NR661 Professional Portfolio Part 2 Examples

The following are excerpts from prior students’ work to provide examples of what we are looking for in this assignment. These examples may not be replicated.

SAMPLE OF ONE EXEMPLAR (STUDENT A)

Exemplar #1

NR-510-0 Leadership and Role of the APN (November 2016)

APN Professional Development Plan

Registered Nurses, who have chosen to pursue a career in Advanced Practice Nursing, face several

obstacles during the transition from clinical to advanced practice nursing. One of those obstacles is the role

confusion. As RN, the nurse is primarily executing physician orders. As an NP, the nurse has to manage to

effectively combine the nursing knowledge with the medical knowledge in order to provide the best care.

Those skills are built during the years spent as a student as new knowledge is gained (DeNisco, 2016).

Another important point in the education of the NP is the detailed knowledge of the NP’s scope of

practice, and especially the scope in the State of the NP’s intended practice. There are differences between the

NP’s scope of practice from state to state. Nurse Practitioners also have to develop a positive relationship with

physicians in order to overcome differences and prejudice that currently exist between both professions. Last

but not least, NP’s have to be able to educate patients and families on the scope of practice and knowledge that

they can provide in order to alleviate doubts regarding Advanced Practice Nursing that currently exist

(DeNisco, 2016).

One of the strategies for the APN students to achieve a smooth role transition is the crafting of an APN

professional development plan. By doing this, the APN students would have a clear idea regarding the NP

scope of practice, the potential issues related to their future practice, their individual competence, and the

strategies needed to secure their first job (DeNisco, 2016).

As an FNP student, residing and planning to work in Ohio, my professional development plan would

outline my career plans as they relate to the rules and regulations in this particular state.

NP Scope of Practice.

Leadership and Role of the APN . Each NP has to enter a

Standard Care Arrangement with a physician, who is a part of the practice that the NP is involved with. This

agreement is a subject to review every two years (Lawriter, 2016). The NP is also allowed to prescribe

medications (including schedule II substances) after obtaining a Certificate to Prescribe (Ohio Board of

Nursing, 2016). In the state of Ohio, a direct physician supervision is not required. The NP has to be able to

connect to the collaborating physician if needed by phone, internet, radio, or in person (Lawriter, 2016). There

is a change in the APN certification, which would be implemented in 2017. Instead of issuing a certificate, the

state would issue an APRN license, which would specify the particular certification of the holder (Molnar,

2016). Although, the collaborating with a physician is still required in Ohio, the tendencies are for expanding

the NP scope of practice in the future.

Personal Assessment.

It is very important for an NP graduate student to conduct a personal assessment in order to determine the

level of competence and readiness for starting a new career. One such assessment is the Benner’s novice to

expert self-assessment (DeNisco, 2016). Since this is a new role, all students would start their careers at the

novice level. However, a basic competence and knowledge is necessary in order to advance to the next levels

of advanced beginner, competent, proficient, and finally, the highest level of expert. It is important for the NP

student to carefully examine his or her biggest strengths in order to choose an area of practice that would

provide the smoothest role-transition possible. To help with this decision, there are several different points to

be reviewed, such as desired areas of development, expectations of the new role, potential fears and

anticipated issues, expected gains, strategies for coping with stress, and setting of initial goals and objectives

to fulfil in the first few months of the new role.

After taking those points under consideration, for my personal assessment, I have determined that as I have the

most experience in emergency room settings, I would feel more comfortable to start my career in an Express

Care or Minor Emergency ER setting. As I have worked with NP’s in those settings for several years, I am

familiar of the nature of their duties, and I would feel more comfortable to begin from there. As I complete the

role transition and reach a higher level on the Benner’s scale, I would consider advancing toward the more

involved Family Practice career.

Although, transitioning to the new role of Advanced Practice Nurse is highly stressful, it is also exciting. An

NP could use the best from two worlds, the nursing and the medical—the nurse would look at the whole

person and the practitioner would determine the medical condition. Smooth coordination of the two types of

knowledge would provide for delivering an excellent healthcare with improved patient outcomes.

The biggest fear of this new role would be the amount of liability that the NP carries. A nurse is used to be

primarily carry out orders, while the NP is now responsible to determine what those orders would be. This

would be the most difficult part of the process of role-transition; therefore, it is extremely important that the

new NP builds a strong relationship with other, more experienced NP’s as well as the collaborating physician.

Physicians are another source of worries for new NP’s due to some physicians’ dismissive attitudes toward

Nurse Practitioners. This could be resolved when NP’s and Physicians realize that good collaboration would

increase the practice patient satisfaction scores and improve patient outcomes (Bourgeois-Law, 2008).

My biggest expectations are related to gaining knowledge of the new role and experience in the field of work.

In healthcare, there is never enough knowledge to be gained. Evidence based researches are determining new

practices every day, so keeping informed with the newest findings in healthcare would provide continuous

learning and improvement of the care that I would provide.

Another important consideration is the high level of stress related to the transition to a new role. I personally

apply several strategies to deal with that. One, and most important of all is to ask for help, when needed.

Naturally, the practice would not wish to see their newest employee fail as they have invested in education and

training. Therefore, people would help if asked to. This is also an excellent strategy to learn the culture in the

new work-place as well as become familiar with settings. Asking and accepting help also increases the chance

of better acceptance by the team, as the team members feel that their knowledge is valued and respected. Other

strategies for dealing with stress are listening to music after the end of the work day, taking walks, reading a

book, etc. Another strategy is to discuss stressful events with more experienced co-workers. By doing this, I

can hear their opinions, and usually, something that seemed like the end of the world to me turns out not to be

such a big issue.

When starting a new career, it is helpful to set simple goals for the first several months, such as becoming

familiar with the work-settings, the policies and regulations in the facility, become familiar with the rest of the

team members, and take a note of the patients’ census and acuity in the particular practice. Throughout the

first year, the main goal would be to alleviate stress and become familiar with the new role as well as

continuously learn from practice. By the end of the year, my expectation would be that I would have

completely transitioned and adapted to the new role of Advanced Practice Nurse.

Networking and Marketing Strategies.

Before applying for a position in a particular practice, the Nurse Practitioners have to assess the Marketplace.

This includes the scope of practice, rules, and regulations affecting the NP’s in the particular state (DeNisco,

2016). After the NP has chosen the state, where he or she would be practicing, an assessment of the chosen

organization should be conducted, which would include the patient populations that receive care there, the

policies of the facility, the patient census and acuity, and the offered benefits and compensation (DeNisco,

2016). Also, before applying for work, the NP should prepare a professional portfolio containing letters of

recommendation, Curriculum Vitae, outline of experience and scope of practice, and also a cover letter

detailing how the practice would benefit from hiring the NP (DeNisco, 2016).

In the state of Ohio, there are options for the NP’s to work directly for private Family Practice, be employed at

a large healthcare facility, or be employed by a physician groups, which would provide them with work at

various healthcare settings.

Personally, my first choice would be the healthcare facility I am currently working for as an RN. There are

several reasons for this. This is a large facility, which employs a significant number of nurse practitioners at

various Family Practices, Express Cares, ER, and in the hospital. This facility is also affiliated with a very

large hospital system, which in turn offers numerous options for employment. This is also a teaching facility,

which provides various options for advancement in education of the employees. The facility I have in mind is

also designated as one of the best employers in the area, which offers a comprehensive benefit package and

reasonable compensation for the services of APN’s. Another reason for choosing this facility is that I have

well-established network with experienced NP’s and physicians within the facility, who would provide me

with letters of recommendations when needed. They would also be willing to mentor me and help with my

role transition.

Once I have chosen the facility I would like to work in, I would submit an application along with all required

documentation, including a Curriculum Vitae. Curriculum Vitae is similar to Résumé, but it is more detailed

regarding education and professional relations, and it is preferred in academic and healthcare settings. The

Curriculum vitae is preferred to be printed on a quality paper (DeNisco, 2016).

Chamberlain Program Outcomes, MSN Essentials, and/or NONPF Competencies met by

Exemplar #1.

PO #3: Engage in lifelong personal and professional growth through reflective practice and

appreciation of cultural diversity (Cultural Humility).

This particular program outcome was met by developing a personal career plan. Through personal reflection,

potential strengths and weaknesses were identified and strategies for improvement were reviewed. As newly

graduated NP faces the need for role transition, it is very important that that she or he knows how to approach

the most difficult issue of transitioning from carrying out provider’s orders to being the one giving the orders

and the need to develop good leadership skills.

MSN Essential IV: Translating and Integrating Scholarship into Practice.

This essential deals with the ability of the APN to apply current research knowledge into practice (The

essentials of Master’s education in nursing, 2011).

This essential was achieved by drafting a plan, which outlines strategies for application of knowledge from

school into practice and plan for improvement and overcoming possible barriers. This was achieved by

personal reflection of various areas.

NONPF Practice Inquiry Competencies.

This core competence deals with the ability of the NP to apply theoretical knowledge into clinical practice and

demonstrate leadership abilities in implementing changes either alone or in partnership with others (Thomas et

al, 2017).

This core competency was met by outlining plan for personal improvement and career building via reflection

of own strengths and weaknesses as well as strategies for improvement.

NONPF Independent Practice Competencies.

This core competency outlines the ability of the NP to make appropriate decisions based on current evidence-

based knowledge and mutual cooperation with patient. This also discusses the personal development of the NP

from novice to expert (Thomas et al., 2017).

This core competency was met by the development of individualized plan of development from novice to

expert by analyzing personal weaknesses and strengths, developing strategies for improvement, and

identification of personal network within the healthcare system.

Concepts.

Healthcare systems.

Healthcare systems are a network of various disciplines, which provide access to data from various scientific

fields, so providers can easily access it and use for achieving optimal patient outcomes (Kirschner et al.,

2015).

Legal issues.

There are various legal issues related to healthcare. This exemplar particularly discusses the NP scope of

practice. The scope of practice of NPs varies by states and it dictates how an NP should be practicing and what

limitations apply in terms of procedures and need for supervision (Kraus & DuBois, 2017).

Reflection.

Drafting a personal APN professional development plan has helped me identify several problematic areas in

the process of transitioning from the nursing role to the role of provider. In order to successfully complete this

process, there are several steps that are necessary. First it is important for a new graduate to be familiar with

the current state of NP practice, which includes the need for NPs and their relationship with physicians and

patients. It is also essential for a new graduate to be familiar in depth with the scope of practice of the NP in

the state, where they will be practicing. Knowing the scope of practice will ensure that no legal issues will

arise as a result of incorrect practice application. Another important aspect is the new graduate’s personal

reflection of own strengths and weaknesses. This will guide the individual in their future development from

novice to expert. In order to understand this concept, a personal assessment was developed, outlining the

particular areas of strength and areas of existent or perceived weaknesses and a plan for improvement in the

identified areas. Last but not least, a personal network in the healthcare field was identified, which would

assist with employment search and mentoring during the initial stages of practice as a novice NP.

SAMPLE OF ONE EXEMPLAR (STUDENT B)

Week 8 Reflection NR511

Identify Gaps:

My clinical rotation took place at Adult Medicine of Lake County. I found in looking over my clinical

summary that I saw two female patients for every one male which was one of my concerns when this

started because I wanted to ensure that I saw enough female patients to warrant meeting my clinical

requirements. One gap in this rotation would have to be that because they are adult medicine they do

not see any kids. Apart from that a about seventy percent of the patients that I saw were aged 65 and

older. I understand that they have more health issues and come to the doctors more frequently I guess I

just wasn’t aware of the numbers. I will stay at this facility for my next three courses and still am looking

for a place for my pediatric rotation. When I get my pediatric rotation it will constitute my requirements

for the course.

Progress in clinical:

Over the course of the eight weeks I got the chance to see a lot of patients. It was nice to have a

preceptor who really took the time to help guide me in the right direction. Within my second week in

clinical the office manager offered me a job and said he was clearing out a space for me. It helped

remind me that this is the end goal here and that I need to be ready for that day when I finish this

program. I started out seeing patients with my preceptor and was able to transition from the hospital

setting to the outpatient setting over the first couple of weeks. It is a completely different mindset in the

outpatient setting and it definitely took some getting used to. My goal was to be able to see patients by

myself and be able to be comfortable in the environment. By the end of this semester I was seeing

patients by myself and able to piece the necessary pieces together in order to make the correct

diagnosis and provide the appropriate prescription or tell them they did not need a prescription. This

was a big step for me and really helps prepare me for the next step.

Areas of weakness:

My initial area of weakness was getting out of the hospital mindset. I have worked ICU and CVICU for

the past six years and it makes me look at patients a little different. When I would review the charts with

the doctor before we saw the patients she would say, “oh she’s sick” and I would look at the patient and

say she really doesn’t look that bad. This is because I was looking at the patient and comparing them to

the patients I was used to seeing which was not appropriate in the outpatient setting. Another area I

needed to work on was processing my practicum sites computer system. They use tablets and bring

them in the room with them and are able to document, order, and research the patient on the spot. This

is one area where I will continue to need to improve, in order to become more efficient. Another area

that needs improvement is becoming a morning person. Primary care facilities provide care during

normal business hours from 8-5. I have worked night shift for the past three years so getting up and

ready for my rotation was a struggle at times. I am now down to working one night shift per week so I

can start getting used to working on day shift again.

NONPF Competencies:

One of the NP Core competencies I used was integrating appropriate technologies for knowledge

management to improve health care. By getting familiar with my facility and the way they practice I was

able to help provide better care by bringing a tablet into the patient’s room and having all of their

information accessible in live time. It saves time and energy because the patient would ask a question

like am I up to date on all of my vaccinations, when is my next appointment, how did my labs or test

come back and all of this information is right at your fingertips without ever having to leave the room.

This makes life easier for the practitioner as well as the patients.

Another core competency that I used was translating new knowledge into practice. Like I said earlier it

takes a different mindset from the hospital setting in order to provide adequate care to these patients.

A lot of the focus is on primary prevention in the outpatient setting where as the hospital deals with a

lot of tertiary prevention. Going through the lectures and readings, there was a lot of valuable

knowledge that seemed to correlate directly with the practice. From billing and coding to sinusitis and

allergies everything seemed to help in one way or another with the care I was providing.

Reference:

AACN. (2011). The essentials of master’s education of nursing. American Association of Colleges of

Nurses. https://www.bc.edu/content/dam/files/schools/son/pdf2/MastersEssentials11.pdf

NONPF. (2017). NP competencies. National Organization of Nurse Practitioner Faculties.

https://www.nonpf.org/page/14

Identify

and Explain CPO

# 5

MSN ESSENTIAL

# 5 NONPF CC # 7

During this reflection of NR511 there were multiple outcomes and essentials achieved as this reflection

in part has to do with not just what knowledge I had gained in the classroom setting but also out in the

practicum site as well. CPO # 5 was met which advocates for positive health outcomes throughhttps://www.bc.edu/content/dam/files/schools/son/pdf2/MastersEssentials11.pdfhttps://www.nonpf.org/page/14

compassionate evidence-based, collaborative advanced nursing practice. MSN Essential # 5 was met

which is Informatics and Healthcare technologies. NONPF CC # 7 which is health delivery systems

competencies was met also during this time. Throughout this course I got my first taste of primary care

in the outpatient setting. It was busy and at times could be overwhelming. I met CPO # 5 through

working in the practice and providing compassionate evidence based care for many patients. I met MSN

Essential # 5 through using their documentation which was eclincial in order to provide care to the

patients that I was seeing on a daily basis. I met NONPF CC # 7 through the use of eclinical software as

well. It took time but over the course of the semester I became competent in the use of the software

and was able to navigate through and provide better care of the patients because of it. Apart from their

software I downloaded the epocrates app for my phone which was beneficial as well. It allowed me to

have knowledge of disease processes with the appropriate evidence based clinical guidelines in order to

help better manage the patients care.

Connect (Conceptual Definition)

Compassion- sympathetic pity and concern for the sufferings or misfortunes of others.

Technology- Technology is the collection of techniques, skills, methods, and processes used in the

production of goods or services or in the accomplishment of objectives, such as scientific investigation.

Technology can be the knowledge of techniques, processes, and the like, or it can be embedded in

machines to allow for operation without detailed knowledge of their workings.

Compassion and technology are both used to take care of our patients. By showing compassion we are

better able to develop a relationship or rapport with our patients while using technology allows us to

provide optimal care as well. By utilizing both tools together we are able to connect with our patients

and provide the most up to date evidence based care as well.

Reflection

As briefly explained in the identify and explain section of this exemplar each of these

essentials or competencies were met over the course of the class. This is a copy of my

reflection from NR511 which discusses how some of the competencies and curricula

were met in the class. In the classroom we had multiple assignments such as voice

threads, power point presentations and discussions that all led us to meet these

competencies. In the clinical setting is where I began to see the importance of the

competencies. It takes time to become comfortable in new settings. Different

technologies and responsibilities must be mastered in order to maintain a competent

level of function at the masters level. By using e-clinical over the eight weeks I was able

to maintain competency in health delivery systems and informatics and healthcare

technologies. By working in a new office and getting to experience outpatient care it

became very important to be a professional and advocate for positive health outcomes

for my patients. This program helped to instill the use of compassionate, evidence-

based, collaborative care as an advanced practice nurse. One of the main stressors

throughout the courses has been the use of evidence based practice which was used

during every project or discussion we had. By mastering these as well as other essentials

and competencies I feel as though they helped mold me into an advanced practice nurse

and I look forward to putting these knowledge and skill base acquired during this

program to good use in my community.

SAMPLE CONCEPT MAP STUDENT A

Appendix B

Concept Map

SAMPLE CONCEPT MAP STUDENT B

Appendix A: Concept Map

Assessment Plan Assignments Understanding

Compassion Professional

Ethics Credibility Contribution

Personal

Development Caring

Community

Independence Change Adaptation

Technology

Individual/

Patients Evidence Guidelines

Nurse Practitioner

SAMPLE OF SUMMARY GRID STUDENT A

PO outcomes, MSN Essentials, and NONPF competencies met by the Exemplars

P O # 1

P O # 2

P O # 3

P O # 4

P O # 5

M S N I

M S N I I

M S N I I I

M S N I V

M S N V

M S N V I

M S N V I I

M S N V I I I

M S N I X

N O N P F# 1

N O N P F# 2

N O N P F# 3

N O N P F# 4

N O N P F# 5

N O N P F# 6

N O N P F# 7

N O N P F# 8

N O N P F# 9

E # 1

v v v v

E # 2

v v v V V V V V V v V V v

E # 3

v v v

E # 4

v v v v v

E # 5

v v v

E # 6

v v v

E # 7

v v v

E # 8

v v v

E # 9

v v v

E # 1 0

v v v

SAMPLE OF SUMMARY GRID STUDENT B

Appendix B: Grid Outcomes and Essentials

Exemplar CPO MSN ESSENTIAL NONPF CC 1 3 & 4 3 & 4 2 & 4 2 5 5 7 3 5 8 8 & 9 4 1 7 8 5 4 4 6 & 7 6 2 2 & 6 3 & 5 7 5 1 & 9 1 8 4 4 5 9 1 4 9 10 3 8 9

• Exemplar #1
  • NR-510-0 Leadership and Role of the APN (November 2016)
    • APN Professional Development Plan
      • NP Scope of Practice.
      • Networking and Marketing Strategies.
    • Chamberlain Program Outcomes, MSN Essentials, and/or NONPF Competencies met by Exemplar #1.
      • PO #3: Engage in lifelong personal and professional growth through reflective practice and appreciation of cultural diversity (Cultural Humility).
      • MSN Essential IV: Translating and Integrating Scholarship into Practice.
      • NONPF Practice Inquiry Competencies.
      • NONPF Independent Practice Competencies.
    • Concepts.
      • Healthcare systems.
      • Legal issues.
    • Reflection.
    • Identify Gaps:
    • Progress in clinical:
    • Areas of weakness:
    • NONPF Competencies:
    • Identify and Explain CPO # 5
    • Connect (Conceptual Definition)
    • Reflection
• Appendix B
  • Concept Map
    • Appendix B: Grid Outcomes and Essentials

Portfolio Assignment with 3 example papers.

APA formate

No plagiarism

Graduate level quality work needed

Requirements: 

This assignment should be an entire document in either word or PDF format with a title page noting the assignment name, student name, course, etc. The assignment should also include a table of contents denoting what of the below documents are on which pages. APA format and writing at the graduate-level is expected.

Using work that you have completed during the MSN program here at Chamberlain University, gather your prior submissions and identify a minimum of 10 exemplars of your graduate work.

Use the worksheet below as a guide to copy your exemplar and to identify with Chamberlain Program Outcome, MSN Essential, and NONPF Competency that each exemplar meets.

You must include at least 10 exemplars, and as a group, each Chamberlain Program Outcome, MSN Essential, and NONPF Competency has to be addressed at least once.

If you do not have an exemplar that meets these criteria, you can write an exemplar in the area that is not represented by your prior work.

Identify at least 2 concepts from each exemplar and how they connect to the Chamberlain Program Outcome, MSN Essential, and NONPF Competency that you have identified.

Reflect on how you have met the outcome, essential, and/or competency for each exemplar and how it has transformed you as a prospective masters-prepared advanced practice nurse.

Combine the 2 concepts from each exemplar and create a concept map on how these concepts interconnect and interrelate to each other in the framework of the NONPF Competencies.

All items are to be written as a formal APA paper. Do not use the worksheet table mentioned in #2 above in the body of your assignment. The purpose of the worksheet is to help you gather resources.

Exemplars are defined as a prior assignment you completed in the FNP program that you feel is a good reflection of the work you have accomplished while a graduate student. Typically, it’s an assignment that you may have enjoyed completing, learned something new from, or did well academically. Think of it as your “best work.” An exemplar should be considered for the portfolio if it:

Taught you something

Provided new understandings and/or changed your practice

Made you clearly see a difference being made

Made you notice something new

Opened up new ways of solving problems or new lines of inquiry

Changed the way you think about a clinical issue or problem

Was particularly demanding or memorable

Examples: a paper, SOAP note, notable discussion thread, etc.

Running head: MAIKEL MITCHEL PORTFOLIO PART II 1

MAIKEL MITCHEL PORTFOLIO PART II 4

Portfolio Part II

NAME

Chamberlain University

NR661 APN Capstone

Contents Background 4 Exemplar I: NR503 Population Health, Epidemiology & Statistical Principles 4 Identify and Explain 11 Chamberlain Program Outcomes 11 Connect 13 Reflection 13 Exemplar II: NR 505 Advance Research Methods Week 3 15 Identify and Explain 23 Connect 24 Reflection 25 Exemplar III: NR 507 Advanced Pathophysiology 26 Identify and Explain 27 Connect 29 Reflection 29 Exemplar IV: NR 508 Advanced Pharmacology 30 Identify and Explain 32 Connect 34 Reflection 34 Exemplar V: NR 509 Advanced Physical Assessments 35 Identify and Explain 36 Connect 37 Reflection 38 Exemplar VI: NR510: Leadership and Role of the Advanced Practice Nurse 39 Identify and Explain 45 Connect 46 Reflection 46 Exemplar VII NR 511 Differential Diagnoses and Primary Care 48 Identify and Explain 50 Reflection 52 Exemplar VIII: NR 601 Primary Care of the Maturing and Ageing Family 53 Identify and Explain 57 Connect 58 Reflection 58 Exemplar IX: NR 602 Primary Care of the Childbearing and Childbearing Family 59 Identify and Explain 62  Ethics Competencies 63 Connect 64 Reflection 64 Exemplar X: NR 602 Advanced Clinical Care and Practice Across the Lifespan of Practinum 65 Identify and Explain 67 Connect 69 Reflection 69 Appendix A: Mind Concept 71 Appendix B: Tabulation of outcome, Essentials and Competencies achieved 72

Background

As a result of the comprehensive and intense nursing education program at Chamberlain cumulating into an award of Masters of Science in Nursing, the following is a documention of the journey through the Program Outcomes, Master’s Education Essentials as well as the National Organization of Nurse Practioner Faculties Core Competencies all of which bear the abbrevations PO, MSN Essentials, and NONPF. Correspondingly, this documentation will cover all of the ten exemplars and give an assessment on views of the right argument that all of the above requirements have been covered.

Exemplar I: NR503 Population Health, Epidemiology & Statistical Principles

Introduction

The high number of HIV cases, especially the newly diagnosed cases of the disease constitutes a major health problem in South Florida and the entire country. Although, the preventive efforts for HIV have led to a considerable reduction in the number of new diagnoses, some populations and regions are disproportionately affected by the disease. As such, the proportion of individuals living with the disease is considerable higher in some regions and populations, and this could largely be attributed to high-risk behaviors, economic and social factors that place these groups at a higher risk for infection. This has created a huge concern especially among the healthcare professionals due to the consequences and health risks associated with the disease.

The Centers for Disease Control and Prevention (2016), estimates that about 1.2 million individuals in the US have HIV. Moreover, a considerable proportion of these individuals are not aware of their HIV status. In regard to transmission category, majority of the new cases of HIV are recorded among MSM (men who have sex with men) across all the ethnic and racial groups. On the other hand, African-Americans constitute the high affected group with the highest prevalence followed by the Hispanics.

In regard to South Florida, HIV constitutes the major health problem in the region that affects a substantial proportion of the population. According to AIDSVu (2016), about 25,669 individuals living in Miami-Dade County were found to have HIV in 2013. In addition, about seventy-two percent of individuals living with the disease were men while the rest were women. As such, this indicates that the rate of HIV within the region is higher among men as compared to women. HIV is usually associated with numerous consequences including reduced productivity and increased cases of hospitalization that have a huge economic burden on patients, families, employers and the entire healthcare system. Furthermore, HIV usually weakens an individual’s immune system whereby this predisposes one to various infections like tuberculosis and candidiasis as well as other health complications including kidney disease and certain forms of cancer. Hence, this stresses the urgent need to effectively assess the problem of HIV in the region, identify the contributing factors to these problems and subsequently develop efficient strategies for addressing this problem. As such, the purpose of this paper is to assess the problem of HIV, particularly in South Florida and develop suitable strategies for addressing this problem in order to enhance the community’s health.

Background of the disease

HIV (Human immunodeficiency virus) is a virus that weakens an individual’s immune system and interferes with the ability of the body to fight various disease causing organisms. The virus may lead to the development of AIDS (Acquired immunodeficiency syndrome) especially if it is not treated. However, even with the treatments, it is impossible for the human body to effectively fight off HIV and get rid of the virus completely; hence it is a life-time disease.

HIV usually attacks the immune system, particularly the CD4 cells whereby this weakens the system and subsequently the body’s ability to fight off various disease causing organisms (Bradley et al., 2014). Lack of treatment for HIV decreases the number the number of T-cells whereby this increases the vulnerability of an individual to various opportunistic infections as well as cancers. Ultimately, the virus destroys most of the CD4 cells, hence affecting the body’s ability to fight off diseases as well as infections and progression of the disease to the last stage that is known as AIDS. During the last state, the immune system is severely weakened and this leads to an increase in various opportunistic illnesses that ultimately lead to death. HIV is associated with various symptoms, though they usually vary based on the stage of infection. Acute HIV is the initial stage of the disease and is usually characterized by a variety of symptoms that include; headaches, rashes, fever, swellings in the lymph glands, muscle aches and sore throat (Bradley et al., 2014). In most cases, these symptoms develop two months after one is infected. Lack of treatment causes multiplication of the virus leading to destruction of the immune cells whereby this leads to the development of chronic symptoms including; fatigue, diarrhea, fever, weight loss, shingles and thrust. Ultimately, lack of treatment causes severe weakening of the immune systems and leads to the progression of the disease to AIDS. Some of the symptoms associated with this stage include; recurrent fever, persistent fatigue, skin rashes, unusual lesions in the mouth, weight loss and chronic diarrhea. HIV is transmitted in various ways that include; engaging in sexual intercourse with a partner who is infected with the disease, blood transfusion, sharing of contaminated needles, breast feeding or during pregnancy. However, the treatment of HIV mother and screening of blood during transfusion usually lowers the chances of transmission (Bradley et al., 2014).

Although HIV is incurable, the disease is controllable through proper treatments or medical care. Typically, antiretroviral therapy is the recognized treatment for HIV and when they are taken appropriately these medications usually help in prolonging the lives of infected individual and enables them to enjoy an active and healthy life (World Health Organization, 2014).

HIV constitutes one of the major health problems in South Florida, and statistics provided by various departments indicate that the rate of HIV has dramatically increased in the recent years and is currently higher than the national average. According to a survey carried out by the Centers for Disease Control and Prevention in 2015, the number of individuals diagnosed with HIV was about 38.8 per 100,000 individuals in Miami-Fort Lauderdale-West Palm Beach. In addition, the survey indicated that about 51.2 cases per 100,000 individuals were diagnosed with the disease within the same year in Miami-Dade County (CDC, 2015). This shows that the rate of HIV new infections is higher than the national average that was about 12.3 cases per 100,000 individuals within the same year. On the other hand, the survey showed that the highest number of cases was recorded among MSM (men who have sex with men). For instance, in Miami-Dade County, there were about 8,293 cases recorded among this group. Similarly, according to AIDSVu (2016), in 2013 about 25,669 individuals were found to have HIV in Miami-Dade County and men comprised the highest percentage (72%) of this population. In regard to ethnicity, the percentage of individuals who were diagnosed with the disease within the same years was 45%, 42% and 12% among Blacks, Hispanics and Whites respectively. Moreover, about four-hundred and fifty nine individuals died as a result of this disease in the county and about 2,274 of HIV-related deaths were recorded in 2013 in Florida. Similarly, according to the Health Communities Institute (2017), Non-Hispanic Blacks constitute the highest percentage of HIV cases while non-Hispanic Whites have the least number of cases, and the MSM group, specifically those aged between twenty and twenty-nine years constitute the highest percentage of new infections.

Overall, these statistics indicate that the rate of HIV in Miami is higher than state as well as national rate. This emphasizes the urgent need to undertake the appropriate actions to prevent new infections and foster optimal control of the disease among those who are already infected. The table below shows the differences in the rate of HIV in Miami, Florida and at the national level.

Prevalence rates of HIV

Geographical area	Year (2015)
Miami	51.2 cases per 100,000 individuals
Florida	24.5 cases per 100,000 individuals
United states	12.3 cases per 100,000 individuals

Surveillance methods for reporting the disease to providers

Surveillance and reporting of HIV to providers is an essential aspect that helps the healthcare providers to understand the extent of the problem and subsequently come up with relevant interventions for preventing and controlling the disease. As such, there are numerous surveillance methods utilized in the region that enable the provider to acquire the correct information pertaining to the disease. Some of the surveillance methods utilized in the region include; surveying and analyzing of the clinical records on the diagnosed cases and incidences of HIV, morbidity as well as the mortality rates. In regard to this, there are various agencies that are involved in the collection of data related to HIV, analysis and interpretation of HIV care practices, morbidity rates, risks factors and mortality rates in the region. These agencies report their findings to the relevant healthcare departments and providers and usually offer recommendations on the on the community’s health status and the improvements that can be made to enhance the community’s health. Among the key agencies or organizations involved in HIV surveillance include, the Centers for Disease Control and Prevention, the Health Council of South Florida and Florida Department of Health. These agencies usually collect accurate as well as complete data relating to HIV and analyze the trends of the disease. This information helps healthcare providers in developing appropriate interventions to curb the disease.

Epidemiology analysis of the disease

HIV is one of the most widespread disease is South Florida and accounts for a large percentage of deaths as well as hospitalization cases within the region. According to CDC (2016), about 51.2 cases per 100,000 individuals were diagnosed with the disease in 2015 in Miami-Dade County. In addition, South Florida is ranked among the top regions with the highest number of newly diagnosed cases of the disease and the rate is about three times higher than the national rate. In relation to ethnicity, the Non-Hispanic Blacks constitute the highest percentage of HIV cases while non-Hispanic Whites have the least number of cases while the MSM group constitutes the highest percentage of HIV infections (CDC, 2016). For instance, blacks constitute about 45% of individuals suffering from this disease in Miami-Dade County. Moreover, HIV accounts for a great percentage of the hospitalizations and is among the major reasons for hospital visits. This increase the healthcare costs incurred by the healthcare organizations, patients and families. For instance, the average annual cost of treating an individual patient suffering from HIV is about $ 25,000. Overall, the disease is associated with numerous consequences including reduced productivity and increased cases of hospitalization that have a huge economic burden on patients, families, employers and the entire healthcare system.

Diagnosis of the disease and standards for screening and prevention

Diagnosis of HIV is a key aspect that helps in early identification of this disease and consequently enables individuals diagnosed with the disease to start treatments during the initial stages of the disease whereby this prevent the progressions and foster optimal management of the disease. As such, numerous guidelines on screening of HIV have been developed so as to promote early detection and treatment of the disease. Some of the screening test used in the diagnosis of HIV includes; the CD4 count test and viral load test (Bradley et al., 2014). The CD4 test is used in measuring the number of the CD4 cells in an individual’s blood sample and the normal CD4 count for a healthy person is between 500–1,600 cells/mm3. The USPSTF (US Preventive Services Task Force) recommends that screening for HIV should be performed in all individuals aged between fifteen and sixty –five years.

Plan

Based on the increased prevalence and the high number of new HIV cases in the region, there is an urgent need to come up with a comprehensive action plan for addressing this problem in order to enhance the community’s health. As such, I plan on increasing HIV awareness within the community though educating the community members on the risks as well as consequences associated with HIV and the need to minimize the high-risk behaviors like engaging in sexual intercourse with multiple partners. Moreover, I will endeavor to educate the population on safe sex practices like the use of condoms and the importance of regular screening and encourage the community members and the benefits of screening. Additionally, I will closely work with the relevant stakeholders as well as the policy makers to promote HIV screening within the community and minimize stigmatization of individuals suffering from the disease, since this is one of the key factors that hinder optimal screening of the disease.

Conclusion

HIV is a major health problem in Miami, Florida that is associated with numerous consequences and health risks. Lack of treatment of the disease usually increases one’s vulnerability to various infectious diseases and increases the risk of developing other related complications. The disease presents a huge economic burden on the healthcare system, families, employers and patients due to the associated health expenditures as well as indirect costs. As such, there is an urgent need to develop and implement effective measures to prevent the spread of this disease.

Identify and Explain

Chamberlain Program Outcomes

· PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care)

AACN MSN Essentials

· Essential I: Background for Practice from Sciences and Humanities

NONPF Core Competencies

· Scientific Foundation Competencies

· Technology and Information Literacy Competencies

The course Program Outcome #1 largely applied to the study I carried on HIV in South Florida in the United States. The Program Outcome #1 was realized by calculating HIV prevalence in various areas in the State of Florida. The prevalence was broken down to address specific populations of interest. Surveillance methods for HIV were discussed and this is an application of techniques to ensure high quality community intervention plan. The intervention plan to increase health awareness on HIV is prioritizing the patients which mean it is patient centric. I have systematically applied analysis of the HIV prevalence in South Florida and suggested an intervention plan.

The MSN Essential I that captures the need to develop competencies of understanding and using the background for practice in humanities and sciences informed the systematic approach to understanding prevalence of HIV in the target community. As demonstrated in studying prevalence of HIV and designing a community intervention for Miami, I relied on scientific findings from the field of nursing, quality improvement, public health as well as organizational sciences to advocate for continual improvement of health outcomes of the target community. For instance, I invoked scientific findings to understand how widespread HIV is in Miami. The concepts of prevalence and incidence are borrowed from statistics. I had to rely on organizational concepts to understand ways of interacting with the community in my intervention plan.

I also demonstrated NONPF Core Competencies and in particular the scientific foundation competencies by thinking critically concerning data on HIV and applying evidence based practice to design a health intervention plan for the target population. I went further and included research outcomes to improve practice approaches and outcomes of HIV patient. I have also included knowledge from other disciplines to arrive at a conclusion that is highly applicable. The Technology and Information Literacy Competencies as a NONPF competence was accomplished by using a spreadsheet application to determine prevalence of HIV from the data collected.

Connect

Screening: In nursing context, health screening refers to a test carried out to determine a condition prior to symptoms manifestation. Health screening is used to help detect conditions and diseases early enough to make it easier to treat. In this manner, screening is part of preventive care. Adequate health awareness is needed to encourage health screening (Porter et al., 2016).

Surveillance: Disease surveillance refers to information-oriented activity that entails gathering, analyzing and interpreting large volumes of relevant health data from different sources. Technology and informatics can be used to enhance disease surveillance by enabling real time analysis. Disease surveillance should lead to effective management and enhanced preventive health measures. Surveillance of diseases is normally a continuing process and demands systematic gathering of data and information relevant to tracking the incidence rate and prevalence of the disease (Porter et al., 2016).

Reflection

This course has allowed me to test scientific foundations in realizing Program Outcome #1 to promote safe and high quality patient-driven care anchored in holistic health tenets. I had to invoke several scientific studies on prevalence of HIV in Miami to fully understand the status of the disease in this target population. I had to compare several studies to conclude on the prevalence of HIV in Miami as well as determining the incident rate in Miami. Dividing the study into smaller segments allowed me to fully address every aspects of the study including determing the potentially responsive plan. For instance I went further to analyze prevalence rates in men having sex with men.

By having a background in humanities and sciences, it become easier to understand evidence based research articles on HIV prevalence and intervention plans in Miami. The MSN Essential I informed my competencies of understanding and using the background for practice in humanities and sciences informed the systematic approach to understanding prevalence of HIV in the target community. Through having a background in humanities, I understood the factors given for the vulnerability of the target population in Miami and this informed the treatment plan. A nurse should also possess NONPF core competencies such as scientific foundation competencies. I managed to include research outcomes to enhance practice approaches to managing HIV. By using a spreadsheet application to compute prevalence of HIV from the data given I had operationalized Technology and Information Literacy Competencies, a NONPF core competency.

References

AIDSVu. (2017). Miami (Miami-Dade County) – AIDSVu. Retrieved from https://aidsvu.org/state/florida/miami/

Bradley, H., Hall, H. I., Wolitski, R. J., Van Handel, M. M., Stone, A. E., LaFlam, M., … & Patel, R. (2014). Vital signs: HIV diagnosis, care, and treatment among persons living with HIV—United States, 2011. MMWR Morb Mortal Wkly Rep, 63(47), 1113-7.

Centers for Disease Control and Prevention. (2015). HIV Surveillance | Reports| Resource Library | HIV/AIDS | CDC. Retrieved from https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html

Centers for Disease Control and Prevention. (2016). Today’s HIV/AIDS Epidemic. Retrieved from https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/todaysepidemic-508.pdf

Health Communities Institute. (2017). Miami-Dade Matters:: Indicators :: HIV Incidence Rate :: County : Miami-Dade. Retrieved from http://www.miamidadematters.org/index.php?module=indicators&controller=index&action=view&indicatorId=263&localeId=414

Porter, S., Qureshi, R., Caldwell, B. A., Echevarria, M., Dubbs, W. B., & Sullivan, M. W. (2016). Developmental Surveillance and Screening Practices by Pediatric Primary Care Providers. Infants & Young Children, 29(2), 91-101.

World Health Organization. (2014). Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations.

Exemplar II: NR 505 Advance Research Methods Week 3

Author, Year of Publication	Purpose	Sample	Design	Level of Evidence	Findings	Limitations
Gupta, Shukla, & Tyagi (2016)	To evaluate the degree of know-how and practice of bio-hazardous waste management among the health care fraternity	Convenience sample of 89 health care personnel encompassing doctors, laboratory technicians, health workers, nurses, pharmacists and also class IV workers	Cross-Sectional Study aimed at investigating the degree of awareness on infectious waste in each identified category of health care personnel	VI: evidence from a single descriptive study	15 doctors, 22 class IV, 32 laboratory technicians, and 20 nurses responded. 93% of medical officers had remarkable awareness on medical waste generation and legislation as compared to 100% doctors, 95% nurses, 90% lab technicians, and 0%to 4.6% among class IV workers	The findings cannot be generalized due to small sample size
Das, S. K., & Biswas, R (2016)	Assessing the knowledge and practice regarding biomedical waste management of health care providers in a tertiary facility	The study deployed a convenience sample of 198 hospital staff working in different capacities but within the departments of obstetrics, surgery, general medicine, and gynecology.	Descriptive study of staff awareness and practice with regards to medical waste management	VI: evidence from a single descriptive study	All subjects had heard about biomedical waste, 1.5% had formal training on the same, 6.6% had know-how on the use of five-color coding, 31% understood correct disposal of sharps, 70.2% knew the use of masks and gloves, and 41.4% knew there is a risk of HIV/AIDS transmission through bio-medical waste	The study’s main drawback was its small sample size thus affecting the generalizability of findings.
Njiru, M.W., Mutai, C., & Gikunju, J (2013)	Assess both the extent of awareness and practice regarding bio-medical waste management among health care personnel in one Kenyatta National Hospital, Kenya.	A convenience sample of 244 healthcare personnel comprising 17 doctors, 129 nurse, and 98 support staff was used.	A Cross-Sectional study design	VI evidence from a single descriptive study	The overall awareness level stood at 60%. In terms of categories, doctors scored 51%, nurses 65%, and support staff 55%.	The study is overly generalized as it does not explain in which areas the said personnel score exemplary and in which areas they require training.
Sharma (2010)	Assess the awareness of bio-medical waste management rules among health care personnel in Agra	A convenience sample of 1972 participants was selected. The subjects came from three strata namely: apex government hospitals; government and non-government FRU; and private healthcare facilities	Descriptive Study design was used.	VI evidence from a single descriptive study	Only 33.21% of the personnel in apex government hospitals knew about the rules governing the management of bio-medical waste as compared to 29.09% and 17.07% in government and non-government hospitals and private hospitals respectively.	Relying explicitly on questionnaire technique of gathering data, this study suffers three main shortcomings. First, it lacks the validity of data. Second, there is no sure way of eliminating interviewee bias in answering the questions. Third, the formulation of questionnaires is vulnerable to subjectivity of the researcher.

Summary

The research concern or question addressed in the research summary table is: “What is the degree of awareness and practice of bio-medical waste management among health-care personnel?” All of the samples were convenience samples of healthcare personnel ranging from doctors, nurses, laboratory technicians, and support staff. The use of convenience sampling could have been necessitated by several factors such as cost effectiveness. Since this method does not require an elaborate setup, overhead costs are maintained at minimal levels and this frees funds for use in other aspects of the research. It should also be noted that most research studies that use convenience sampling collect their data from the populations at hand. Sample groups are therefore readily available when using this method and this enhances ease of study as researchers need not travel long distances to collect data.

Three of the studies investigate the extent to which health care personnel ranging from medical doctors, nurses, laboratory practitioners, and support staff are aware of the existent of both bio-medical wastes and management practices of these wastes. The fourth study takes a twist from the awareness of infectious waste and management practices to the awareness of the bio-medical waste management rules. Hence, all the studies answer the research question in remarkable uniformity; the extent to which the healthcare personnel is aware of bio-medical waste management practices is very wanting.

Turning to the selection of the sample and the number of subjects selected for the investigations, these studies score quite low. Beginning with the selection of the samples, convenience sampling negatively affects the validity of research findings in various ways. Firstly, convenience sampling relies heavily on the judgment of the researcher especially with regards to the number of subjects. Hence, the technique can easily lead to either over-representation or under-representation of certain groups within the sample. Secondly, the sampling frame is unknown and the sample is not realized randomly. Consequently, it is highly unlikely that the sample will be an accurate subset of the population. In cases of unrepresentative sample, the ability to generalize findings for the entire population is greatly hampered. Besides the use of convenience sampling, these studies also utilized very small numbers except in the case of Sharma (2010). These small sample sizes also affect the researchers’ ability to generalize findings.

Having identified the major limitations of these studies as small sample sizes and the sampling technique, future researchers can remedy them by increasing the sample size and using a purposive sampling technique. Widening the sample sizes would move a long in enhancing the generalizability of findings. As a result, findings in bio-medical waste awareness will have the required authority to drive policy formulations and implementations. Most importantly, future researchers should direct their energies towards investigation of the health risks associated with improper management of bio-medical wastes to both healthcare personnel and the general public. Empirical research findings showing the existence of evidence-based connections between bio-medical wastes and susceptibility to some diseases would move a long way in invoking the health care practitioners to embrace the already existing rules with regards to infectious waste management.

Despite the above highlighted limitations, the evidence that these studies unveil is strong enough to suggest change in practice. There are two primary rationales why these findings are enough to trigger change in the management of bio-medical wastes. First and foremost, bio-medical wastes contravene the culture of safety in healthcare facilities both for the practitioners and the patients. One way of cultivating and maintaining a culture of safety is failing to tolerate egregious behavior such as improper management of infectious wastes. Secondly, professional codes of conduct, Code of ethics, and competency set by healthcare regulatory bodies require healthcare facilities and personnel to practice with accordance to rules. In this light, there are a host of rules established with regards to appropriate management of biomedical wastes. Hence, healthcare personnel have an obligation not only to orient themselves on existing legislations with regards to bio-medical wastes but also to practice them. In addition, professional standards require that practicing individuals always engage in self-evaluation on their practice and improve where need be.

Accordingly, therefore, relevant stakeholders should take their positions towards boosting awareness on bio-medical wastage and proper management practices. For example, academicians should integrate bio-medical wastes in healthcare education so as to ensure that prior to being registered as a healthcare practitioner one is not aware of biomedical wastes but also the best approaches of handling it in accordance with set legislations. Similarly, organizations tasked with overseeing and enforcing professional and ethical conduct on healthcare personnel should develop standards with regards to the management of bio-hazardous waste. Doing so would invoke all parties under these regulatory umbrellas to update themselves with regards to the risks associated with bio-medical wastes as well as proper management practices and governing rules. The lack of adequate legislative force is one of the major reasons behind the huge gap between bio-hazardous waste regulations and executions and awareness. In addition to expanding research in this area, it is imperative for future researchers focusing on the degree of awareness of bio-medical wastes management practices to consider utilizing large sample sizes.

Identify and Explain

Chamberlain Program Outcomes

· PO #5: Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary nursing)

AACN MSN Essentials

· Essential VI: Health Policy and Advocacy

NONPF Core Competencies

· Scientific Foundation Competencies

· Policy Competencies

One of the ways that nurses can advocate for desirable health outcomes via compassionate and collaborative advanced nursing practice is through implementing evidence-based practice as demanded by Program Outcome #5. Correspondingly, I have been taken through on how to conduct a critique of a scientific research that involved selecting appropriate research article, summarizing it and then reviewing its from topic coding, research design, methodology, and presentation of research findings. I discovered that every study will have limitation as each research has a scope.

I engaged in advanced research methods to help inform health policy and advocacy as suggested by MSN Essential VI. The Essential VI of MSN Essentials acknowledges that a nurse prepared at the master’s level should help apply the outcomes of research within the nursing practice setting, work as an agent of change, resolve nursing practice issues, and disseminate the findings. I agree that having the ability to translate nursing research findings is an important as several nurses may have difficulties implementing theoretical research.

I realized that I needed to possess scientific foundation competencies as specified in the NONPF Core Competencies. For policy competencies I used health informatics to determine guideline for best approach to health issues. A nurse should think critically about current research articles on a particular nursing issue and utilize the scientific evidence to enhance nursing practice. Critiquing and implementing study findings requires invoking knowledge from other fields apart from nursing such as humanities to assist in nursing work. The findings from the studies given can be infused in nursing practice methods to improve patient outcomes. The critiquing of the research articles provided can be used to help inform next research on the specific evidence-based approaches.

Connect

Research gap: The areas for which there is inadequate information that constraints the ability to arrive at a concluison for a research question is known as a research gap. A research gap should lead to a research need and eventually a new research to address the missing link in research. For one to conclude a research gap exists, a comprehensive search and literature review on the issue should be conducted (Moule, Aveyard & Goodman, 2016).

Research Limitation: In each, there are aspects that a researcher cannot fully control and this referred to as research limitation. Since each research has a scope, every research article will exhibit research limitations. The conditions that an investigator cannot fully manager but constraint the conclusions and methodology are termed as research limitations. For this reason any research limitations should be mentioned as they might impact the results mentioned. Investigators should not avoid capturing limitations of their research and stating limitations of your research is a desirable attribute of scientic study (Moule, Aveyard & Goodman, 2016).

Reflection

This course has opened up my mind on ways of conducting scientific research critique. Program Outcome #5 advocates for realizing a postive health outcomes through engaging colaborative and compassionnate advanced nursing practices that are evidence-based. For this reason, I hold the view that nurses should possess the competency of effectively critiquing a research article to elicit its strengths and weaknesses as part of enhancing quality of the research that will be translated into practice. With this in mind, I find MSN Essential VI that pushes for nurses trained at master’s level to apply the study outcomes in nursing practice settings.

Having gone through this course, I think nurses may experience challenges on correctly critiquing research articles to lead to translating the research into evidence based practice. It is therefore important for a nurse to exhibit NONPF Core Competencies especially the scientific foundation competencies. I managed to think critically about the current literature on the topic given and used the evidence to suggest a new nursing practice. I realized that one has to conduct a wide search of all possible research articles and then use filters to remain with high value and relevant research article. understanding the implications of each research design, sample size, research gaps and research limitations is important.

References

Das, S. K., & Biswas, R. (2016). Awareness and practice of biomedical waste management among healthcare providers in a tertiary care hospital of West Bengal, India. International Journal of Medicine and Public Health, 6, 19-25.

Gupta, N. K., Shukla, M., & Tyagi, S. (2016). Knowledge, attitude and practices of biomedical waste management among health care personnel in selected primary health care centres in Lucknow. International Journal of Community Medicine and Public Health, 3 (1), 309-313.

Moule, P., Aveyard, H., & Goodman, M. (2016). Nursing research: An introduction. Sage.

Njiru, M.W., Mutai, C., & Gikunju, J. (2013). Awareness and practice on biomedical waste management among health care personnel in Kenyatta National Hospital. East African Medical Journal, 90 (2), 52-58.

Sharma, S. (2010). Awareness about bio-medical waste management among health care personnel of some important medical centres in Agra. International Journal of Environmental Science and Development, 1 (3), 251-255.

Exemplar III: NR 507 Advanced Pathophysiology

Reflecting back over the past several weeks, I have recognized that achieving the course outcomes that are required have contributed to meeting program outcomes, master’s essentials, and core competencies for the nurse practitioner.  By analyzing pathophysiologic mechanisms of disease states, we have built a foundation for understanding what this course has offered.  We have explored physiological processes and recognize what changes in otherwise normal physiology can cause.  By recognizing risk factors for disease, we gain the comprehensive knowledge required to meet healthcare needs of individuals as we grow professionally to become nurse practitioners.  With this knowledge, I will continue to apply and integrate evidence-based practices and preventions to provide the best care that we have been educated and trained to give.  One study confirmed that educating nurses with current strong clinical skills compounds the effects of advanced nursing programs in creating successful and effective APN’s (Robinson & Dearmon, 2013).  Further applying this knowledge in practice, we will carry out the goals intended under the MSN Essential VIII: Clinical Prevention and Population Health for Improving Health (AACN, 2011). 

Examining age-specific data, we have found evidence supporting nursing sciences that contribute to improving practice processes and advanced nursing care.  The scientific foundation core competencies help us to understand the importance of integrating the research that we have been required to do in this course that has supported our discussions and new found knowledge in the related areas.  As we share and discuss our findings, we have reviewed pathophysiological findings and can apply new practice approaches as we inch closer to completing the remainder of our competencies.  I will continue to build upon this knowledge in the weeks and months to come as I remember the course content and objectives met here in advanced pathophysiology. 

Identify and Explain

Chamberlain Program Outcomes

· PO #2: Create a caring environment for achieving quality health outcomes (Care-Focused)

· PO #4: Integrate professional values through scholarship and service in health care (Professional identity)

AACN MSN Essentials

· Essential VIII: Clinical Prevention and Population Health for Improving Health

NONPF Core Competencies

· Independent Practice Competencies

· Policy Competencies

In this course, I have been taken through on ways of infusing professional values via scholarship and service in healthcare in line with Program Outcome #4. The numerous case studies given in this course has helped me build clinical skills as well as apply the concepts and skills learned. I find this course as highly critical as it concerns correct diagnosis and understanding the abnormal health status of a patient. One of the ways I operationalized Program Outcome #2 of creating a caring environment was to follow the ‘know your patient’ guidelines without assuming anything even for returning patients. A caring environment encourages openness and contributes to accurate problem specification. Correct problem definition is critical in informing responsive treatment plan including delivering positive outcomes healthcare to the patient. Nurses can help detect a misdiagnosis if they have clinical skills and this course was highly critical to nursing care.

I find the Essential VIII that calls for clinical prevention as well as population for enhancing health as highly connected to Program Outcome #4 in this course. A nurse prepared at a master’s level has to integrate broad, patient-centered, organizational and culturally competent concepts to deliver, manage and assess clinical care to the patient. The cases provided in this course helped walk me through different pathophysiology scenario allowing me to test various concepts learned throughout the nursing course. Through reviewing the pathophysiology I managed to prepare appropriate preventive care programs.

All of these developments imply that a nurse will have to exhibit independent practice competencies as part of NONPF Core Competencies. In the case studies I analyzed and solved, I was working as an independent practitioner. I was also operating professionally while remaining accountable to every action. For practice inquiry competencies I managed to critique current research before arriving at evidence –based practice. All these demonstrated that I can manage both undiagnosed and diagnosed patients as an autonomous nursing practitioner.

Connect

Autonomic Nervous System: The autonomic nervous system controls internal organs functions. The autonomic nervous system is integral of the peripheral nervous system and also controls body muscles. Since autonomic nervous system works reflexively and involuntary we are unaware of it. Nevertheless, individuals can be trained to exert some control on functions of the autonomic nervous system such as blood pressure (Tappen, 2016).

Renal system: The renal system concerns a group of body organs that filter out substances and excess fluid from the bloodstream. Production, storage and elimination of urine is done by the urinary system and the kidneys excrete the excess fluid waste. Extra blood and wastes are filtered by the kidneys from blood (Tappen, 2016).

Reflection

This course took me through endocrine system, neurologic system and urologic system among other areas of advanced pathophysiliogy. Throghout the course I realized Program Outcome # 4 outcomes that requires a nurse to integrate professional values via scholarship and service in healthcare. Through the numerous case studies given, I have developed clinical skills and applied concepts and skills. All of these skills learned have seen me improve on accurate diagnosis and analysis of different cases of patients. As I indicated, correct definition of a problem is important as the subsequent processes and plans will utilize that definition. I discovered that the Essential VIII that calls for clinical prevention as well as population for enhancing health as strongly linked to Program Outcome #4 in this course.

In analyzing and solving all of the case studies given, I had to integrate broad, patient-centered, organizational and culturally competent concepts to deliver, manage and assess clinical care to the patient. The importance of the cases provided in this course is that they helped me walk through different pathophysiology scenarios allowing me to test various concepts learned throughout the nursing course. I believe that nurses have to exhibit independent practice competencies as part of NONPF Core Competencies. In the case studies I managed to analyze and solved, I was working as an independent practitioner.

References

American Association of Colleges of Nursing.  The Essentials of Masters Education for Nursing (2011). Retrieved from http://www.aacn.nche.edu/education-resources/MastersEssentials11.pdf

Robinson, B. K., & Dearmon, V. (2013). Evidence-based nursing education: Effective use of instructional design and simulated learning environments to enhance knowledge transfer in undergraduate nursing students. Journal of Professional Nursing, 29(4), 203-209.  doi:10.1016/j.profnurs.2012.04.022

Tappen, R. M. (2016). Advanced nursing research: From theory to practice. Jones & Bartlett Publishers.

Exemplar IV: NR 508 Advanced Pharmacology

In reflection, Chamberlain University has enabled me to comprise information about patients in the clinical setting to diagnose and treat them appropriately.  Using the sources made available by the college assisted me to use evidence-based research for my differential diagnosis as well.  As a master’s prepared nurse, I am gaining a better understanding of the application and integration of appropriate care to patients while focusing on organization, and knowledge, while considering individuality, family dynamic, and distinct populations.  This course has enabled me to learn that through pharmacokinetics and appropriate drug choices for patients, the proper treatment can be given.         Trust and therapeutic communication are key when attempting to meet the needs of our patients. Effective communication and assessment will establish trust while applying knowledge in an advanced care setting.  At the beginning of this class, we determined the importance of establishing a therapeutic relationship and assessing the patient’s motivation and ability to learn (Chamberlain College of Nursing, 2017).  Over the course of my career, I have learned how essential communication is in the healthcare setting can be. All healthcare providers working together must be on the same page because things can get missed, and ultimately delay treatment or the possibility of recovery.          Producing an advanced level of understanding of nursing and relevant sciences, and then facilitating it into my practice was evaluated each week of this course through our case studies. For example, we needed to narrow each case study down to one primary diagnosis, which wasn’t always easy as many diagnoses can mimic others. For example, in week six the primary diagnosis for this patient was gout when it could have been bursitis or osteoarthritis. It is necessary as a practitioner that we rule out other diagnoses by evaluating all the signs and symptoms that the patient presents with as well as diagnostic testing.          Advanced research also produced a positive effect when it came to prescribing medications. I have gained an appreciation for the use of clinical guidelines. Healthcare is evolving every day, so we need to use the most recent evidence based clinical guidelines for diseases such as asthma, heart failure, hypertension, and diabetes which will help to provide our patients with appropriate, effective, and efficient care. Prioritization, communicating effectively, application of evidence-based medicine, collaborating with medical teams, and involving families in the treatment plan are all key elements in master-level nursing practice.         The Nurse Practitioner Core Competencies are essential to prepare individuals for a professional role in the advanced care setting. Using technological systems helps manage and improve health care, but it is important not to forget customer service and personal communication skills with patients as well.  As advanced care nurses, we are often the primary care providers and at the forefront of providing care to individuals.  We sometimes forget that we are in the medical field, and need to communicate to different populations, cultures, and individuals in a way they can understand.  Critically thinking and making complex decisions contributes to the design of the health care setting, and allows us to promote safe, and cost-effective care to individuals and families.             This class was both challenging and enlightening. It provided me with the tools necessary to be able to arrive at a definitive diagnosis for my patient and begin a treatment plan. I will take all of the gained knowledge with me to my future classes, as this will help prepare me for my role as a nurse practitioner. Thank you, Dr. Elam, for all of the positive feedback and support throughout this class, and I wish all of my classmates the very best in your future classes!

Identify and Explain

Chamberlain Program Outcomes

· PO #5: Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary nursing).

AACN MSN Essentials

· Essential VII: Interprofessional Collaboration for Improving Patient and

Population Health Outcomes.

NONPF Core Competencies

· Health Delivery Systems Competencies

Nurses should be able to communicate effectively to clients on the treatment plan and the drugs given. Program Outcome #5 champions for desirable health outcomes by employing an evidence-based and compassionate approach to nursing practice that also elevates collaboration. The case studies in this course provided helped me learn on techniques of developing trust and applying therapeutic communication to help satisfy the needs of the patients. Trust as I learned is established by oeprationalizing knowledge in nursing care contexts by conducting effective communication and evaluation.

Correspondingly, I had to align with MSN Essential VII that addresses interprofessional collaboration for enhancing patient and outcomes of population health. Working with a patient to develop an sustain trust to promote positive health outcomes required that I communicate, consult, and collaborate with other professionals in the healthcare field to help manage and coordinate care. For instance, a nurse has to liaise with the laboratory technician, the clinical officer and doctor among other healthcare professionals to enhance positive health outcomes for a patient.

It is important to develop NONPF Core Competencies and in particular the health delivery systems competencies that impacts the operationalization of community and public health programs. From this competence I managed to engance my decision-making skills. In the case studies I analyzed and solved, I developed a culturally competent nursing care, sought to minimize provider and patient risks, and analyzed the impact about organizational structures as well as resource allocation. I believe that a nurse should work with others to enhance healthcare along the continuum.

Connect

Allergy: In this context an allergy refers to an unnecessary immune response to a foreign substance that is normally harmless. The foreign substances are referred to as allergens, the sysmptoms of an allergic reaction range from severe to mild (Lilley, Shelly & Snyder, 2019).

NSAIDs: These are non-steroidal anti-inflammatory drugs that work by inhibiting prostaglandins. The chemicals that trigger the pain and inflammation signal are prostaglandins. NSAIDs are then used to provide relief from inflammation and pain (Lilley, Shelly & Snyder, 2019).

Reflection

I have benefitted a lot by taking this course and I enjoyed the case studies given. Patients exist within a context and nurses have to develop trust between the patient and the healthcare system to ensure positive health outcomes. I subscribe to the assertion that nurses should be able to communicate effectively to clients on the treatment plan and the drugs given. Fortunately, the Program Outcome #5 advocates for desirable health outcomes by employing an evidence-based and compassionate approach to nursing practice that also elevates collaboration. Through the case studies in this course I have improved on techniques of developing trust and applying therapeutic communication to help satisfy the needs of the patients.

Additionally , I managed to align with MSN Essential VII that addresses interprofessional collaboration for enhancing patient and outcomes of population health. For emphasis, it is vital that I work with a patient to develop an sustain trust to promote positive health outcomes required that I communicate, consult, and collaborate with other professionals in the healthcare field to help manage and coordinate care. In real world a nurse has to liaise with the laboratory technician, the clinical officer and doctor among other healthcare professionals to enhance positive health outcomes for a patient. I think NONPF Core Competencies and in particular the health delivery systems competencies that impacts the operationalization of community and public health programs strongly aligns with the Program Outcome #5.

References

Chamberlain College of Nursing. (2016). Graduate Program Outcomes. Retrieved from http://www.chamberlain.edu

Chamberlain College of Nursing. (2017). Pharmacokinetics, Pharmacodynamics, Art of Pharmacotherapeutics, Reproductive System Medications and Drug-OTC-Herbal Interactions. Week 1 lesson. Retrieved from http://www.chamberlain.edu (Links to an external site.)Links to an external site.

Lilley, L. L., Shelly Rainforth Collins, P., & Snyder, J. S. (2019). Pharmacology and the nursing process. Mosby.

Exemplar V: NR 509 Advanced Physical Assessments

Reflecting back to week one of this class I was not expecting how much time I was going to need in order to be able to successfully pass the class. I was overwhelmed with the amount of information and the amount of documentation I had to do with our famous patient Tina Jones. Immersion week was a great experience and also nerve wracking, lot of work on week 7 with Shadow Health and getting ready for the APEA. 

My lowest score in the APEA exam was Respiratory, Gastroenterology, and Neurology. I am planning on dedicated a more structured schedule in the near future and be able to schedule a live review for the APEA. The school library has lots of resources that are very helpful and evidence based. 

I want to say thank you to all of my classmates that I met in immersion week, it was great studying and reviewing with all of you.

And specifically I want to thank Dr Green for been such a great teacher and for always give so good advice. Dr Green you have taken lots of time to help each of us to succeed in this class, you show that you really care. Stay that way 

Thank you 

Maikel

Identify and Explain

Chamberlain Program Outcomes

· PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care).

AACN MSN Essentials

· Essential IX: Master’s-Level Nursing Practice

NONPF Core Competencies

· Independent Practice Competencies

This course helped me become keener on diagnostics and screening all of which exemplify Program Outcome #1 that champion for a nurse to help provide safe and patient-centered high-quality care that is influenced by holistic health principles. I learned that one needs to have a lot of background nursing information and develop critical thinking to become good at conducting advanced physical assessments. Through the case studies evaluated, I realize that I should improve more on applying physical assessment concepts especially when handling real-world patients.

Since advanced physical assessments impact healthcare outcomes for populations, individuals and systems then it aligns with Essential IX of MSN Essentials that addresses Nursing Practice at Master’s Level. By making physical assessment of a patient I was influencing the health outcomes of the patient which operationalizes Essential IX of MSN Essentials. I was demonstrating an advanced level of comprehension of nursing as well as relevant fields. I think a physical assessment constitutes a direct nursing intervention as it informs the next course of action in determining the health outcomes of a patient.

By working autonomously I was exhibiting NONPF Core Competencies and in particular, the independent practice competencies. By analyzing the case studies professionally and demonstrating the accountability I was operationalizing independent practice competencies. A competent nurse should distinguish between abnormal and normal health results and I demonstrated this in the case studies I solved. By using diagnostic protocols and screening procedures I exhibited independent practice competencies. However, working autonomous does not overlook the need to collaborate with other professionals in the healthcare field.

Connect

Shadow health: Shadow health refers to a software intended to give virtual learning to healthcare students by providing simulations such as giving digital clinic experience, and pharmacology among others. All of these features provide students with a virtual environment to test their knowledge and skills and build confidence as well as discover weaknesses and opportunities (Foronda et al., 2019).

Gastroenterology: Gastroenterologists is a field of medicine that interrogates, diagnoses, and suggests treatment including listing preventive care for hepatological and gastrointestinal organs and tissues (Tappen, 2016).

Reflection

This is another critical course even though all the other courses are as important as this one. The sensitivity of this course is that it involves diagnostic and screening all of which directly inform the treatment plan and a mistake at this stage can be fatal and costly. As such I find this course and operationalizing Program Outcome #1 that champion for a nurse to help provide safe and patient-centered high quality care that is influenced by holistic health principles. I discovered that one needs to have background nursing information and develop critical thinking to become good at conducting advanced physical assessments. Shadow Health and case studies helped me test my skills and knowledge of physical assessment.

I used several aspects of Essential IX of MSN Essentials that concerns Nursing Practice at Master’s Level. The physical assessment of a patient I performed influenced the health outcomes of the patient implying that physical assessment operationalizes Essential IX of MSN Essentials. I was demonstrating an advanced level of comprehension of nursing as well as relevant fields. Through working independently, I demonstrated NONPF Core Competencies and in particular, the independent practice competencies. Shadow Health simulations and evaluating case studies professionally including demonstrating accountability I operationalized the independent practice competencies.

References

Foronda, C. L., Alfes, C. M., Dev, P., Kleinheksel, A. J., Nelson Jr, D. A., O’donnell, J. M., & Samosky, J. T. (2017). Virtually nursing: Emerging technologies in nursing education. Nurse educator, 42(1), 14-17.

Tappen, R. M. (2016). Advanced nursing research: From theory to practice. Jones & Bartlett Publishers.

Exemplar VI: NR510: Leadership and Role of the Advanced Practice Nurse

Introduction

The field of nursing offers a wide range of possible careers or employment opportunities, starting from hourly rate positions to specialists working in different areas from pediatrics to geriatrics. Holding either a master’s degree or a doctorate in nursing, Advanced Practice Nurses (APN) are the most highly trained of all registered nurses. The functions previously reserved for doctors such as requesting and interpreting laboratory tests, diagnosing condition, administering anesthesia and prescribing medications can now be performed by these professionals. (“What is the Difference between”, 2017)

In this professional development plan, the scope of practice, educational, licensure and regulatory requirements for APN’s will be discussed. Information about the author regarding the strengths and weaknesses and personal assessment will be explored as well.

APN Scope of Practice

Being an APN (Advance Practice Nurse) means to be able to carry out ethical and safe acts, procedures, protocols and practice guidelines using their cognitive, integrative and technical abilities. Being an APN also includes the capability of patient and peer education, mentorship and clinical mentorship; accountability to interpret and utilize researches in order to advance and continually improve nursing practice. (“Scope of Practice of Advanced Practice Nurse”, 2017) Each state indicates different scope of practice for APNs depending on the city they practice.

Education Requirements

To become an advanced practice nurse, one must have a Master of Science in Nursing (MSN). While others proceed and earn a doctoral degree for those who wish to become Clinical Nurse Specialists. After earning a master’s degree, one must obtain a certification which varies depending on the type of advance practice nurse one wishes to become. This requires applying and passing an exam in order to practice as an APRN. (“Advanced Practice Nursing Fact Sheet”, 2017)

Licensure and Regulatory Requirements

Nursing practice laws and regulations are specific to each state. It is regulated by the Boards of Nursing (BONs), a state governmental agency which aims to protect the public’s health welfare by ensuring and governing the safe practice of nursing. This mission is achieved by enumerating the standards for safe nursing care and issuing nursing licenses. After the issuance of a license, the BON continues to monitor licensees’ compliance to state laws and taking action for those who have exhibited unsafe nursing practice. (“About Boards of Nursing”, 2017) Each state’s BON has specific certification requirements which sometimes require maintenance through an ongoing number of continuing hours of training.

Practice Environment Details

There are three types of practice environment, the full practice, reduced practice and restricted practice. In the Full practice, states under this environment has state practice and licensure law for all nurse practitioners to evaluate patients, diagnose, request and interpret diagnostic tests, initiate and manage treatments under the license authority as recommended by the Institute of Medicine and National Council of State Boards of Nursing. Examples of the states under this environment are Alaska, Nevada, North Dakota and Washington. (“State practice environment for nurse practitioners”, 2017).

In the reduced practice, State law limits the setting or scope of one or more elements of NP practice. It also requires a collaborative agreement with an outside health discipline before an NP can provide care. Examples of the states under this environment are Illinois, New Jersey, New York and Wisconsin. (“State practice environment for nurse practitioners”, 2017).

In the restricted practice, the state requires an outside health discipline to supervise, delegate or team manage an NP before they can provide health care. Examples of the states under this environment are California, Florida, Georgia and Virginia. (“State practice environment for nurse practitioners”, 2017).

Assessment

Either a professional or undergraduate, it is very necessary to review and assess possible career paths. To check which career is most interesting for them, how they can get there, the risks and advantages of pursuing a certain career, the possible effect this may cause to the individual, their families and loved ones. There are many factors to consider in choosing which APN career to pursue. One can either be a nurse practitioner, clinical nurse specialist, certified registered nurse anesthetics or certified nurse-midwives. Each offers varying advantages over the other, in terms of abilities, scope of practice, compensation, work environment, market demand and so on.

In choosing a career path, one must consider its willingness to relocate, if not then its willingness to commute with a follow-up question of how far. If transferring to another career path is being considered, the challenge and the risks of being a novice on a new field should be properly accounted.

In choosing any career it is very important to ensure a continuous learning and education in order to be able to cope up with the fast growth of today’s age. New technologies, methods and information are being developed every day.

Strengths

Being patient and caring is an essential characteristic needed for a health care provider. Sometimes patient may not be able to immediately understand what the health care provider is trying to convey, sometimes their current medical condition makes them irritable and difficult to handle and sometimes they have a lot of questions, doubts and fears. The different personalities and traits of different patients and even their family members is pretty much a good source of stress. Being patient is necessary for the health care provider in order for them to provide quality care to the patients by carefully explaining to them their medical conditions, the risks they are in, what physical examinations they have to undergo, why they have to do it and how long they need to be treated.

As a health care provider, being naturally caring is the key to providing quality health care. Since nurse practitioners are responsible for taking a patient’s medical history, conducting physical examinations, diagnosing, treating, educating and performing certain medical procedures, it is very difficult to put your heart into what you do if one doesn’t truly care. Patients need someone who is empathetic and sympathetic to their health concerns, problems and needs. Understanding and relating to a patient promotes a healthy relationship making an environment for the patient that is conducive for healing.

Being a team player and outstanding communicator is also a strength a health provider must possess. Being able to get along well to other health care provider with the same facility promotes a healthy work place that both the patients and the practitioners can benefit from. Sometimes, there are patients with limited health literacy while others may have trouble reading and understanding health information due to language barriers. Effectively communicating with patients increases their satisfaction with the medical facility and keeps them aware of best wellness practices.

Weaknesses

Over confidence is a weakness that needs to be addressed as soon as possible. Confidence is great, but over confidence is poisonous. It can lead to misjudgment, overseeing of data and information, and may cause harm to the patient. Sometimes when we are too much comfortable with our jobs, we tend to become overconfident and seldom forget the boundary between patient, health care provider and superiors creating an unprofessional behavior patterns.

Fortunately, this weakness is slowly being addressed by the author by always taking a pause to look at all the data on hand, the situation, the people involved before making decisions and actions of providing health care.

Networking and Marketing Strategies

After acquiring title and license, finding a job in order to apply all the learning is the next step. Previous classmates, professor, medical facility that one used to work at provide a good network in gathering information about job postings. One can also get advice and suggestions from other professionals who are already in business long before you entered the medical industry about which places is good to start your career at, which facility provides the best experience that you could gain and what to write in your resume in order to attract possible employees.

Finding jobs online is also common during this age. There are already a lot of websites available that would provide you with employment possibilities.

A strong resume and professional profile is a necessary in acquiring jobs fast. One must make sure that their resume provides information that would make the employees choose you over other candidates. This is helpful especially in markets with saturated applicants. For medical facilities where a lot of APN’s are aspiring to be hired into, having your profile noticed is challenging since a lot APN’s with better resumes than you are in your competition for a vacant position.

Conclusion

With an additional degree, certification and license, being an APN means having a higher responsibility. More complex job title, more skills to offer and a higher knowledge and authority gives APN new opportunities and challenges than they had before. Nevertheless, regardless of the type of APN, one must never forget that what is necessary is to provide safe and quality health care to patients.

An APN must be able to communicate well to patients and co-workers. They must continue to pursue knowledge and training in order to provide what is best for their patients. Individual strengths must be enhanced and utilized to its full extent while weakness must be improved. This will give way to the development of the APN’s capability, not only in providing carte, but also in leading and setting herself as an example for others.

To choose to become an APN is a huge step a professional will take. It requires time, money and dedication. Therefore, one must choose wisely the career they are about to pursue so that they can fully provide at the most of their abilities and capabilities a safe and quality health care to patients.

Identify and Explain

Chamberlain Program Outcomes

· PO #3: Engage in lifelong personal and professional growth through reflective practice and appreciation of cultural diversity (Cultural Humility)

AACN MSN Essentials

· Essential II: Organizational and Systems Leadership

NONPF Core Competencies

· Leadership Competencies

I feel that nurses are frequently acting as leaders at the low level as well as at high levels. Think of a nurse who gets assigned an intern. The nurse will have to act as a leader to the intern. By pursuing advancement in nursing career, a nurse is aligning with Program Outcome #3 that urges nurses to indulge in continuous professional and personal growth accompanied by cultural diversity accommodation and reflection. By seeking to become an Advanced Nurse Practitioner one is operationalizing Program Outcome #1 by pursuing career growth.

Additionally I think that the MSN Essential II that addresses organizational and system leadership is highly aligned with this course. Through the case studies evaluated in this course I learned to acknowledge systems and organizational leadership as a vital element in promoting safe and high quality nursing care. I also made a connection between leadership models and ethical models in shaping decision making. Through the systems-wide view I have learned to appreciate managerial decisions by realizing how various departments of an organization are connected.

Correspondingly, I had to build leadership competencies from NONPF Core Competencies viewpoint. I began by developing and demonstrating cultural competency when handling patients and relating with colleagues through simulation exercise with peers. Exercising effective communication skills and participating in professional organizations helped me enhance my leadership competences in this course. I am confident that I will embrace leadership opportunities to push for change. I believe nurses should possess impeccable communication skills. I find reflective thinking highly useful as it enables a leader to self-feedback on his or her actions.

Connect

Systems-wide view: A systems-wide approach seeks to take into account the entire units or departments of an organization to accomplish a more practical approach to leadership or operation. While viewing an organization in modular form is beneficial as it enables us to delve deeper to understand each module, it is important to revert back to how the organization will be affected and this what systems-wide concept does (Cherry & Jacob, 2016).

Nursing leadership: The concept of nursing leadership concerns a type of inspiration and guidance that affects clinical or nursing practice which differentiates it from other forms of leadership. Nursing leadership main preoccupation is to advocate for improvement of healthcare environment for the benefit of the patient and nurses (Cherry & Jacob, 2016).

Reflection

Leadership are expected to be leaders and this course offers an opportunity for a nurse to develop leadership competencies for a nursing care environment. While nursing leaders offer leadership at a higher level, individual nurses frequently demonstrate leadership when assigned nursing interns. I aligned with Program Outcome #3 that urges nurses to indulge in continuous professional and personal growth accompanied by cultural sensitivity and reflection thinking. One of the ways in which I operationalized Program Outcome #1 is through seeking to become an Advanced Nurse Practitioner. I hold the view that the MSN Essential II that addresses organizational and system leadership aligns significantly with this course.

The case provided in this course led me to acknowledge systems and organizational leadership as a critical element in promoting safe and high quality nursing care. I also made a connection between leadership models and ethical models in shaping decision making. As a nurse I have acknowledged the systems-wide view that can help us appreciate managerial decisions by realizing how various departments of an organization are connected. The entire course enabled me to build leadership competencies from NONPF Core Competencies viewpoint. I began by developing and demonstrating cultural competency when handling patients and relating with colleagues through simulation exercise with peers. Exercising effective communication skills and participating in professional organizations helped me enhance my leadership competences in this course.

Reference

Advanced Practice Nursing Fact Sheet | 2017 NurseJournal.org. (2017). Retrieved from http://nursejournal.org/advanced-practice/advanced-practice-nursing-fact-sheet/

About Boards of Nursing | NCSBN. (2017). Retrieved from https://www.ncsbn.org/about-boards-of-nursing.htm

Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences.

State practice environment for nurse practitioners – Campaign for Action | Campaign for Action. (2017). Retrieved from https://campaignforaction.org/resource/state-practice-environment-nurse-practitioners/

Scope of Practice of Advanced Practice Nurse (2017). Retrieved from http://medicine.nus.edu.sg/nursing/documents/education/Scope%20of%20Practice%20of%20APN.pdf

What is the Difference between an Advanced Practice Nurse (APN) and a Nurse Practitioner (NP)? (2017). Retrieved from http://www.bestnursingmasters.com/faq/what-is-the-difference-between-an-advanced-practice-nurse-apn-and-a-nurse-practitioner-np/

Exemplar VII NR 511 Differential Diagnoses and Primary Care

This section has been my first clinical rotation in the FNP program; this was a great experience and excellent opportunity to learn and developed new skills. Coming from an ER environment, I thought this was going to be easy and that I had good skills and knowledge on how to treat and manage diseases. This was obviously change soon after I started my clinical rotation and realized that I have a lot to learned in the primary care setting, since the way we manage and treat patient is more into long care and not like ER which is treat them and send them home. Here there is more follow up and more abroad treatment in order for the patient to have a better outcome. When it comes to ordering lab work, it has been very challenging to learn to base my diagnosis and course of treatment base on physical and history since the labs results I won’t have available until a few days later.

When it comes to medication and treatments, it has been very challenging. I have been used to ER protocols in where we already know what to expect even before the physician or NP prescribed it. In primary care setting, we have so many protocols and so many options to treat same disease that sometimes I find myself looking for treatments plan before I go into the room, also I find it difficult when patient have a lot of comorbidities that we need to take in consideration while choosing a plan of care.

The patients I have been able to see and treat in the primary care setting has been teenagers, young adults, middle age and elderly. Among the procedures I have had the opportunity to perform has been, sutures and suture removal, cerumen removal, cast placement, pelvic examinations, and incision and drainage. My preceptor has been very knowledgeable and always in the look out of cases in where I would be challenge and able to learn at the same time, I have been able to manage blood pressure, DM, COPD, asthma among other diseases. I have learned to follow practical guidelines and evidence-based suggestions and treatments to make my clinical rotations well rounded.

I have also noted that I am lacking on exposure and experience on pediatric and women health. This is why I have already secured a pediatric rotation in the near future classes in order for me to fulfill this gap and I am also working on getting into a women health clinic. While I am working on this project, I have been reading and doing research on the different type of population in order for me to be prepared once I am faced with new challenges. This primary care setting has giving me an introduction to women health due to the high number of female patients that are seen daily in my clinical site for pelvic exam and hormonal treatment. While I have not met the women health model yet, I have been working with my preceptor on researching and using evidence-based when it comes to treating this population. I am looking forward in the near future to be able to come up with a plan and treatment and been able to provide as a NP evidence-based care (National Organization of Nurse Practitioner Facilities, 2013).

When it comes to the pediatric model, I have not been exposed to this demographic yet, the clinical site that I have, does not see pediatric, but maybe one or two a month. However, my preceptor has giving me extra work in order for me to be ready in case I am face with this population. From this work, I have learned how to educate parents on vaccinations and the schedule, also on protocols in case I encounter child abuse cases. I still need to work on a physical exam on this type of population (National Organization of Nurse Practitioner Facilities, 2013).

I have learned that as a NP I would be the key to educate patient’s on how to manage and treat or prevent diseases. I would be following guidelines and evidence-based protocols that will guide me on how to educate and treat my patients. While I know that I have a lot to work on before I am able to meet these competencies, I am grateful that my preceptor has initiated the process for me to be ready once I am faced with the upcoming population (National Organization of Nurse Practitioner Facilities, 2013).

Identify and Explain

Chamberlain Program Outcomes

· PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care)

AACN MSN Essentials

· Essential V: Informatics and Healthcare Technologies

· Essential IX: Master’s-Level Nursing Practice

NONPF Core Competencies

· Quality Competencies

Differential diagnosis and primary care course is a critical course in nursing as it determines the final diagnosis and subsequent treatment plan of a patient. In this course, I realized Program Outcome #1 that encourages provision of safe and high quality healthcare that is patient-centered and premised on holistic health principles. Correct diagnosis of a medical condition or illness is a critical element of patient safety and quality attributes of a healthcare system. I managed to use evidence-based practice guidelines as well as reviewing research articles on various medical conditions.

In my reflection I realized that Program Outcome #1 in this course demands Essential IX of MSN Essentials that addresses nursing practice at master’s level. Primary care and differential diagnosis directly impact outcomes of healthcare and this is what Essential IX addresses. Any aspect of nursing practice that directly affects outcomes of healthcare are deemed to constitute master’s level nursing practice because they require keener and detailed approach with high accountability demands. On operationalizing Essential V: Informatics and Healthcare Technologies I used Shadow Health technology to improve on differential diagnoses knowledge.

Furthermore, a nurse needs NONPF competencies to effectively operationalize the other competencies. In this course I developed quality competencies of NONPF competencies to enable me operationalize the other competencies. By applying the best and recent study findings to clinical practice I operationalized NONPF quality competency. I went further to take into account the intricate relationships between safety, cost and quality delivery of healthcare under quality competency when performing primary care through the case study and peer simulations. A nurse should take time to provide feedback to research articles under peer review to enhance the culture of excellence.

Connect

Test sensitivity: Test sensitivity refers to a laboratory test that has high rate of true positive meaning that the test has a significant ability of identifying those with the disease being tested (Cummings et al., 2015). Test specificity: Test specificity refers to a laboratory test that has high rate of true negative implying that the test has a significant ability of identifying those without the disease being tested(Cummings et al., 2015).

Reflection

This is a critical course in nursing because it addresses the sensitive stages of healthcare. As indicated, I think differential diagnosis and primary care course is a vital course in nursing as it informs the final diagnosis and subsequent treatment plan of a patient. Like other courses I had to research more in this course and accomplished Program Outcome #1 that advocates for provision of safe and high quality healthcare that is patient-centered and premised on holistic health principles. Accurate diagnosis of a medical condition is a salient element of patient safety and quality attributes of a healthcare system. I managed to apply evidence-based practice guidelines as well as reviewing research articles on various medical conditions.

Additionally, I realized that Program Outcome #1 in this course demands Essential IX of MSN Essentials that addresses nursing practice at master’s level. Primary care and differential diagnosis directly impact outcomes of healthcare and this is what Essential IX addresses. The case studies I handled required me to demonstrate an advanced level of comprehension when handling differential diagnosis. By using Shadow Health to improve on differential diagnoses, I managed to operationalize Essential V: Informatics and Healthcare Technologies. I also developed quality competencies in this course that are of NONPF competencies to enable me operationalize the other competencies. By applying the best and recent study findings to clinical practice I operationalized NONPF quality competency. I went further to take into account the intricate relationships between safety, cost and quality delivery of healthcare under quality competency when performing primary care through the case study and peer simulations.

References

Cummings, J., Soomans, D., O’laughlin, J., Snapp, V., Jodoin, A., Proco, H., … & Rood, D. (2015). Sensitivity and specificity of a nurse dysphagia screen in stroke patients. MedSurg Nursing, 24(4), 219-224.

National Organization of Nurse Practitioner Facilities. (2013). Nurse practitioner population focused competencies. http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/Competencies/CompilationPopFocusComps2013.pdf

Exemplar VIII: NR 601 Primary Care of the Maturing and Ageing Family

During this past 7 weeks, I have been exposed to a variety of cases and situations during clinical. I have always known and felt that nurses are the ones that will advocate for their patient in order to have the best interest and prognosis in the long run. As I am in route to becoming a Nurse Practitioner, I have realized that advocating for the patients will continue with more responsibilities. For example, I had a case of a woman that returned to the office for her mammogram results and it was an abnormal result, patient had a mass in her breast and I was able to feel her anxiety and fear. I was able to explain to the patient that she needs a referral to oncology and that biopsy was needed in order to identify and treat her. I was able to collaborate with office in order to obtain a referral as soon as possible and make her appointment. Patient currently went and had surgery and is waiting to initiate radiation therapy. I felt that with the proper collaboration and compassion this patient had a quick attention to her illness. Patient still have a long road ahead of her.

Another example that demonstrates compassion and collaboration is an elderly patient with diabetes that lives alone, and family is out of state. Patient came to office and I notices that she was developing an ulcer on her right heel. Patient immediately thought she was going to lose her leg. I was able to make her understand the importance of taking care of that as soon as possible, the importance of her diet and keep normal blood glucose level. I was able to collaborate with a podiatry and with a home health services that treat wound at patient’s home.

I believe that following guidelines and collaborating with other healthcare providers the patient will have a better outcome and prognosis in the long run.

Masters Essential VIII: Clinical Prevention and Population Health for Improving Health

1. Design patient-centered and culturally responsive strategies in the delivery of clinical prevention and health promote on interventions and/or services to individuals, families, communities, and aggregates/clinical populations.

During this course I was made aware about a large portion of women population that is having sexual issues and are not talking about it with their healthcare provider. What I was more surprised to learn is that we as providers are failing at not bringing this up if the woman does not mention it during the visit. I was able to watch Dr Shapiro’s videos in class and was exposed to guidelines that are follow nationwide. I was able to understand that sexual history is part of a physical and that promoting a good and safe sexual live is adding to the quality of live for these patients. I was also made aware that I do have a long way ahead of me when it comes to feel fully comfortable asking a female patient about their sexual history. I have to work on and will have to think and see it as another illness and understanding the causes and different ways of treating this population.

2. Integrate clinical prevention and population health concepts in the development of culturally relevant and linguistically appropriate health education, communication strategies, and interventions.

During this past few weeks I was able to understand and notice how culture influence the way we take care of our health. Been able to do clinical in a big Hispanic population that come from different backgrounds, I was able to notice and made aware how certain cultures are more prone to use home remedies and herbal concoctions than to take their prescribe medication, and some patient will take both medication and home remedies at the same time. I was able to notice first hand that they will listen more and be more compliant and understanding if we are able to communicate in a form that is simple and in their native language. I remember a particular patient that I was giving him instructions on what labs needed to be done for his physical and he was not understanding the part of his PSA blood test. He was familiar with the other ones, but that one. I had to explain in simple language that this is was something that we measure in his blood after certain age to look if there is and elevation in its level and that it that was the case then we will be referring and performing other tests.  

NONPF: #8 Ethics Competencies

1. Integrates ethical principles in decision making.

During this course I was able to understand that patient and family members need to be educated about the illness process and what the prognosis the patient might have. We as nurses need to be following guidelines and using evidence bases data in order to provided information to patients. We need to promote autonomy in order for the patient in his or her right state of mine make they’re on decision based on information provided. I have come across some patients in where the family opt to keep the patient in the dark when it comes to the illness and this makes treatment much difficult since the patient does not have a fully understanding of the prognosis and the options.

2. Evaluates the ethical consequences of decisions.

This clinical rotation has exposed me to how culture influence on treatment and options. I have come across a few patients in where they have declined treatment because of religion beliefs. As a future nurse practitioner I have been put in a dilemma in where I have to make decisions or rather give alternative solutions to the dilemma. 

3. Applies ethically sound solutions to complex issues related to individuals, populations and systems of care

During this 7 weeks I have been experiencing several cases in where the elderly put the health decision into the family members, and I have noticed that in the Hispanic population they sometimes do not ask the patient what they want, instead they go by what they are costumed to. Family do not explain to the patient what risk or benefits are of the treatments, specifically in terminal illness such as cancer. While I do know that we have to respect their culture and believes, I normally opt to educate the family member and making understand that the patient is the one with their life at stake. 

In general this rotation has been excellent and I feel like I have learned a lot, I feel that this class have prepared me to be a better NP and to be aware not only of the physical but the whole patient. And must important, to work on my confidence on asking female patient about sexual history 

Thank you Dr Alters for you patience and time and teaching. You have been one of the best instructors I have had while in this online program. 

Identify and Explain

Chamberlain Program Outcomes

· PO #5: Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary nursing)

AACN MSN Essentials

· Essential VII: Interprofessional Collaboration for Improving Patient and Population Health Outcomes

NONPF Core Competencies

· Ethics Competencies

When I assisted a patient to get a referral by liasing with the relevant office I had operationalized Program Outcome #5 that urges for positive outcomes in health by engaging in evidence-based and compassionate advanced nursing practice and still collaborating with other departments and professionals in healthcare. I have also advocated for patients in stations I have served and I feel that nurses have a moral duty to assist patients beyond the hospital or current work station. Nurses have adequate and skills to promote health and advocate for better health outcomes for patients.

Further analysis of how I realized Program Outcome #5 indicates that I invoked Essential VII from MSN Essentials that concerns interprofessional collaboration to enhance population and patient outcomes of health. By working with the hospital departments to help the patient get a referral for the unusal mammogram results I managed to operationalize Essential VII of MSN Essentials. A nurse should consult with other health professionals as I did with the case of the patient who had unsual mammogram results. All these illustrations demonstrate how critical nursing competencies are in influencing nursing actions and delivery at workplace.

Concerning NONPF competencies I invoked ethics competencies to help actualize the other competencies explained in this reflection. I discovered that patients and their families require to be taken through the illness process including the prognosis that the patient has and this was possible by infusing ethical principles in decision making. I encountered patients whose cultural beliefs conflicted with the treatment plan and I had to invoke several nursing ethical models to influence the final decision of the patient. This course was not only interesting but it also opens up the complex world of nursing care.

Connect

Geriaritics: Geriaritics refers to a field that focuses on assisting ageing patients cope with physical changes of their bodies as they progress with age (Zaccagnini & White, 2015).

Orthopedic: Orthopedic refers to a speciality field of medicine that addresses the diagnosing, correcting, preventing, and treating individuals with skeletal deformities (Zaccagnini & White, 2015).

Reflection

Nurses routine interaction with patients creats room for complex demands especially where nurses have to take into account conflicting cultural views and the treatment plan or where the family and the patient differ including socioeconomic challenges. Fortunately, nurses are adequately trained to navigate through such situations with significant benefits for the patient. I have faced such scenarios. For instance, when I assisted a patient to get a referral by liasing with the relevant office I had operationalized Program Outcome #5 that advocates for positive outcomes in health by engaging in evidence-based and compassionate advanced nursing practice and still collaborating with other departments and professionals in healthcare.

Additionally, nurses require MSN Essentials and I had to invoke Essential VII from MSN Essentials that captures need for interprofessional collaboration to enhance population and patient outcomes of health. When I worked with the hospital departments to help the patient get a referral for the unusal mammogram results I managed to operationalize Essential VII of MSN Essentials. I invoked ethics competencies of NONPF competencies to help actualize the other competencies explained in this reflection. I discovered that patients and their families require to be taken through the illness process including the prognosis that the patient has and this was possible by infusing ethical principles in decision making.

References

Berry, S., Kiel, D. P., Schmader, K. E., & Sullivan, D. J. (2017). Falls: Prevention in nursing care facilities and the hospital setting. Uptodate. com.

Zaccagnini, M., & White, K. (2015). The doctor of nursing practice essentials. Jones & Bartlett Learning.

Exemplar IX: NR 602 Primary Care of the Childbearing and Childbearing Family

They have been seven weeks of great and intense learning. As I soldier on to becoming an advanced practice nurse, this class has prepared me to meet the MSN program outcome #1, the MSN Essential VII, and the Nurse Practitioner Core Competencies #8.

Program outcome #1:

     Provide high quality, safe, patient-centered care grounded in holistic health principles. (holistic health & patient-centered care). Florence Nightingale was the first nurse to emphasize the significance of holistic care. Holistic care can contribute to patient’s satisfaction with healthcare. Patients of all races and religious have the right to receive safe, patient-centered and holistic care (Andrus, 2014). This course has prepared me to meet the MSN program outcome by addressing patient’s physical, emotional, social and spiritual needs, restores their balances and enables them to deal with their illnesses, consequently improving their lives. One patient had a situation when her primary care provider was away. The provider on call took care of her immediate need. Understanding every patient needs and directing/involving the patient and their family with a high quality, safe, knowledgeable approach, brings in the best outcomes. The patient felt safe and said that she can trust the staff, even if it was not the same provider every time, because they communicated with each other. When my patient needs prescription refills, especially, the narcotics, following the state regulations and primary care policies, keeps the patient and providers safe. I have seen many patients use herbal medication and refuse surgery because they do not believe that it will cure them. Informing the patient with the facts we have and accepting their holistic principles can be challenging at times. One patient was anemic and refused to get admitted for blood transfusion as she was Jehovah witness (Wong, 2013).

MSN Essential VII: Interprofessional Collaboration for Improving Patient and Population Health Outcomes

Recognizes that the master’s-prepared nurse, as a member and leader of interprofessional teams, communicates, collaborates, and consults with other health professionals to manage and coordinate care.

     As a mastered prepared nurse, to lead and coordinate interdisciplinary teams across care environments to reduce barriers, facilitate access to care and improve health outcomes. The MSN Essential VII helps to understand our own professional identity while gaining an understanding of other professional’s roles on the health care team. We do see patients have complex health needs and typically require more than one provider to address issues regarding their health status. As a family nurse practitioner working in interprofessional teams can best communicate and address these complex and challenging needs. Moreover, an interprofessional approach may allow sharing of expertise and perspectives to form a common goal of restoring or maintaining an individual’s health and improving outcomes while combining resources (Sohi, Champagne, & Shidler, 2015). It is important that all providers involved in a patient’s care should have an open communication and equality of resources. For instance, if one of my patients, a woman of childbearing age may need a team of health care providers for high-risk pregnancies, ultrasound technicians, lactation consultants and family support. Some individual patients with diabetes may need care from her provider, community health worker, pharmacists, social workers, a registered dietician and for some an endocrinologist. Further, it is important that poor interprofessional collaboration can have a negative impact on the quality of patient care. Thus, skills in working as an interprofessional team is important for high quality care.

Nurse Practitioner Core Competencies

# 8 Ethics Competencies

1. Integrates ethical principles in decision making.

2. Evaluates the ethical consequences of decisions.

3. Applies ethically sound solutions to complex issues related to individuals, populations and systems of care.

     This course has prepared me as a family nurse practitioner to promote comprehensive patient-centered care in a holistic manner. We do see and experience several topics during clinical encounters and the different ways patients perceive their health and their ability to cope. An example of these topic is the culture like eye contact, touch, spirituality, decision-making, health-beliefs, health-care practices, and non-verbal communications (Saguil & Phelps, 2012) Ethically patients have the right to refuse care. But it is the responsibility of the provider to ascertain if the patient has enough information to make an informed decision regarding refusal of care. As a provider communicating with patients in a fully open manner, allows to explore a patient’s main reason for a visit, associated concerns, and need for information. An example of which includes patients with Jehovah’s Witness who tend to refuse blood as a part of their faith and beliefs. At times a blood transfusion could be the only way to save the patient’s life, but as a practitioner one must respect the faith and values of their spiritual beliefs and offer only the understanding of the consequences of their decisions (Wong, 2013). Another example, when parents refuse vaccinations for their children. Integrating ethical principles and helping parents to make right decision is the responsibility of the provider. As providers offering community referrals (hospice, palliative care, social services) for problems that cause suffering, chronic pain, grief, domestic violence, and broken relationships. Providing physical comfort and emotional support is important.

Identify and Explain

Chamberlain Program Outcomes

· PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care)

AACN MSN Essentials

· Essential VII: Interprofessional Collaboration for Improving Patient and Population Health Outcomes.

NONPF Core Competencies

· Ethics Competencies

By addressing the emotional, spritual, physiological and spiritual needs of a patient I operationalized Program Outcome # 1 that urges nurses to deliver safe, high quality and patient-oriented care that is build on holistic health tenets. The health is holistic when we look at a patient as a whole. Another way in which I actualize Program Outcome #1 is by seeking to understand a patient deeper and forming a trust relationship with the patient. The Program Outcome #1 is central to transformative healthcare and wil recur throughout nursing care practice.

All of the above could not have not possible without relying on MSN Essentials, Essential VII that explores interprofessional collaboration to realize population and patient health outcomes. I have made attempts to lead and help coordinate diverse teams to lower barriers and enhance health desired outcomes of health. Through Essential VII, I learned to aprpeciate other professionals while feeling contended with my profession. There are patients with complex needs and will require several providers to satisfy their needs with respect to healthcare. It is imperative that nurses develop the skills and experience of working with others including communication. I find it important for nurses to engage in interprofessional interaction which can provides an aopportunity to share information and experiences that can enhance health outcomes.

Expectedly, I had to invoke NONPF competencies and in particular the Ethics Competencies. I agree with Saguil and Phelps (2012) argument that ethically patients can refuse care but it remains the duty of nurses to assess if such patients have been given adequate information to decline care. Correspondingly, I am always open with patients and invoke cultural competencies to avail all the relevant information to a patient and the patient family in a way that is not overwheling. The information I give is complete and simple enough for a non-healthcare person to understand.

Connect

Postnatal depression: This is a form of depression that some parents face after having a baby. Postnatal depression is common and affects mostly women after childbirth but it can also affect fathers. Its signs include disconnecting from the baby and entertaining thoughts of harming the child (Agrawal, 2015). Postpartum hemorrhage: Postpartum hemorrhage refers to excessive bleeding after chilbirth. The condition is among the leading causes of maternal mortality (Agrawal, 2015).

Reflection

This course has offered a lot especially on ways ofaddressing the emotional, spritual, physiological and spiritual needs of a patient which in essence helped me operationalize Program Outcome # 1. The Program Outcome #1 urges nurses to give safe, high quality and patient-oriented care that is build on holistic health tenets. As a nurse I thin health is holistic when we look at a patient as a whole. I also accomplished Program Outcome #1 is by seeking to understand a patient deeper and forming a trust relationship with the patient. I relied on MSN Essentials, Essential VII that explores interprofessional collaboration to realize population and patient health outcomes.

In most cases handling patients requires a nurse to collaborate with other professionals. I believe a nurse should learn to coordinate diverse teams to minimize barriers and enhance health desired outcomes of health. For instance, through Essential VII, I learned to aprpeciate other professionals while feeling contended with my profession. There are patients with complex needs and will require several providers to satisfy the identified needs in relation to healthcare. I managed to invoke NONPF competencies and in particular the Ethics Competencies. The argument by Saguil and Phelps (2012) that ethically patients can refuse care but it remains the duty of nurses to assess if such patients have been given adequate information to decline care merits. I always to remain open with patients to encourage communication.

References:

Agrawal, P. (2015). Maternal mortality and morbidity in the United States of America.

Andrus, V. L. (2014). Person-Centered Care: Enhancing Patient (Person) Engagement. Beginnings, 34(1), 18-21.

Saguil, A. & Phelps, K. (2012). The spiritual assessment. American Family Physician, 86(6), 546-550.

Sohi, J., Champagne, M., & Shidler, S. (2015). Improving health care professionals’ collaboration to facilitate patient participation in decisions regarding life-prolonging care: An action research project. Journal of Interprofessional Care, 29(5), 409-414.

Wong, D. S. (2013). Blood transfusion and Jehovah’s Witnesses revisited: Implications for surgeons. Surgical Practice, 16(4), 128-132.

Exemplar X: NR 602 Advanced Clinical Care and Practice Across the Lifespan of Practinum

Working full time, clinical, homework with due dates, quizzes, and then of course life itself has been challenging. I am so glad this course is ending because it means we move towards the last course of the program, meaning there is a light at the end of this tunnel.

Program Outcome #4:  Integrate professional values through scholarship and service in health care. (Professional identity)

Reflecting back throughout the last eight weeks, I have been able to integrate professional values through scholarship and service in health care in many ways. According to American Association of Colleges of Nursing (2011), scholarship in nursing can be defined as those activities that systematically advance the teaching, research, and practice of nursing through rigorous inquiry that is significant to the profession, is creative, can be documented, can be replicated or elaborated, and can be peer-reviewed through various methods. Most of the disease processes covered in class, one can actually apply what one has learned in clinicals. There were many occasions where we were covering a specific disease process and the next day, I would see it in clinicals.

MSN Essential IV: Translating and Integrating Scholarship into Practice Recognize that the master’s-prepared nurse applies research outcomes within the practice setting, resolves practice problems, works as a change agent, and disseminates results.

This outcome has been met by all the discussions, case studies about different diseases, and making up case studies for others to uncover what is going on. Utilizing clinical practice guidelines when available to recognize, plan, treat and manage certain diseases and then sharing it with the class satisfies this outcome. To develop skills and knowledge and rendering the best research and evidence to provide quality health care in clinicals solidifies the clinical experience.  In discussions, one can present a plan based on what one has learned, however, a different student may be able to interpret the guidelines another way and present a plan in another way. This takes the case study to another level because now both students and whoever reads the discussion benefit from the information shared.  A similar situation happened in week 3 for the cardiovascular case study. After reading the JNC 8 guidelines for the treatment of hypertension, there was a part for one to decide which stage of hypertension “Larry” was in.  There was a point where some students were confused. Through discussions with each other and explaining the guidelines, this confusion was resolved.  Through the translation of evidence, patient safety and care responses can be recalibrated to optimize outcomes for patients (Curtis, Fry, Shaban, & Considine, 2016).

Nurse Practitioner Core Competencies # 7: Health Delivery System Competencies

The health delivery system competencies refer to the planning, development, and implementation of public and community health programs.  These skills include negotiating, consensus-building, and partnering. These competencies instruct on healthcare reform and organizational decision-making (AACN, 2011). Nurse Practitioners will use data from information systems to improve practice and review cost, safety, effectiveness, and any alternatives when proposing changes in care or to practice.  In the clinic that I am currently doing clinicals, they have a team dedicated solely to billing. Not only is team very active in educating everyone in regards to different requirements each insurance has but they make sure everyone part of the clinic is aware and educated about these requirements. For me, I have been working in the hospital for the last 5 years where I don’t really pay much attention to that part of healthcare. Now, I learn something new every time I go to the clinic in regards to new requirements for Medicare, Medicaid, and other insurances.  It is definitely important to know and understand this part of healthcare to be able to provide quality care.

Identify and Explain

Chamberlain Program Outcomes

· PO #4: Integrate professional values through scholarship and service in health care (Professional identity)

AACN MSN Essentials

· Essential III: Quality Improvement and Safety

· Essential IV: Translating and Integrating Scholarship into Practice

NONPF Core Competencies

· Health Delivery Systems Competencies

This course offered me an opportunity to realize Program Outcome #4 that requires a nurse to incorporate professional values via service in healthcare and scholarship. For instance, I have learned to make help patients whose lifestyle or work attracts ridicule and stereotypes form the community to feel comfortable. Nurses are expected to rise above personal prejudices when handling patients even in cases where a patient does not seem to follow treatment plan. This course has offered useful insights on behavioral health and cultural diversity concerns.

Expectedly, performing advanced differential diagnosis required me to rely on Essential IV of MSN Essentials that covers translating and incorporating scholarship into nursing practice as well as acknowledging that Advanced Nursing Practitioner should resolve problems. When I use clinical practice guidelines to acknowledge, treat, manage and plan particular diseases then Program Outcome #4 has been operationalized using Essential IV. As a nurse I have covered a lot of theory, simulations, case studies and laboratory sessions at the end of it all I have to apply what I learned in a real world hospital or clinic as I have done.

However, a NONPF competency is necessary to operationalize Program Outcome #4 and Essential IV and the Health Delivery System Competencies as part of NONPF competencies was invoked in this course. Essential III concerns quality improvement and safety which I attained by utilizing evidence-based research to improve on current practices. I used negotiation skills, partnership, and building consensus to succeed in delivering healthcare services. The competencies here can help inform organizational decision-making including healthcare reform. I used evidence-based practice guidelines to lower provider and patient risks.

Connect

Cyrotherapy: A form of treatment that entails using freezing temperatures is referre dto as cyrotehrapy. It is relatively new and its benefits cannot be ascertained and should be considered as an alternative treatment (Song et al., 2016). Immunization: Sometimes referred to as innoculation or vaccination, immunization refers to the process of safely administering a mild form an infectious agent to the body to enable the body gradually build defenses against the pathogen. Vaccine is a common term for the mild form of a pathogen that can be safely introduced into the human body to trigger the immune system to form defenses against the pathogen (Wilder-Smith et al., 2017).

Reflection

I found this course captivating and immerses a student into the core of nursing care. Through thos course I got an opportunity to operationalize Program Outcome #4 that requires a nurse to incorporate professional values via service in healthcare and scholarship. I have learned to make help patients whose lifestyle or work attracts ridicule and stereotypes form the community to feel comfortable. I hold the view that nurses is expected to rise above personal prejudices when handling patients even in cases where a patient does not seem to follow treatment plan. The

Essential IV of MSN Essentials that covers translating and incorporating scholarship into nursing practice guided my approach to resolve problems.

I noticed that when I apply clinical practice guidelines to acknowledge, treat, manage and plan particular diseases then Program Outcome #4 has been operationalized using Essential IV. As a nurse I have covered a lot of theory, simulations, case studies and laboratory sessions at the end of it all I have to apply what I learned in a real world hospital or clinic as I have done. A NONPF competency is used to operationalize Program Outcome #4 and Essential IV and the Health Delivery System Competencies as part of NONPF competencies was invoked in this course.

References

American Association of Colleges of Nursing (AACN). (2011). Defining Scholarship for the Discipline of Nursing. Retrieved from http://www.aacnnursing.org/News-Information/Position-Statements-White-Papers/Defining-Scholarship (Links to an external site.)Links to an external site.

Curtis, K., Fry, M., Shaban, R. Z., & Considine, J. (2016). Translating research findings to clinical nursing practice. Journal of Clinical Nursing, 26(5-6), 862-872.

Song, M., Sun, X., Tian, X., Zhang, X., Shi, T., Sun, R., & Dai, W. (2016). Compressive cryotherapy versus cryotherapy alone in patients undergoing knee surgery: a meta-analysis. Springerplus, 5(1), 1074.

Wilder-Smith, A., Longini, I., Zuber, P. L., Bärnighausen, T., Edmunds, W. J., Dean, N., … & Gessner, B. D. (2017). The public health value of vaccines beyond efficacy: methods, measures and outcomes. BMC medicine, 15(1), 138.

Appendix A: Mind Concept

Appendix B: Tabulation of outcome, Essentials and Competencies achieved

Exemplar# Title	Program outcome Met	MSN Essentials Met	NONPF Core Competencies Met
Exemplar I: NR503 Population Health, Epidemiology & Statistical PrinciplesChamberlain College of Nursing	PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care)	Essential I: Background for Practice from Sciences and Humanities	Scientific Foundation Competencies.Technology and Information Literacy Competencies
Exemplar II: NR 505 Advance Research Methods Week 3	PO #5: Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary nursing)	Essential VI: Health Policy and Advocacy	Scientific Foundation CompetenciesPolicy Competencies
Exemplar III: NR 507 Advanced Pathophysiology	PO #2: Create a caring environment for achieving quality health outcomes (Care-Focused)PO #4: Integrate professional values through scholarship and service in health care (Professional identity)	Essential VIII: Clinical Prevention and Population Health for Improving Health	Independent Practice Competencies.Policy Competencies.
Exemplar IV: NR 508 Advanced Pharmacology	PO #5: Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary nursing)	Essential VII: Interprofessional Collaboration for Improving Patient andPopulation Health Outcomes.	Health Delivery Systems Competencies
Exemplar V: NR 509 Advanced Physical Assessments	PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care).	Essential IX: Master’s-Level Nursing Practice	Independent Practice Competencies
Exemplar VI: NR510: Leadership and Role of the Advanced Practice Nurse	PO #3: Engage in lifelong personal and professional growth through reflective practice and appreciation of cultural diversity (Cultural Humility))	Essential IX: Master’s-Level Nursing Practice	Leadership Competencies
Exemplar VII NR 511 Differential Diagnoses and Primary Care	PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care)	Essential V: Informatics and Healthcare TechnologiesEssential IX: Master’s-Level Nursing Practice	Quality Competencies
Exemplar VIII: NR 601 Primary Care of the Maturing and Ageing Family	PO #5: Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary nursing))	Essential VII: Interprofessional Collaboration for Improving Patient and Population Health Outcomes	Ethics Competencies
Exemplar IX: NR 602 Primary Care of the Childbearing and Childbearing Family	PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care)	Essential VII: Interprofessional Collaboration for Improving Patient and Population Health Outcomes.	Ethics Competencies
Exemplar X: NR 602 Advanced Clinical Care and Practice Across the Lifespan of Practinum	PO #4: Integrate professional values through scholarship and service in health care (Professional identity)	Essential III: Quality Improvement and SafetyEssential IV: Translating and Integrating Scholarship into Practice	Health Delivery Systems Competencies