This week your Discussion will focus on interprofessional practice. This Discussion is an opportunity for you to examine your perspective and experiences with interprofessional collaborative practice and to apply your knowledge to managing patient care.

To prepare:

Identify a professional nursing organization and review their position on interprofessional practice

Review the following case study: INTERPROFESSION PRACTICE

Case Study:

Ms. Tuckerno has been diagnosed with multiple sclerosis (MS). The patient receives care at an internal medicine clinic. Her internist is not in the office today and she is being treated by the nurse practitioner. The patient is on two medications for her MS, three different blood pressure medications, one medication for thyroid disease, one diabetic pill daily, insulin injections twice a day, she uses medical cannabis, and uses eye drops for glaucoma. Upon assessing the patient, the nurse practitioner (NP) decides her treatment plan should be adjusted. The NP discontinues some of the patient’s meds and discontinues medical cannabis. She orders the patient to follow up in two weeks.

The patient returns and is seen by her internist. The internist speaks with the patient and reviews her medical chart. The internist states to the patient, “I am dissatisfied with the care you received from the nurse practitioner.” The internist places the patient back on originally prescribed medications and medical cannabis.

Post  2 pages on : An explanation of your understanding of interprofessional practice.

 Also, explain the position on interprofessional practice for a professional nursing organization that you are a member of or of which you plan to become a member.

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 Then, explain what you think is the best collaborative approach to manage Ms. Tuckerno’s care.

References

Required Readings

Altman, S. H., Butler, A. S., Shern, L. (Eds.). (2015). Assessing Progress on the IOM Report The Future of Nursing. Washington, DC: The National Academies Press. Retrieved from http://www.nationalacademies.org/hmd/Reports/2015/Assessing-Progress-on-the-IOM-Report-The-Future-of-Nursing.aspx doi: 10.17226/21838

Bankston, K., & Glazer, G., (2013) Legislative: Interprofessional collaboration: What’s taking so long? OJIN: The Online Journal of Issues in Nursing, 19(1).

Buppert, C. (2015). Appendix 11-D: Sample Professional Services Agreement. In Nurse Practitioner’s Business Practice and Legal Guide (5th ed.) (417-422). Burlington, MA: Jones & Bartlett.

Buppert, C. (2015). Legal Scope of Nurse Practitioner Practice. In Nurse Practitioner’s Business Practice and Legal Guide (5th ed.) (37-78). Burlington, MA: Jones & Bartlett.

 Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare redesign. OJIN: The Online Journal of Issues in Nursing, 19(2).

Note: Retrieved from the Walden Library databases.

Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2014). Collaboration. In Advanced Practice Nursing: An Integrative Approach (5th ed.) (299-327). St. Louis, MO: Elsevier Saunders INTERPROFESSION PRACTICE.

To prepare:

· Select a client family that you have observed or counseled at your practicum site.

· Review pages 137–142 of Wheeler (2014) and the Hernandez Family Genogram 

  video in this week’s Learning Resources. (SEE ATTACHED VIDEO TRANSCRIPT)

· Reflect on elements of writing a comprehensive client assessment and creating a  

  genogram for the client you selected ACCESSING CLIENT FAMILIES.

                                                                         The Assignment

                                          Part 1: Comprehensive Client Family Assessment

Create a comprehensive client assessment for your selected client family that addresses (without violating HIPAA regulations) the following:

· Demographic information

· Presenting problem

· History or present illness

· Past psychiatric history

· Medical history

· Substance use history

· Developmental history

· Family psychiatric history

· Psychosocial history

· History of abuse and/or trauma

· Review of systems

· Physical assessment

· Mental status exam

· Differential diagnosis

· Case formulation

· Treatment plan

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                                                Part 2: Family Genogram

Develop a genogram for the client family you selected. The genogram should extend back at least three generations (parents, grandparents, and great grandparents).

N:B. (1)PLEASE THIS ASSIGNMENT HAS 2 PARTS, AND I HAVE ATTACHED A SAMPLE OF THE ASSIGNMENT, BUT THE SAMPLE TALKS ONLY ABOUT HERNANDEZ, BUT THIS ASSIGNMENT IS FOCUS ON HERNANDEZ FAMILY. 

(2). HERNANDEZ FAMILY GENOGRAM VIDEO TRANSCRIPT IS ATTACHED INCASE YOU CAN NOT VIEW THE VIDEO ACCESSING CLIENT FAMILIES

                                                      Learning Resources

Required Readings

Nichols, M. (2014). The essentials of family therapy (6th ed.). Boston, MA: Pearson.

• Chapter 8, “Experiential      Family Therapy” (pp. 129–147)
• Chapter 13, “Narrative Therapy” (pp. 243–258)

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.

• “Genograms” pp. 137-142

Cohn, A. S. (2014). Romeo and Julius: A narrative therapy intervention for sexual-minority couples. Journal of Family Psychotherapy, 25(1), 73–77. doi:10.1080/08975353.2014.881696

Escudero, V., Boogmans, E., Loots, G., & Friedlander, M. L. (2012). Alliance rupture and repair in conjoint family therapy: An exploratory study. Psychotherapy, 49(1), 26–37. doi:10.1037/a0026747

Freedman, J. (2014). Witnessing and positioning: Structuring narrative therapy with families and couples. Australian & New Zealand Journal of Family Therapy, 35(1), 20–30. doi:10.1002/anzf.1043

Phipps, W. D., & Vorster, C. (2011). Narrative therapy: A return to the intrapsychic perspective. Journal of Family Psychotherapy, 22(2), 128–147. doi:10.1080/08975353.2011.578036

Saltzman, W. R., Pynoos, R. S., Lester, P., Layne, C. M., & Beardslee, W. R. (2013). Enhancing family resilience through family narrative co-construction. Clinical Child and Family Psychology Review, 16(3), 294–310. doi:10.1007/s10567-013-0142-2

                                                    Required Media

Governors State University (Producer). (2009). Emotionally focused couples therapy [Video file]. Chicago, IL: Author.

Laureate Education (Producer). (2013b). Hernandez family genogram [Video file]. Baltimore, MD: Author. (SEE ATTACHED VIDEO TRANSCRIPT)

Psychotherapy.net (Producer). (1998). Narrative family therapy [Video file]. San Francisco, CA: Author. ACCESSING CLIENT FAMILIES 

What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient?

These are some of the questions you might consider when selecting a treatment plan for a patient. As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives on a daily basis. Patients and their families will often place trust in you because of your position.

With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. In this Discussion, you explore ethical and legal implications of scenarios and consider how to appropriately respond ETHICAL AND LEGAL IMPLICATION OF PRESCRIBING DRUGS.

Scenario 1:

As a nurse practitioner, you prescribe medications for your patients. You make an error when prescribing medication to a 5-year-old patient. Rather than dosing him appropriately, you prescribe a dose suitable for an adult.

Scenario 2:

A friend calls and asks you to prescribe a medication for her. You have this autonomy, but you don’t have your friend’s medical history. You write the prescription anyway.

Scenario 3:

You see another nurse practitioner writing a prescription for her husband who is not a patient of the nurse practitioner. The prescription is for a narcotic. You can’t decide whether or not to report the incident.

Scenario 4:

During your lunch break at the hospital, you read a journal article on pharmacoeconomics. You think of a couple of patients who have recently mentioned their financial difficulties. You wonder if some of the expensive drugs you have prescribed are sufficiently managing the patients’ health conditions and improving their quality of life.

To prepare:

• – Review Chapter 1 of the Arcangelo and Peterson text, as      well as articles from the American Nurses Association, Anderson and      Townsend, the Drug Enforcement Administration, and Philipsend and Soeken.
• – Select one of the four scenarios listed above.
• – Consider the ethical and legal implications of the      scenario for all stakeholders involved such as the prescriber, pharmacist,      patient, and the patient’s family.
• – Think about two strategies that you, as an advanced      practice nurse, would use to guide your ethically and legally responsible      decision-making in this scenario.

With these thoughts in mind:

Post an explanation of the ethical and legal implications of the scenario you selected on all stakeholders involved such as the prescriber, pharmacist, patient, and the patient’s family. Describe two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario.

– This work should have Introduction and conclusion

– This work should have at 3 to 5current references (Year 2012 and up)

– Use at least 2 references from class Learning Resources ETHICAL AND LEGAL IMPLICATION OF PRESCRIBING DRUGS

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The following Resources are not acceptable:

1. Wikipedia

2. Cdc.gov- nonhealthcare professionals section

3. Webmd.com

4. Mayoclinic.com

Required Readings

**Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

• Chapter 1, “Issues for the      Practitioner in Drug Therapy” (pp. 3–14)
       This chapter introduces issues relating to drug therapy such as adverse      drug events and medication adherence. It also explores drug safety, the      practitioner’s role and responsibilities in prescribing, and prescription      writing.
• Chapter 59, “The Economics      of Pharmacotherapeutics” (pp. 1009-1018)
       This chapter analyzes the costs of drug therapy to health care systems and      society and explores practice guideline compliance and current issues in      medical care.
• Chapter 60, “Integrative Approaches to      Pharmacotherapy—A Look at Complex Cases” (pp. 1021-1036)
       This chapter examines issues in individual patient cases. It explores      concepts relating to evaluation, drug selection, patient education, and      alternative treatment options.

**Crigger, N., & Holcomb, L. (2008). Improving nurse practitioner practice through rational prescribing. The Journal for Nurse Practitioners, 4(2), 120–125.

Note: Retrieved from the Walden Library databases.

This article explores issues relating to prescription drugs, specifically the frequency in which drugs are prescribed to patients. It also examines factors to consider before beginning drug therapy plans with patients.

**Philipsen, N. C., & Soeken, D. (2011). Preparing to blow the whistle: A survival guide for nurses. The Journal for Nurse Practitioners, 7(9), 740–746.

Note: Retrieved from the Walden Library databases.

This article examines issues that nurses encounter when reporting errors in medical settings. It also outlines the role of ethics and the responsibility of nurses to notify all individuals who are impacted by a medical error.

**American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Nursing World. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics-For-Nurses.html

This article outlines ethical standards in the nursing profession and identifies nine provisions of care that must be adhered to by all nurses.

**Anderson, P., & Townsend, T. (2010). Medication errors: Don’t let them happen to you. American Nurse Today, 5(3), 23–28. Retrieved from https://americannursetoday.com/medication-errors-dont-let-them-happen-to-you/

This article examines factors that lead to medication errors as well as consequences of these errors on patients and nurses. It also recommends methods for avoiding and eliminating medication errors.

**Drug Enforcement Administration. (n.d.). Mid-level practitioners authorization by state. Retrieved from August 23, 2012, http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html

This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.

**Drugs.com. (2012). Retrieved from http://www.drugs.com/

This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.

**Institute for Safe Medication Practices. (2012). ISMP’s list of error-prone abbreviations, symbols, and dose designations. Retrieved from http://www.ismp.org/Tools/errorproneabbreviations.pdf

This website provides a list of prescription writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors.

**Byrne, W. (2011). U.S. nurse practitioner prescribing law: A state-by-state summary. Medscape Nurses. Retrieved from http://www.medscape.com/viewarticle/440315

**Drug Enforcement Administration. (n.d.). Code of federal regulations. Retrieved August 23, 2012, from http://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm ETHICAL AND LEGAL IMPLICATION OF PRESCRIBING DRUGS

                            PATIENT: Keola Akana 

THIS ASSIGNMENT HAS TWO PART QUESTIONS

                                                INSTRUCTION

Please keep in mind you will also be required to recognize a variety of signs and symptoms linked to abnormalities in these skills. 

Therefore, in order to prepare for the simulation, you are required to complete the Pre-Briefing questions & Drug Cards below and submit to the faculty facilitating the simulation prior to the start of pre-briefing. If you do not complete the pre-briefing questions below and submit to faculty facilitating the simulation prior to the start of pre-briefing, you will not be permitted to participate in the simulation. 

                                  PART 1  QUESTIONS   

SCENARIO OVERVIEW: 

Keola Akana is a 70-year-old male with a history of heart failure. He was admitted to the medical-surgical unit early on Monday morning for medication adjustment, monitoring, and cardiac rehabilitation. The scenario takes place on Monday at 0900, at which time morning medications are due. 

1. What are the nutritional implications, key assessment findings, and nursing interventions for a patient with hypokalemia? 

2. What are the signs and symptoms of digoxin toxicity and how would the nurse assess for these symptoms? In your response, be sure to include specific body systems Pre-Briefing Simulation And Drug Cards Nursing Project.

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3. How would the nurse provide family-centered care? 

PLEASE USE REFERENCE LESS THAN 5 YEARS OLD AND APA FORMAT NEEDED.

                          PART 11 QUESTIONS   

SCENARIO OVERVIEW: 

Keola Akana is a 70-year-old male with a history of heart failure. He was admitted to the medical-surgical unit early on Monday morning for medication adjustment, monitoring and cardiac rehabilitation.  During this scenario, students will have the opportunity to assess and manage medication administration for a patient experiencing digoxin toxicity.

FOR EACH OF THE FOLLOWING DRUGS BELOW THAT WAS PRESCRIBED FOR THE ABOVE PATIENT WITH HEART FAILURE, WRITE OUT IN DRUG CARD FORMAT FOLLOWING THE HEADING BELOW

1) THE INDICATION, (2) DOSAGE, (3) CONTRAINDICATION, (4) SIDE EFFECTS, (5) ADVERSE EFFECTS AND (6) NURSING CONSIDERATION

⦁ Patient: Keola Akana Drug Lists

Lasix 40 mg po now and daily 

Potassium Chloride CR 10 mEq po daily

Digoxin 0.25 mg po now and daily 

Atenolol 50mg po now and daily 

Acetaminophen 650 mg po Q 4 hrs PRN mild pain or temp greater than 101.3 

IV saline flush Q 8hrs and PRN 

N:B: SEE THE ATTACHED SAMPLE OF THE DRUG CARD LIST Pre-Briefing Simulation And Drug Cards Nursing Project