includes devices which require a physician order to purchase (Medical Practice Act of the Code of Virginia, 2020). With the rise of medical marijuana legalization, there should be an individual licensure available to providers to be able to prescribe this in areas where the practice is accepted.

4.     Skin is the largest organ and one of our first defenses against bacteria, viruses, and injury. Across the life span there are multiple rashes that our patients may experience. Treating rashes in the primary care setting, can be difficult as one disease can present in multiple ways, similar rashes can have differential diagnosis. Collaborating with specialist and more experienced practitioners can prevent the use of unnecessary prescriptions and decrease unnecessary costs.

References

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2017). Pharmacotherapeutics for advanced practice. (Fourth Edition). Wolters Kluwer.

Medical Practice Act of the Code of Virginia, Va. Stat. §§ 54.1-2957 (2020). http://www.dhp.virginia.gov/media/dhpweb/docs/nursing/leg/MedPractAct_Nursing.pdf

Code of Virginia, Va. Stat. § 54.1-3455. (1999). https://law.lis.virginia.gov/vacode/title54.1/chapter34/section54.1-3455/

 

Discussion 2

In the state of Connecticut, advanced practice registered nurses (APRNs) such as certified nurse practitioners (CNPs) have full practice authority (FPA).  This means that APRNs are allowed to practice autonomously to the fullest extent of their education, training, knowledge, and skills (AANP, 2020). However, immediately after initial licensure, the Connecticut State Nurse Practice Act (NPA) requires that the APRN enters into an agreement with a licensed practicing physician in the state for a period of three years (Connecticut State Department of Public Health, 2020). This must be in a written agreement as stipulated in the Connecticut general statutes §20-87a(2). I believe there should not be any restrictions on the scope of practice for APRNs whatsoever. Restrictions and requirements for supervision by a physician (even if it is just for the first three years of practice as in the case of Connecticut) hinders the APRN from exercising their knowledge and skills freely (Ortiz et al., 2018; Peterson, 2017; Duncan & Sheppard, 2015). In my opinion, the benefit of the initial 3 years of the agreement allows the APRN to gain valuable experience with a more experienced physician. After those years, the APRN can now practice independently and autonomously in Connecticut.

            In the initial three years after graduating and getting licensure. In the agreement (Conn. Gen. Stat. §20-87a(3)), the physician will supervise the APRN prescribing and decide the level of Schedule II and III controlled substances the APRN can prescribe (Connecticut State Department of Public Health, 2020). Again, not allowing APRNs to prescribe all classes of scheduled medications is hindering their practice and the provision of primary health care (PHC). A collaborative approach to treating rashes across the lifespan involves the CNP treating the patient at first contact (PHC). However, if the condition does not resolve, the CNP should refer the patient to a Dermatologist.

References

American Association of Nurse Practitioners [AANP] (October 20, 2020). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environment

Connecticut State Department of Public Health (2020). Connecticut general statutes chapter 378 – Nursing. https://portal.ct.gov/DPH/Public-Health-Hearing-Office/Board-of-Examiners-for-Nursing/Board-of-Examiners-for-Nursing

Duncan, C.G. & Sheppard, K.G. (2015). Barriers to nurse practitioner full practice authority (FPA): State of the science. International Journal of Nursing Student Scholarship, 2. https://journalhosting.ucalgary.ca/index.php/ijnss/article/view/56778

Ortiz, J., Hofler, R., Bushy, A., Lin, Y-L., Khanijahani, A., & Bitney, A. (2018). Impact of nurse practitioner practice regulations on rural population health outcomes. Healthcare (Basel), 6(2), 65-72. https://doi.org/10.3390/healthcare6020065

Peterson, M.E. (2017). Barriers to practice and the impact on health care: A nurse practitioner focus. Journal of the Advanced Practitioner in Oncology, 8(1), 74-81. https://doi.org/10.6004/jadpro.2017.8.1.6.

 

 

Discussion 3

Locate your state’s nurse practice act (NPA) and associated regulations governing prescribing by advanced practice nurses (CNPs, CRNAs, CNMs, CNSs). Answer and discuss the following in this forum:

  1. Does your NPA require the APRN to have a collaborative agreement with a physician? Discuss whether you think the NPA should or should not need the APRN to have a collaborative agreement, and explain why/why not.
  2. Does your NPA require the APRN to have a prescribing agreement with a physician? Discuss whether you think the NPA should or should not require the APRN to have a prescribing agreement, and explain why/why not.
  3. Does your NPA permit APRNs to prescribe all classes (schedules) of medications? Discuss whether you think the NPA should or should not permit APRNs to prescribe all classes of medications, and explain why/why not.

In my state, Idaho, nurse practitioners (NPs) have full practice authority (FPA) within their scope of practice. The scope of practice for NPs relates to the population focus of study and the specific specialization the advanced nurse practitioner obtained. In Idaho, advanced practice focus recognized are family/individual across the lifespan, adult-gerontology, women’s health/gender-related, neonatal, pediatrics, and psychiatric-mental health. A physician collaborative agreement and a prescribing agreement is not required. This means that Idaho state law allows NPs independent responsibility to assess, diagnose, treat, and monitor medical conditions. NPs are permitted to order and interpret tests, order or prescribe nonpharmaceutical therapies, and pharmaceuticals including schedule II through V controlled substances. If NPs received their education after December 31, 2015, they are automatically granted prescriptive authority when they receive their NP Idaho license. Following this, thirty hours of continuing education in advanced nursing pharmacotherapeutics is required upon renewal of license every two years (American Association of Nurse Practitioners, 2020; Idaho Board of Nursing, 2020). N521 – State’s nurse practice act (NPA) advanced practice nurses (CNPs, CRNAs, CNMs, CNSs prescription regulation discussion essays

According to studies comparing states that have given NPs FPA with those states with restrictions, states with NP FPA have shown improvement in access of care for populations in rural, underrepresented locations, improved efficiency in care allowing for prompt care rather than delayed care, the cost burden is decreased and promotes patient-centered care allowing patients to choose their primary caregivers (American Association of Nurse Practitioners, 2019). Further studies examine the educational preparation of NPs. Rather than strictly time-based clinicals, NPs educational programs are competency-based, meaning advanced skills must be demonstrated to advance in their program. Along with competency-based knowledge and skillsets, NPs services have been studied and evaluated for years showing that NPs persistently provided superior quality and safe care demonstrated by positive clinical outcomes (American Association of Nurse Practitioners, 2017). I have been studying and reading about NPs’ positive clinical outcomes for years, and it is my humble opinion that NPs should be fully independent. The claim that NPs expanded role in primary care was harmful to patients is not substantiated with studies that show increased patient satisfaction and improved patient care outcomes. Physicians and NPs can and do work together and provide collaborative care that shows ongoing promise for enhancing patient health and health care outcomes. The medical home model demonstrates this collaborative care process that fits the functions of primary care in providing comprehensive and coordinated patient care, patient-centered care, and improved timely access to medical services patients need (Institute of Medicine, 2011; U.S. Department of Health & Human Services, n.d.).

  1. Describe collaborative approaches to treating rashes across the lifespan. Should the CNP treat without a collaborator or consultant? Support your statements based upon evidence.

Some unambiguous rashes that respond well to standard treatment may not need other multidisciplinary specialty input; however, it is essential for the nurse practitioner to recognize if and when skin conditions need further interprofessional collaboration and specialty referrals. Studies show improved patient outcomes when multidisciplinary approaches are used to treat various skin conditions. For instance, patients who do not respond to common acne treatment may need a dermatologist referral for further evaluation and workup for advanced treatment recommendations. Patients with eczema related to allergies would need multidisciplinary care involving an allergist, nutritionist, and dermatologist. Patients with skin cancer would require collaboration and specialty care of a dermatologist, dermatology oncology, radiation, and surgical oncology, etc. (Hilton, 2018; Arcangelo, Peterson, Reinhold, & Wilbur, 2017; LeBovidge, et al., 2016).

References:

American Association of Nurse Practitioners. (2019, December). Issues at a glance: Full practice authority. https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-full-practice-brief

American Association of Nurse Practitioners. (2017). Clinical outcomes: The yardstick of educational effectiveness. https://www.aanp.org/advocacy/advocacy-resource/position-statements/clinical-outcomes-the-yardstick-of-educational-effectiveness

American Association of Nurse Practitioners. (2020, October 20). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environment

Arcangelo, V. P., Peterson, A., Reinhold, J., & Wilbur, V. (2017). Pharmacotherapeutics for advanced practice: A practical approach. Philadelphia: Wolters Kluwer.

Hilton, L. (2018, February 17). Multidisciplinary care improves patient outcomes. https://www.dermatologytimes.com/view/multidisciplinary-care-improves-patient-outcomes

Idaho Board of Nursing. (2020, July 1). Rules of the Idaho Board of Nursing. https://adminrules.idaho.gov/rules/current/24/243401.pdf

Institute of Medicine of the National Academies. (2011). The future of nursing: Leading change, advancing health. Washington, D.C: National Academies Press. https://www.nap.edu/read/12956/chapter/1#iv

LeBovidge, J. S., Elverson, W., Timmons, K., Hawryluk, E., Rea, C., Lee, M., & Schneider, L. (2016, August 1). Multidisciplinary interventions in the management of atopic dermatitis. The Journal of Allergy and Clinical Immunology, 325-334. https://www.jacionline.org/article/S0091-6749(16)30145-2/fulltext

U.S. Department of Health & Human Services. (n.d.). Defining the PCMH. https://pcmh.ahrq.gov/page/defining-pcmh

 

 

 

Discussion 4

The state of Kentucky requires advanced practice registered nurses (APRN) to have a collaborative agreement with a physician.  A collaborative practice requires an agreement with the nurse practitioner and the physician that uses a referral-consultant relationship (Arcangelo et al., 2017, p. 8).  Advanced practice nurses in Kentucky must use a collaborative agreement with a physician to prescribe class II-V drugs until they have been practicing for a minimum of four years.  After four years the advanced practice nurse may practice without a collaborative agreement for the advanced practice registered nurse’s prescriptive authority for nonscheduled legend drugs or the nurse can choose to continue with the agreement (H.R. Resolution KRS 314.011, 2014, p. 5).  According to the federal trade commission (FTC), collaborative agreements lead to an increase in health care costs, reduced quality of patient care, and limiting patients access to healthcare (Hoebelheinrich & Ramirez, 2020, p. 11).   Collaborative approaches to treating a rash include not only the nurse practitioner but also an educator, dermatologist, and physician recommendations.  It would be beneficial to the nurse practitioner if he/she used the guidance from a dermatologist if traditional treatments failed.

 

References

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2017). Pharmacotherapeutics for Advanced Practice: a practical approach (4th ed.). Wolters Kluwer.

H.R. Res. KRS 314.011, 8 Cong. Rec. 1 (2014) (enacted). https://kbn.ky.gov/practice/Documents/ARNPPresAuthSched.pdf

Hoebelheinrich, K., & Ramirez, J. P. (2020). Do Collaborative Practice Agreements Make APRNs Safe Practitioners?. Nebraska Nursing News, 37(1), 1–14. Retrieved December 23, 2020, from https://doi.org/https://center4nursing.nebraska.gov/sites/center4nursing.nebraska.gov/files/doc/Do%20Collaborative%20Practice%20Agreements%20Make%20APRNs%20Safe%20Practitioners%20-%20Hoebelheinrich%20%26%20Ramirez%20%E2%80%93%20Nursing%20News%20Winter%202020.pdf

Texas State APRNs Prescriptive Authority

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Texas State APRNs Prescriptive Authority

APRNs in Texas do not have full practice authority under current state law. While doctors no longer have to be on-site to supervise, APRNs must have a collaborative agreement with a physician. This collaborative agreement requires that the supervising physician conduct chart reviews and hold monthly meetings with the APRN to discuss care plans and any issues with patient care.  According to the Texas nursing practice act, APRNs must have written prescriptive delegation from a supervising physician. This allows the APRN to prescribe medications, including controlled substances. However, the supervising physician’s name, address, and telephone number must be included on the prescription drug order. If the prescribed medication is a controlled substance, the supervising physician’s DEA number must also be included. In addition, APRNs may only prescribe controlled substances in Schedule II in a hospital based facility and as part of care relating to a patient  who has been admitted to the hospital for a length of stay of 24 hours or grater, or is receiving services or is receiving services in the emergency department or as part of the plan of care for the treatment of a person who has a terminal illness and is receiving hospice care. Other schedule related restrictions for APRNs include limiting prescriptions of controlled substances in III-V to a 90 day supply and requiring consultation with delegating physicians for patients under 2 years old ((Frequently Asked Questions – Advanced Practice Registered Nurse 2013). Texas State APRNs Prescriptive Authority

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In the state of Texas, the collaborative and prescribing agreement are considered the same so for the purposes of this discussion, my answer is the same for both questions. I think that some APRNs in Texas should be able to practice independently. Texas is a very large state (geographically) with large rural areas. These areas are traditionally underserved and APRNs, particularly Family Nurse Practitioners could help increase access to medical care in these areas. However, I do think that there should be some limitations, depending on scope of practice. The current practice act gives APRNs quite a bit of leeway in determining appropriate scope. Requiring a collaborative physician is an attempt to limit instances where APRNs might try to provide care out of their scope. I also think that nurse anesthetists and certified nurse midwives should have collaborative agreements with physicians of some sort. While current laws may be overly restrictive, these are practice areas in which I think it might be beneficial to have a collaborative team. In the case of prescriptive authority for Schedule II-V drugs, I think that current regulations are reasonable because the state does allow APRNs to prescribe all classes of medications. I do think that NPAs should allow APRNs to prescribe all classes of drugs. However, there should be some limitations based on the APRNs education and practice setting.

Dermatologic conditions such as rashes can be difficult to treat because there are many potential causes. Rashes can be caused by viruses, fungi, physical irritation, parasites, plants, insects, bacteria, and even some autoimmune disorders (Rashes, 2020). and treatment will depend on the cause. While most APRNs can easily manage common rashes, determination of the cause of rare or unusual rashes may present a challenge for even the most experienced clinicians. As such, it is important to ensure that proper assessment is taking place. Collaboration could look like having multiple providers examine the rash and determining which, if any, laboratory tests should be ordered.

 

References

Frequently Asked Questions – Advanced Practice Registered Nurse. (2013). Retrieved

December 23, 2020, from https://www.bon.texas.gov/faq_practice_aprn.asp

Rashes. (2019, June 20). Retrieved December 24, 2020, from https://ufhealth.org/rashes

Discussion 1

Locate your state’s nurse practice act (NPA) and associated regulations governing prescribing by advanced practice nurses (CNPs, CRNAs, CNMs, CNSs). Answer and discuss the following in this forum:

  1. Does your NPA require the APRN to have a collaborative agreement with a physician? Discuss whether you think the NPA should or should not require the APRN to have a collaborative agreement, and explain why/why not.
  2. Does your NPA require the APRN to have a prescribing agreement with a physician? Discuss whether you think the NPA should or should not require the APRN to have a prescribing agreement, and explain why/why not.
  3. Does your NPA permit APRNs to prescribe all classes (schedules) of medications? Discuss whether you think the NPA should or should not permit APRNs to prescribe all classes of medications, and explain why/why not.
  4. Describe collaborative approaches to treating rashes across the lifespan. Should the CNP treat without a collaborator or consultant? Support your statements based upon evidence.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria. Texas State APRNs Prescriptive Authority

APRNs Prescriptive Authority in Florida

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APRNs Prescriptive Authority in Florida

In the state of Florida, the NPA now allows APRN’s to practice independently with a few practice authorities in place. Some of the requirements include a completion of three specific graduate level courses within a timeframe, at least 3,000 clinical hours, and a financial responsibility of liability coverage. The APRN may engage in autonomous practice only in primary care practice of family medicine, pediatrics, or internal medicine. They can admit, manage care, and discharge the patients.

“A collaborative practice agreement is a written statement that defines the joint practice of a physician and an APN in a collaborative and complementary working relationship” (Herman & Ziel, 1999).  In my opinion, APRN’s should have a collaborative agreement with a physician. Whether they are new or have been practicing for a long time, coming across a diagnosis or situation they are unfamiliar with may happen. Having the resource of bouncing ideas off of a physician with more education or experience is beneficial for the nurse and the patient. APRNs Prescriptive Authority in Florida

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With a collaborative practice agreement, APRN’s work under a physician but can independently prescribe after the appropriate education, courses, and approval by the Florida board of nursing. If the NP is practicing autonomously, they may prescribe any drug and schedule II-V controlled substances. I agree that APRN’s should be able to prescribe to their ability. The prevalence of nurse practitioners seeing patients is increasing daily, therefore, in order to see the abundance of patients, this is beneficial and necessary. The appropriate education and pharmacology courses prepares them for the job. “The authority of prescription has become a reality amongst nurses in a great number of countries in response to growing demands for healthcare, tight budget constraints and the growth of nursing specialties as a result of the expansion and advancement of their scope of practice” (Ling, et al., 2018).

Treatment of a rash is within the scope of a CNP. The practitioners are trained to perform thorough physical assessments, obtain medical histories, diagnose, and treat accordingly. “A registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice” (Fagerstrom, 2012). It is partly necessary for the CNP to have experience in the appropriate point in the lifespan, however, in a broad spectrum it can be done. This also goes back to the collaboration between the APRN and the physician. If they are unfamiliar with the certain condition, it is a learning opportunity to refer to the physician, develop the appropriate treatment plan for the age, and prescribe the correct medications. APRNs Prescriptive Authority in Florida

 

References

Fagerstrom, L. (2012). The impact of advanced practice nursing in healthcare: recipe for developing countries. Annals of neurosciences. 19(1): 1-2.

Florida Scope of Practice Policy (2020). Practice Authority. Retrieved from: https://scopeofpracticepolicy.org/states/fl/

Herman, J., and Ziel, S.(1999). Collaborative practice agreements for advanced practice nurses: what you should know. AACN Clinical Issues. 10(3): 337-42.

Ling, D.L., Lyu, C.M., Liu, H., Xiao, X., and Yu, H.J. (2018). The necessity and possibility of implementation of nurse prescribing in China: An international perspective. International Journal of Nursing Sciences. 5(1): 72-80.

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Discussion 1

Locate your state’s nurse practice act (NPA) and associated regulations governing prescribing by advanced practice nurses (CNPs, CRNAs, CNMs, CNSs). Answer and discuss the following in this forum:

  1. Does your NPA require the APRN to have a collaborative agreement with a physician? Discuss whether you think the NPA should or should not require the APRN to have a collaborative agreement, and explain why/why not.
  2. Does your NPA require the APRN to have a prescribing agreement with a physician? Discuss whether you think the NPA should or should not require the APRN to have a prescribing agreement, and explain why/why not.
  3. Does your NPA permit APRNs to prescribe all classes (schedules) of medications? Discuss whether you think the NPA should or should not permit APRNs to prescribe all classes of medications, and explain why/why not.
  4. Describe collaborative approaches to treating rashes across the lifespan. Should the CNP treat without a collaborator or consultant? Support your statements based upon evidence.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria. APRNs Prescriptive Authority in Florida

N521-Advanced Pharmacology Module Two: Pharmacokinetics and Pharmacodynamics

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N521-Advanced Pharmacology Module Two: Pharmacokinetics and Pharmacodynamics

Module 2 Overview
Introduction
All medications and remedies are made of chemical substances. As such, those substances can have interactions and responses of various types to other drugs or to the patient’s chemical makeup, too. This week we will explore those interactions and intended responses as we look at Pharmacokinetics and Pharmacodynamics. We will also explore the use of complementary and alternative therapies and possible desirable and undesirable effects when these therapies are intertwined with prescribed medications.

Learning Objectives
After completing this module, you will be able to:

Discuss the mechanism of action of each major drug class and natural product at the molecular/cellular and organ/organ system level.
Identify the fundamental principles of pharmacology related to prescribed drugs, over-the-counter drugs and natural products.
Evaluate common side effects and interactions associated with the major classes of drugs.
Utilized evidence-based practice to prevent drug interactions and adverse events
Reading & Resources
Read Chapter 2, 3, 6, 9 & 59 InArcangelo, V. P., & Peterson, A. M. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins. N521-Advanced Pharmacology Module Two: Pharmacokinetics and Pharmacodynamics

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Learning Activities

Discussion: Participate in Discussion 2.
Test: Complete Progress Test 1. Click on the Progress Test 1 link for more details.
Discussion 2
A.C. is a 60-year-old Caucasian woman with newly diagnosed peptic ulcer disease, generalized anxiety disorder, and iron deficiency anemia. She also has a long history of asthma and depression. She is a strong believer of herbal medicine. She takes St. John’s wort for her depression, iron pills for her anemia, and alprazolam (Xanax) as needed for her anxiety. During her asthma exacerbation, she is instructed to take prednisone for at least 5 days. She also takes esomeprazole (Nexium) for her peptic ulcer disease. Three months later, she experienced severe fatigue, shortness of breath, dizziness, and swelling/soreness in the tongue. Her asthma is well controlled with the occasional use of albuterol (Proventil) inhaler. During her physical exam, her physician suspected that she had bacterial vaginosis and gave her a prescription for a 1-week course of metronidazole (Flagyl). She drinks at least two to three cans of beer per day.

Review the above case and post a discussion that evaluates the potential for interactions that may increase drug availability. What is the cause of increased drug availability? Evaluate for interactions that will decrease drug availability. What is the cause of decreased drug availability? What recommendations may be made concerning the co-administration of these medications?

Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria. N521-Advanced Pharmacology Module Two: Pharmacokinetics and Pharmacodynamics

N521-Advanced Pharmacology Discussion 3 Mild Persistent Asthma

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N521-Advanced Pharmacology Discussion 3 Mild Persistent Asthma

Discussion 3

M. L. is a 15-year-old Hispanic female who plays soccer for her school team. She has noticed that when running, she sometimes has trouble catching her breath. She also reports an increased runny nose and itchy eyes. She has a frequent dry cough and is awakened with coughing spells at least four times a week. Her mother and father have seasonal allergies and her mother has asthma. This morning she woke up and heard “funny sounds” when she took a breath. Her coughing increased when she took a deep breath. In her nose, the mucosa is pale and swollen bilaterally. Her lungs have bilateral expiratory wheezing; respirations are 22 and PEF is 400. Her heart shows a normal sinus rhythm, with no murmurs or gallops; pulse is 72; and there is no cyanosis.

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Diagnosis: Mild Persistent Asthma

In this discussion forum:

  1. Discuss specific goals of pharmacotherapy for treating M. L.’s mild persistent asthma.
  2. Discuss the drug therapy a CNP would likely prescribe and why.
  3. Discuss the parameters for monitoring the success of the therapy.
  4. Discuss age appropriate health promotion recommendations you would consider for M. L.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria. N521-Advanced Pharmacology Discussion 3 Mild Persistent Asthma

N521-Advanced Pharmacology Module Three: Special Populations – Across the lifespan

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N521-Advanced Pharmacology Module Three: Special Populations – Across the lifespan

 

Module 3 Overview

Introduction

This week we will explore pharmacotherapy for special populations such as pediatrics, geriatrics, the pregnant patient and nursing mothers, as well as examining the interactions of over-the-counter medications to prescribed therapies.  The advanced practice nurse must be familiar with pathophysiologic changes related to age and disease.  Considerations for prescriptive therapy must be based upon the uniqueness of each diverse patient.

Learning Objectives

After completing this module, you will be able to:

  • Utilize advanced nursing and pharmacological interventions in select case studies to resolve complex and biological, psychological, physiological and pathophysiologic conditions.
  • Synthesize pathophysiologic changes related to the lifespan and recommend approiate evidence-based prescribing behaviors
  • Teach patients, family members, and others from diverse populations regarding safe and effective use of drugs and natural products. N521-Advanced Pharmacology Module Three: Special Populations – Across the lifespan

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Reading & Resources

Read Chapters 4, 5, 6, 7 & 14 In Arcangelo, V. P., & Peterson, A. M. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.

Learning Activities

  • Discussion: Participate in Discussion 3.
  • Test: Complete Progress Test 2. Click on the Progress Test 2 link for more details.

Discussion 3

M. L. is a 15-year-old Hispanic female who plays soccer for her school team. She has noticed that when running, she sometimes has trouble catching her breath. She also reports an increased runny nose and itchy eyes. She has a frequent dry cough and is awakened with coughing spells at least four times a week. Her mother and father have seasonal allergies and her mother has asthma. This morning she woke up and heard “funny sounds” when she took a breath. Her coughing increased when she took a deep breath. In her nose, the mucosa is pale and swollen bilaterally. Her lungs have bilateral expiratory wheezing; respirations are 22 and PEF is 400. Her heart shows a normal sinus rhythm, with no murmurs or gallops; pulse is 72; and there is no cyanosis.

Diagnosis: Mild Persistent Asthma

In this discussion forum:

  1. Discuss specific goals of pharmacotherapy for treating M. L.’s mild persistent asthma.
  2. Discuss the drug therapy a CNP would likely prescribe and why.
  3. Discuss the parameters for monitoring the success of the therapy.
  4. Discuss age appropriate health promotion recommendations you would consider for M. L.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria. N521-Advanced Pharmacology Module Three: Special Populations – Across the lifespan