PICOT/Evidence Appraisal Assignment – nr439

Purpose

Clear identification of the problem or opportunity is the first step in evidence-based nursing. This assignment offers a tool to assist in the identification of the problem, proposed intervention, and desired outcomes. Completion of the assignment will include identification of the problem or concern using the PICOT format.

Course Outcomes

This PICOT/Evidence Appraisal Assignment – nr439 assignment enables the student to meet the following Course Outcome.

CO1: Examine the sources of evidence that contribute to professional nursing practice. (PO7)

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Due Date

Submit the completed PICOT Worksheet form (Links to an external site.)Links to an external site. by Sunday, 11:59 p.m. MT at the end of Week 3.

Points

This PICOT/Evidence Appraisal Assignment – nr439 assignment is worth 200 points.

Directions

Read these guidelines including the grading rubrics below. Watch this video on how to complete the assignment at http://www.brainshark.com/devry/vu?pi=zHZzQomrNzHr05z0 (Links to an external site.)Links to an external site.

Download the PICOT Worksheet form (Links to an external site.)Links to an external site..

Consider what is the nursing problem or issue that you have uncovered. Make sure it is related to nursing, i.e., one that a nurse can solve independently. Do not select a medical problem that is dependent upon a medical professional to resolve.

Download an Example (Links to an external site.)Links to an external site. of how to fill in the worksheet to help you complete your own form. PICOT/Evidence Appraisal Assignment – nr439

Submit the completed PICOT Worksheet form.

Example 1:

What is the PICO(T) question?

Will influenza immunization compliancy rates increase if flu clinics are provided in a Flu PODS and immunization clinics at convenient times covering all shifts?

Define each element of the question below:

P- (Patient, population, or problem): Hospital employees and volunteers required to have the influenza immunization annually

I -(Intervention): Offer multiple Flu “PODS” and immunization clinics to hospital employees and volunteers making it convenient to receive the required immunization. Offer at a variety of times, available to all shifts

C- (Comparison with other treatment/current practice): Compare analytics showing employees and volunteers who received flu shot prior to 2016 when Flu PODS and immunization clinics were not offered compared to 2016 where Flu PODS and immunization clinics are offered to accommodate shifts. Track number of employees/volunteers coming at each hour time frame.

O- (Desired outcome): Increase of compliance of receiving the annual mandatory flu shot by employees and volunteers

Example 2:

What is the PICO(T) question?

For non-diabetic patients on corticosteroid therapy, does monitoring for headache, fatigue, nausea, vomiting, and blurred vision hourly vs. no observations for signs of hyperglycemia promote improvement of pulmonary complications?

Define each element of the question below:

P- (Patient, population, or problem): Non-diabetic patients on corticosteroid therapy.

I- (Intervention): Monitoring for headache, fatigue, nausea, vomiting, and blurred vision

C- (Comparison with other treatment/current practice): No observations for signs of hyperglycemia

O- (Desired outcome): Improvement of pulmonary complications

T-(Time): 90 days

PICOT/Evidence Appraisal Assignment – nr439

Advanced Registered Nurse Scope of Practice Essay

Scope of practice

Part 1. A discussion of the scope of your future role as an advanced registered nurse, including any regulatory, certification, or accreditation agencies that define that scope.

My motivation for gaining an advanced registered nurse qualification is to become an educator who prepares the next crop of nurses for practice. I expect that being a nurse educator will allow me to engage individuals aspiring to become nurses in a formal education process where I will impart professional nursing skills and concepts. I anticipate that being an educator is a specialty role for advanced registered nurses since it deviates from the traditional role of nurses to engage patients in providing primary care, and instead move towards preparing future nurses for practice (Grinspun & Bajnok, 2018).

I anticipate that my ability to practice as a nurse educator will be determined by four elements. The first element is the regulatory requirements. Like any other education program, nursing programs are managed by professional bodies that determine if the educators are qualified to prepare students at the level of education. This includes having the right accreditation and certification that is recognized by the relevant authorities, and considered as an indication of qualification as an educator. The second element is educational background. A higher level of education is typically preferred since it is indicative of professional proficiency and knowledge, as well as familiarity with important concepts that influence practice Advanced Registered Nurse Scope of Practice Essay. It is not uncommon for educators to be engaged in research activities and to be authorities who have published materials. Successfully completing education courses are also preferred since this is an indication of an understanding of how to educate others having understood the different education theories and what learners require (Cherry & Jacobs, 2013).

The third element is the work conditions. Good earning potential and work conditions can be good motivators for taking on the role of an educator. For instance, a tenured position would be preferable over a non-tenured position since it offers greater job security, autonomy and permanency that reduces work-related stress. The final element is the educator responsibilities and roles. This element influences practice as an educator through matching capabilities to expectations such as advising students, teaching, practicing as a nurse, and conducting research. Each education institution has unique expectations of its faculty members, and these expectations must be matched to capabilities (Milstead & Short, 2019).

There are two agencies that define the scope of practice for advanced registered nurses who take on the role of educators. The first agency is the National League for Nursing (NLN) that offers accreditation services for nurse educators across the USA. The agency exercises its accreditation authority through the Commission for Nursing Education Accreditation (CNEA), as a branch of NLN whose singular responsibility is to accredit nurse educators with a focus on ensuring that education services focus on the core values of excellence, caring, diversity and integrity. The second agency that defines the scope of practice for nurse educators is the National Commission for Certifying Agencies (NCCA). This is a national agency that offers certification to nurse educators. It draws its authority from the National Organization for Competency Assurance (NOCA). The NCCA has the primary responsibility of certifying nurse educators using the most current practice standards, a responsibility that it fulfils through regularly updating its certification requirements and ensuring that nurse educators meet the requirements before being permitted to practice.

There are two certification programs that define the scope of practice for nurse educators. Firstly, the certified nurse education program enables nurse educators to facilitate learning activities in nurse education facilities. Some of the activities that the program permits educators to engage in include curriculum design, as well as teaching, advising and evaluating nursing students. Secondly, the certified nurse educator program enables nurse educators to facilitate the clinical components of nurse learning activities (Black, 2016).

Part 2. A discussion of three professional nursing organizations that you think are most influential in advancing the scope and influence of advanced nursing.

The three professional nursing organizations that are most influential in advancing the scope and influence of advanced nursing are the NLN, American Association for Colleges of Nursing (AACN) and Organization for Associate Degree Nursing (OADN). The first organization is the NLN that draws members from among nurses and focuses on ensuring that nursing excellence is not compromised. It achieves this by facilitating professional development among advanced registered nurses. This occurs through managing testing services, research grants and teaching resources for its members. Besides that, the NLN has a direct influence on the scope of nurse educators through managing their qualifications for practice and credentialing (National League of Nursing, 2020) Advanced Registered Nurse Scope of Practice Essay.The second organization is the AACN, the national agency whose primary responsibility is to improve the quality of nurse academics. It does this by promoting advanced nursing practice, research and education. This agency focuses on improving health care in general and nursing care delivery in particular through establishing the quality standards for nursing education, In addition, it aids the nursing education institutions to implement these standards. Besides that, it supports professional nursing practice (American Association for Colleges of Nursing, 2020). The third organization is the OADN, the national agency that represents advanced registered nurses and advocates for their interests. It draws its members from among nurses who have associate degree nursing qualifications. The agency’s primary responsibility is to promote an idealized future for advanced registered nurses while enhancing the quality of their education and strengthening their professional roles. Additionally, the agency presents a platform for unifying nurse professionals through supporting networking opportunities and disseminating information even as it partners with other organizations (Organization for Associate Degree Nursing, 2020).

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Concerning the three organizations (NLN, AACN and OADN), perhaps the most important organization is the NLN. It is the oldest nurses’ organization in the USA since it was formed in 1893. It has the most number of members and has much influence. It has 37,000 individual members and 1,200 institutions. The organization focuses on promoting nursing education excellence as its primary mission. It does this through building a diverse and strong nursing workforce with the capacity to advance the health agenda at the global and national levels (National League of Nursing, 2020). NLN is distinctive from the AACN and OADN since it draws members from across the world while the two are restricted to drawing members from the USA. Besides that, the members of NLN are not restricted to any single group and include health care organizations, education organizations, the public, nurse practitioners, and nurse educators. As a member of NLN, I expect to be exposed to nurse diversity since I will have access to a global network of nurses. Additionally, NLN members have access to assessment and testing services, research grants, networking opportunities and development programs that help with professional growth and development. In its long history of existence, the NLN has always remained current by revising its objectives and operations, and continuously renewing itself. These measures ensure that the organization remains relevant with regards to improving, enhancing and expanding the provision of nursing services while supporting efforts to deliver high quality nursing education (National League of Nursing, 2020).

The NLN is aligned with my worldview and philosophy of care. All through its long history, the organization has continuously evolved to remain relevant. I believe that nursing is an evolving profession and there is always room for improvement. As such, I am always open to new knowledge and experiences. Through having access to a large network of nurses and other stakeholders, I am able to engage in discussions, discover new knowledge and contribute to practice changes so that I experience professional growth even as the profession matures. In addition, the organization offers research and education opportunities along with access to current evidence that enhance my practice. As a result, the organization presents many resources that nurses can use to improve professional skills, knowledge and practice.

Part 3. A discussion of a controversial or evolving issue that is most likely to affect your scope of practice or role in the next few years.

Nurses play an important role in health care delivery. Although nursing is typically a rewarding career, particularly for those whose primary focus is on providing care, challenges abound to make it a demanding profession. One of the most controversial issues that nurses face is that they are underpaid and overworked. In fact, many nurses feel that their pay rates are low when considering their duties and responsibilities. The pressure is heightened by the fact that medical organizations are forced to comply with industry regulations and standards around nurse-to-patient ratios. This has created a situation in which nurses either find themselves single-handedly doing the work of two nurses or working for longer than they are supposed to work. The issue also places the health of nurses at risk. This controversial issue has had the inevitable distinction of causing high turnover rates among nurses and low recruitment rates so that nurse number populations remain low. The nurse populations are likely to remain low and the available nurses being overworked unless the pay rate and working hours can be improved (Huff, Kline & Peterson, 2015).

References

Accreditation Commission for Education in Nursing (2020). Home. Retrieved from https://www.acenursing.org/

American Association for Colleges of Nursing (2020). About AACN. Retrieved from https://www.aacnnursing.org/About-AACN

National League of Nursing (2020). About. Retrieved from http://www.nln.org/about

Organization for Associate Degree Nursing (2020). About OADN. Retrieved from https://www.oadn.org/about-us/about-oadn

Black, B. (2016). Professional nursing-e-book: concepts & challenges. New York, NY: Elsevier Health Sciences.

Grinspun, D. & Bajnok, I. (2018). Transforming nursing through knowledge: best practices for guideline development, implementation science, and evaluation. Indianapolis, IN: Sigma Theta Tau International.

Cherry, B. & Jacob, S. (2013). Contemporary nursing, issues, trends, & management (6^th ed.). Amsterdam: Elsevier Health Sciences.

Huff, R., Kline, M. & Peterson, D. (2015). Health promotion in multicultural populations: a handbook for practitioners and students (3^rd ed.). Thousand Oaks, CA: SAGE Publications, Inc.

Stanhope, M. & Lancaster, J. (2014). Public health nursing: population-centered health care in the community (8^th ed.). Maryland Heights, MO: Elsevier/Mosby.

Milstead, J. & Short, N. (2019). Health policy and politics: a nurse’s guide (6^th ed.). Burlington, MA: Jones & Bartlett Learning Advanced Registered Nurse Scope of Practice Essay

Advanced registered nursing graduates are entering the profession at dynamic time when roles and scope of practice are shifting based on developments in legislation and policy in response to the evolving needs of the health care system. Professional nursing organizations play an important role in making sure the perspectives of advanced registered nurses are heard, and in supporting nurse specialties in their efforts to expand their scope of practice and their full participation throughout the health care system.
For this assignment, you will conduct research on the current scope of practice for your specialty and efforts that are being made to expand that scope and the role of the advanced nurse in positively influencing the health care system. Write a 1,250-1,500-word paper that includes the following:
A discussion of the scope of your future role as an advanced registered nurse, including any regulatory, certification, or accreditation agencies that define that scope.
A discussion of three professional nursing organizations that you think are most influential in advancing the scope and influence of advanced nursing. Of these organizations, evaluate the one that you would most like to join. How do its goals and mission fit in with your worldview and philosophy of care? How might membership in this organization improve your practice?
A discussion of a controversial or evolving issue that is most likely to affect your scope of practice or role in the next few years. How do you think this issue could influence the profession and other stakeholders, and why does it matters to the advanced registered nurse?
You are required to cite five to 10 sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required

Family Nurse Practitioner Practicum Experience Reflection: Relationship with Professional Goals and Clinical Skills Self-Assessment

The family nurse practitioner (FNP) role is an important one as we provide both curative and preventive health services to marginalised communities (Hu & Forgeron, 2018). To be precise, the FNP provides primary health care or PHC to the underserved and vulnerable populations in the US who do not have access to a physician.

In my practicum experience as a trainee FNP, I faced some challenges given that it is now that I am beginning to accumulate clinical skills in practicums. A particular patient encounter stands out for me. This was a 34 year-old female patient who came with a chief complaint of dizziness. After history taking and physical examination under the supervision of my preceptor, we reached a diagnosis of vestibular migraine. Family Nurse Practitioner Practicum Experience Reflection: Relationship with Professional Goals and Clinical Skills Self-Assessment. To me, this was the first time that I was beginning to relate theoretical clinical concepts to a real clinical situation. The challenge was immense. I found the synthesis of information from the history and the physical examination to arrive at a diagnosis a challenging but critical clinical skill. Furthermore, ruling out the other differential diagnoses proved to be an uphill task. I however quickly realised that the difficulty I was experiencing was because I had no clinical experience and still did not know how to manage my time in the clinical area (I spent an inordinate amount of time performing each task, like physical examination). From my preceptor, I learnt that in the clinical area I needed to consult other professionals like the physician if I had any difficulty. This effective communication is important (Vermeir et al., 2015). Luckily, I am inclined towards using only evidence-based interventions from my training (EBP) and practice integrity and honesty in following policies, standards of practice, and professional guidelines (Correa-de-Araujo, 2016; Poorchangizi et al., 2019). These attributes helped me a lot.

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My professional goal is to be a FNP that uses evidence-based practice (EBP) to solve community health problems.

References

Correa-de-Araujo R. (2016). Evidence-Based Practice in the United States: Challenges, Progress, and Future Directions. Health Care for Women International, 37(1), 2–22. https://doi.org/10.1080/07399332.2015.1102269.

Hu, J., & Forgeron, P. (2018). Thinking, educating, acting: Developing advanced practice nursing. International Journal of Nursing Sciences, 5(2), 99–100. https://doi.org/10.1016/j.ijnss.2018.04.006.

Poorchangizi, B., Borhani, F., Abbaszadeh, A. et al. (2019). The importance of professional values from nursing students’ perspectives. BMC Nursing, 18(26). https://doi.org/10.1186/s12912-019-0351-1.

Vermeir, P., Vandijck, D., Degroote, S., Peleman, R., Verhaeghe, R., Mortier, E., Hallaert, G., Van Daele, S., Buylaert, W., & Vogelaers, D. (2015). Communication in healthcare: a narrative review of the literature and practical recommendations. International Journal of Clinical Practice, 69(11), 1257–1267. https://doi.org/10.1111/ijcp.12686.

Introduction

Family nurse practitioners (FNP) provide primary care and acute care services while focusing on health promotion and disease prevention. FNPs work in the community setting, nursing homes, clinics, and hospitals to diagnose, make appropriate prescriptions, perform examinations, and provide patient education (Gadbois et al., 2015). In Texas, nurse practitioners attend a high number of patients. Healthcare professionals are assigned with DEA numbers that allow one to prescribe drugs, and this includes legal prescription of controlled substances. This paper will discuss the appropriate prescriptive authority for Lori, a new FNP in Texas. additionally, the process of obtaining the DEA number will be described as well as the safe prescribing practices for Lori as a nurse practitioner.

Appropriate Prescriptive Authority

Lori will require a written agreement with the supervising physician outlining the medications and devices she may prescribe. In Texas, physicians can delegate prescribing and ordering of prescription medications, nonprescription medications, and medical devices and equipment to an APRN. In addition, the supervising can also delegate the prescribing and ordering of Schedules III-V Controlled Substances and Schedule II Controlled Substances to Lori as an APRN, with the specific requirements (Peterson, 2017).

DEA Registration Process

Lori will apply for the DEA number online. She will go to www.deadiversion.usdoj.gov website and then follow all the guiding steps during the application. During application, Lori will need to fill all the six sections that include personal information; practicing state; practice information; background; prescription schedules; and charges. Lori will also need to fill the drug schedules she intends to prescribe (Tierney et al, 2015). After applying, Lori will wait for three business days and the application will be availed for editing or approved Prescriptive authority in Texas, Obtaining the DEA number and safe prescribing practices.To confirm the approval of the DEA number or make any inquiries, Lori can call 800.882.9539. Lori is required to have an active license from the state she intends to practice when applying for the DEA number.

DEA will allow Lori to prescribe mediations classified as ‘controlled substances’ (Tierney et al, 2015). It is therefore clear that DEA regulates and controls prescription of controlled substances by ensuring that APRNs only prescribe the drugs they have authority to prescribe and also prevent APRNs from making illegal prescriptions.

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Lori will have various responsibilities after obtaining her DEA number. Once Lori obtains the DEA number, it will be her responsibility to ensure that she accurately and appropriately prescribes the controlled substances. Texas allows APRNs to prescribe some schedule medications, and as per the agreement with the supervising physician. Therefore, Lori should ensure that she prescribes only the authorized schedule drugs (Dineen & DuBois, 2016).

It is also the responsibility of Lori to make sure that she does not do any illegal prescription and that she prescribes controlled substances on cases that are medically allowed and appropriate. Moreover, Lori will need to enquire if the prescription monitoring program (PMP) allows her to obtain any information regarding the prescription of the controlled substances (Marco et al, 2016). If she is allowed, she had the duty of obtaining the information to determine if there have been illegal prescriptions that have been dispensed utilizing her DEA number. In case she notes illegal prescriptions under her DEA numbers, she should report and forward the information to DEA for further investigations (Tierney et al, 2015).

Safe Prescribing Practices

Safe prescribing practices include Lori ensuring that she only prescribes the medications she is authorized to and as per her scope of practice. If Lori intends to prescribe the controlled substances, she should ensure that she registers with DEA (Green & Stacey, 2015).

Before prescribing opioids, barbiturates or benzodiazepines, Lori should ensure that she checks the history of the patient in the prescription monitoring program (PMP) because there is a PMP in Texas. the PMP collects information from pharmacists and other healthcare providers to facilitate safe patient care during prescription and use of controlled substances. Additionally, the PMP monitors the prescribing of controlled substances to establish if there is any misuse or abuse. Lori will be needed to confirm with the PMP for all prescriptions of the controlled substances to prevent any duplication of their prescriptions (Elder et al, 2018).

Conclusion

A written agreement with the supervising physician indicating the medications and devices Lori can prescribe will be necessary according to the Texas laws. Lori can obtain her DEA number online to allow her to prescribe medications, including controlled substances. Finally, Lori will need to prescribe according to her scope of practice and follow the required prescriptive laws Prescriptive authority in Texas, Obtaining the DEA number and safe prescribing practices.

References

Dineen K & DuBois J. (2016). Between a Rock and a Hard Place: Can Physicians Prescribe Opioids to Treat Pain Adequately While Avoiding Legal Sanction? Am J Law Med. 42(1), 7–52.

Elder J, Garett D & Pines. (2018). Optimal Implementation of Prescription Drug Monitoring Programs in the Emergency Department. West J Emerg Med. 19(2), 387–391.

Gadbois, E. A., Miller, E. A., Tyler, D., & Intrator, O. (2015). Trends in state regulation of nurse practitioners and physician assistants, 2001 to 2010. Medical care research and review: MCRR, 72(2), 200–219. https://doi.org/10.1177/1077558714563763.

Green S & Stacey P. (2015). Optimizing the Use of State Prescription Drug Monitoring Programs for Public Safety. Journal of Nursing Regulation. 6(3), 4–10.

Marco C, Venkat A &Baker EF, et al. (2016). Prescription drug monitoring programs: ethical issues in the emergency department. Ann Emerg Med. 68(5), 589–98.

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.

Tierney M, Finnell D, Naegle M, LaBelle C & Gordon A. (2015). Advanced Practice Nurses: Increasing Access to Opioid Treatment by Expanding the Pool of Qualified Buprenorphine Prescribers. Substance Abuse. 36(4) Prescriptive authority in Texas, Obtaining the DEA number and safe prescribing practices.