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Translating Evidence into Clinical Practice – MN 566 Essay

Infection Control Evidence-Based Practice

Medicine demands the highest standards of care and safest practice. It deals with human life and guarding it is the pillar of the entirety of its practice. EBP is defines as the approach and the blueprint of the research practice that is used to transition data from results of a research or investigation into safe practice and application of care protocols. DiCenso et al ., (2017) explains that EBP is the a mirror of the safe and high standards performance of patient care derived from research that is used to meet patient’s needs. There are several EBP methods used widely in nowadays medicine practice such as infection control, use of O2 in COPD patients, weight management in CHF patients…etc. For the purpose of this paper the subjectivity of it will be toward infection control and importance of EBP in raising it in such standards and why it should be used in or practice. Translating Evidence into Clinical Practice – MN 566 Essay.

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Leads to highest quality care and patient outcomes

Infection prevention in any healthcare facility is a safety process that is never overlooked by the organization itself. Not only does an infection acquired in hospital cost the institution enormous amount in healthcare, but it places the lives of the patient at risk. When considering providing care to patients and no exposure or contraction of infection was carried on during the service, the outcome should look into safe practice and proper utilization of the standards that assure prevention of infection and controlling it. Translating Evidence into Clinical Practice – MN 566 Essay Loveday et al., (2014) explains that use of PPE, hand washing hygiene and use of proper barrier precautions represent high quality of care and positive outcomes for patients that are fragile and in a weak status at the time of the care provided. There are two components of quality of care: accessibility and efficiency of it. If the care accessed was not efficient in getting patient better and instead added another infection to their condition, it failed to provide quality care. (Donabedian,1988). Preventing transmission of infection to patient does exactly that, maintains the standards of care and assures quality in delivering it. So another way of thinking of the infection control EBP is that is used as measuring tool as well, of how the institution provides and guarantees safe and effective care. Translating Evidence into Clinical Practice – MN 566 Essay.

                                       Reduces health care costs

Trybou et al ,. (2016) states that: “Hospital Acquired Infections (HAIs) are considered to be one of the most serious patient safety issues in healthcare today. It has been shown that HAIs contribute significantly not only to morbidity and mortality, but also to excessive costs for the health care system and for hospitalized patients. Since possibilities of prevention and control exist, hospital quality can be improved while simultaneously the cost of care is reduced”. HAIs are used as a tool to measure the quality of health services an institution provides and the Center for Medicare Services (CMS) tracks and registers these. Based on their record the CMS determines their compensation or penalization of the place. Schmier (2016) Explains that: “HAI avoidance through use of health care antiseptics has a demonstrable and substantial impact on health care expenditures; the costs here are exclusive of administrative penalties or long-term outcomes for patients and caregivers such as lost productivity or indirect costs.”. If the spread of infection is controlled, the cost for its recovery is less and the sources of healthcare payment are not used up for it. This leads to reduces cost of care overall.

Reduces geographic variations in the delivery of care

Being used as a state-wide international standard, infection prevention is seeing as a practice of safe healthcare anywhere in the world. If all the places adopt efficient and qualitative EBP that aim to prevent infection spread, the geographic diversity of care provided will be eliminated and the delivery of care will be unanimous and safe anywhere. In a study conducted in Scutari, turkey, a decrease from 43% to 2% was noticed in a hospital where safe infection prevention practices were utilized. (Loveday, 2014).

Increases healthcare provider empowerment and role satisfaction

Other benefit of the infection prevention as part of the EBP strategy and practice is that it allows for an increased empowerment and satisfaction for the healthcare providers. With providers being the front line of delivery of care, being able to prevent the infection means that their year of hard work, expertise and extensive knowledge are functioning the expected way and quality care is being offered due to their performance, dedication and safe practice. This way the professionals take responsibility and charge in leading the projects that pioneer infection prevention, which then leads to quality care, customer satisfaction and reduced healthcare cost as well. Translating Evidence into Clinical Practice – MN 566 Essay.

Reduces healthcare provider turnover rate

When infections are prevented and the tam of the providers is the one directing the safety practice, the workload for the staff is reduced as well. Loveday et al., (2014) explained that when the workload is decreased the staff, nurses and other providers have better outcomes in their performance due their balanced work-life schedule. Translating Evidence into Clinical Practice – MN 566 Essay. They don’t have to work extra due to complications from the infections, therefore, prevention is the best strategy in assuring low staff turnover and pleasant work environment with assured longevity in the positions occupied.

Increases reimbursement from 3rd party payers

CMS has enabled the requirements that any infection acquired while in the hospital, will not be covered by Medicare. The hospital will have to pay for the infection treatment itself. There has been a reported increase of hospital bills from 28 billion to 45 billion that is accrued due to hospital acquired infections. (Loveday & colleges,2014). Like Medicare, the majority of other private insurances, follow the same principles when it comes to compensating for HAIs. So controlled HAI rates, lead to an increase of reimbursement from the third-party payors compare to the decreased amount of payment they provide for the hospital when a HAI is contracted. Translating Evidence into Clinical Practice – MN 566 Essay.

Reduces complications and payment denials

The Deficit Reduction Act of 2005, specified, that not only will Medicare not pay for any infection acquired while inpatient, but there cannot be even a billing send to the with claims of compensation for the treatment of the patient that encountered a HAI.(Melnyk, Gallagher-Ford, Long, & Fineout-Overholt,2014).The reasoning behind that is that I the patient did not present with these symptoms initially, he/she got the infection while there and the hospital failed to provide safe and quality care by preventing infection and not doing what they are supposed to do Translating Evidence into Clinical Practice – MN 566 Essay.

Meets the expectation of an informed public

Lastly, infection prevention based on EBP is a routine that can set an example for the public as to how to adopt safe and quality healthcare and prevent the spread of infection sin the community. EBP that streamlines all the quality measures, including infection prevention, can be found in abundance in media. That helps the community to be informed, compare data among institutions or providers, spread the knowledge and sensitize each other about precautionary steps.

 

 

 

 

 

References

DiCenso, A., Guyatt, G., & Ciliska, D. (2014). 
Evidence-Based Nursing-E-Book: A Guide to Clinical Practice
. Elsevier Health Sciences.

Donabedian, A. (1988). The quality of care: how can it be assessed?.
Jama
,
260
(12), 1743-1748.

Last Name, F. M. (Year). Article Title.
Journal Title
, Pages From – To. Translating Evidence into Clinical Practice – MN 566 Essay.

Last Name, F. M. (Year).
Book Title.
City Name: Publisher Name.

Loveday, H. P., Wilson, J., Pratt, R. J., Golsorkhi, M., Tingle, A., Bak, A., … & Wilcox, M. (2014). epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. 
The Journal of Hospital Infection
, 
86
, S1-S70. doi: 10.1016/S0195-6701(13)60012-2.

Melnyk, B. M., Gallagher‐Ford, L., Long, L. E., & Fineout‐Overholt, E. (2014). The establishment of evidence‐based practice competencies for practicing registered nurses and advanced practice nurses in real‐world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. 
Worldviews on Evidence‐Based Nursing
, 
11
(1), 5-15.

Schmier, J. K., Hulme-Lowe, C. K., Semenova, S., Klenk, J. A., DeLeo, P. C., Sedlak, R., & Carlson, P. A. (2016). Estimated hospital costs associated with preventable health care-associated infections if health care antiseptic products were unavailable.
ClinicoEconomics and outcomes research : CEOR
,
8
, 197-205. doi:10.2147/CEOR.S102505 Translating Evidence into Clinical Practice – MN 566 Essay

Trybou, J., Spaepen, E., Vermeulen, B., Porrez, L., & Annemans, L. (2013). Hospital-acquired infections in Belgian acute-care hospitals: financial burden of disease and potential cost savings.
Acta Clinica Belgica
,
68
(3), 199-205.

Primary Care Vs Acute Care Nurse Practitioner Essay

Discuss the differences between a Primary Care Nurse Practitioner and an Acute Care Nurse Practitioner and their scope of practice. Why is this important to know as you move from being a nurse into your new role as an NP? Please include sources and references to support your discussion.

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(Haut & Madden, 2015)

Gardenier, Knestrick, & Edwards-Tuttle (2017) mention that the nurse practitioner (NP’s) scope of practice is a result of their educational preparation, the endorsement of their education by means of the accomplishment of board certification, and licensure that grants the legal authority to practice. Primary Care Vs Acute Care Nurse Practitioner Essay. AANP.org (2019), suggest that the major difference between the two advanced practice registered nurses (APRN’s) is the particular areas of practice for which the individual has received education and gained experience, and in which he or she has demonstrated competency.

As APRNs, both types of NPs must graduate from a demanding, graduate-level nurse practitioner program before practicing.  Respectively, each nurse practitioner is acknowledged as an expert in their corresponding specialty and works in partnership to provide evidence based care and to enhance patient outcomes (NONPF, 2012). Primary Care Vs Acute Care Nurse Practitioner Essay.

The Acute Care Nurse Practitioners (ACNP) are educated, certified, and licensed to provide restorative care in emergent and non-emergent situations.  These patients are frequently suffering from a sporadic exacerbation of a chronic disease or a complex critical illness, they can be unstable or can result from an acute traumatic event (Hoyt & Proehl, 2015). Primary Care Vs Acute Care Nurse Practitioner Essay.

The Family Nurse Practitioner (FNP) is also one who is educated, certified and licensed to provide care for chronic illnesses, ensuring that patients receive adequate preventative care, health screenings, routine check-ups, order diagnostic tests when needed, promote healthy lifestyles, guide patients in efforts of disease prevention and generally has consistent care defined by a long-term relationship with the patient (Judge-Ellis & Wilson, 2017).

It is important for NP’s and APRN’s to know and adhere to the scope of practice because this is the rules, the regulations, and the boundaries within which a fully qualified practitioner with substantial and appropriate training, knowledge, and experience may practice.

References:

AANP.org. (2019, April 19).
Nurse Practitioners in Primary Care
. Retrieved from American Association of Nurse Practitioners (AANP): https://www.aanp.org/advocacy/advocacy-resource/position-statements/nurse-practitioners-in-primary-care

Gardenier, D., Knestrick, J., & Edwards-Tuttle, C. (2017). Should Primary Care Nurse Practitioners be Permitted to Work in Acute Care Settings?
The Journal for Nurse Practitioners
, 326–327.

Hoyt, K. S., & Proehl, J. A. (2015). Family Nurse Practitioner or Acute Care Nurse Practitioner in the Emergency Department?
Advanced Emergency Nursing Journal
, 243–246. Primary Care Vs Acute Care Nurse Practitioner Essay.

Judge-Ellis, T., & Wilson, T. R. (2017). Time and NP Practice: Naming, Claiming, and Explaining the Role of Nurse Practitioners.
The Journal for Nurse Practitioners
, 583–589.

NONPF. (2012, June).
Statement on Acute Care and Primary Care Certified Nurse Practitioners Practice .
Retrieved from NATIONAL ORGANIZATION OF NURSE PRACTITIONER FACULTIES : https://www.pncb.org/sites/default/files/2017-02/NONPF_AC_PC_Statement.pdf Primary Care Vs Acute Care Nurse Practitioner Essay

Fabiola, done

The National Organization of Nurse Practitioner Faculties (NONPF) is the only association explicitly dedicated to upholding superiority nurse practitioner (NP) education at the national and international levels (NONPF, 2012).  I believe nurses should attain advanced levels of education and training through an enriched education structure that stimulates seamless academic development. Since licensing and practice guidelines fluctuate across states, the code of practice regarding scope of practice have variable effects. The tasks nurse practitioners are permitted to execute are determined not by their education and training but by the distinctive state laws under which they work (Haut & Madden, 2015).

References:

Haut, C., & Madden, M. (2015). Hiring Appropriate Providers for Different Populations: Acute Care Nurse Practitioners.
Critical Care Nurse
, 12-18.

NONPF. (2012, June).
Statement on Acute Care and Primary Care Certified Nurse Practitioners Practice .
Retrieved from NATIONAL ORGANIZATION OF NURSE PRACTITIONER FACULTIES :
https://www.pncb.org/sites/default/files/2017-02/NONPF_AC_PC_Statement.pdf

Mary

Lidia, done

Haut & Madden (2015) state that it is crucial that specific job descriptions undoubtedly outline the role of the nurse practitioner pursued by an institute. The employer must classify the population of patients that will be cared for by the nurse practitioner. The job narrative must reveal the practice environment and should spell out the professional and organizational goals for the proposed role, as well as direct patient care, research, staff education, inter-professional collaboration, and administrative responsibilities.  Keough, Stevenson, Martinovich, Young, & Tanabe (2011), noted that nurse practitioners prepared as primary care providers have competencies dissimilar from those equipped for acute care roles. These distinctive educational differences govern an NP’s scope of practice.  Credentialing or obtaining privileges is the process of establishing the qualifications of an individual to work in a specific environment. Primary Care Vs Acute Care Nurse Practitioner Essay.

References:

Haut, C., & Madden, M. (2015). Hiring Appropriate Providers for Different Populations: Acute Care Nurse Practitioners.
Critical Care Nurse
, 12-18.

Keough, V., Stevenson, A., Martinovich, Z., Young, R., & Tanabe, P. (2011). Nurse practitioner certification and practice settings: Implications for education and practice.
Journal of Nursing Scholarship
, 195–202.

AANP.org. (2019, April 19).
Nurse Practitioners in Primary Care
. Retrieved from American Association of Nurse Practitioners (AANP): https://www.aanp.org/advocacy/advocacy-resource/position-statements/nurse-practitioners-in-primary-care

Gardenier, D., Knestrick, J., & Edwards-Tuttle, C. (2017). Should Primary Care Nurse Practitioners be Permitted to Work in Acute Care Settings?
The Journal for Nurse Practitioners
, 326–327.

Haut, C., & Madden, M. (2015). Hiring Appropriate Providers for Different Populations: Acute Care Nurse Practitioners.
Critical Care Nurse
, 12-18. Primary Care Vs Acute Care Nurse Practitioner Essay.

Hoyt, K. S., & Proehl, J. A. (2015). Family Nurse Practitioner or Acute Care Nurse Practitioner in the Emergency Department?
Advanced Emergency Nursing Journal
, 243–246.

Judge-Ellis, T., & Wilson, T. R. (2017). Time and NP Practice: Naming, Claiming, and Explaining the Role of Nurse Practitioners.
The Journal for Nurse Practitioners
, 583–589.

NONPF. (2012, June).
Statement on Acute Care and Primary Care Certified Nurse Practitioners Practice .
Retrieved from NATIONAL ORGANIZATION OF NURSE PRACTITIONER FACULTIES : https://www.pncb.org/sites/default/files/2017-02/NONPF_AC_PC_Statement.pdf

Primary Care Vs Acute Care Nurse Practitioner Essay
 

 

Introduction

N, Done

Hello and welcome to the class.  What a journey to the master’s degree.  Like yourself, I have climbed my way from beginning as a phlebotomist to medical assistant to LPN then to RN to BSN now finally FNP, next will be my DNP and I will officially be done with college. What an experience.  I look forward to interacting with you this 10 weeks in our class.  Best of luck! Mary

 

J, Done

Welcome to class. It is nice to see a fellow class member from Indiana.  I am from southern Indiana.  One of my clinical rotation is with a doctor that practices women’s health, family practice, and Aesthetics, I will not be allowed any involvement with the aesthetics portion, but it will still be interesting.  Nice to read your post and I look forward to interacting with you this rotation. Primary Care Vs Acute Care Nurse Practitioner Essay

M

 

M, done

Welcome! I share you interest in the ICU.  I worked in the ICU/CCU/CVCCU for 8 years. I loved the excitement and being a part of a well refined team.  I agree with you, a supportive network of family, friends and even your work family is imperative to successfully transitioning and conquering going back and completing school.   Best of luck in your journey and I look forward to sharing ideas throughout this class.

Primary Care Vs Acute Care Nurse Practitioner Essay

MN566 Unit 2 Discussion Essay

What does it means to document accurately and appropriately?

According to (Mathioudakis, Rousalova, Gagnat, Saad, & Hardavella, 2016), high quality clinical notes detail the medical history of the patient.  The quality of our record keeping is a reflection of the standard of care we give to our patients. Well documented, and precise patient records is the emblem of a caring and conscientious nurse, but below par documentation can lead to uncertainties about the nurse’s ability. The nursing documentation is where what nursing care the patient gets and the patient’s reaction, in addition to any further outcomes or issues that may influence the patient’s wellbeing.  Document the rationale for your diagnosis and treatment.

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What are the documenting guidelines? When is it appropriate to use abbreviations?

Using SOAP format.  Accurate records will contain observations of clinical outcomes.  Every single submission into the medical record should be signed, timed (24 h clock), dated and legible.  The Joint Commission offers direction to practitioners on safe medication practices through its “Do Not Use” list of abbreviations.  To avoid misinterpretations and possible danger to the patient’s wellbeing, MOI.4 calls for all hospitals to have in place a record for accepted as well as, do-not-use abbreviations and check for proper abbreviation use (JCI, 2018). MN566 Unit 2 Discussion Essay

What is the difference between subjective and objective data?

(Lew & Ghassemzadeh, 2019) noted that subjective information is what the patient tells the provider such as the history, from chief complaint through the review of systems. Objective data all physical exam findings that the provider discovers through exam. Symptoms are the patient’s subjective depiction and ought to be documented under the subjective heading, while a sign is an objective finding related to the related symptom stated by the patient. MN566 Unit 2 Discussion Essay.

What does it mean to demonstrate clinical reasoning skills?

Clinical reasoning skills will help the provider make a pertinent and proper conclusion intended at prevention, diagnosis, and treatment of a patient’s problem. Clinical reasoning involves the ability to critically think.  Clinical reasoning, also known as clinical judgment, is the process by which clinicians collect signs, process information, understand the patient’s medical situation or problem, plan and implement appropriate medical interventions, evaluate outcomes, and learn from this entire process (Benner, Hughes, & Sutphen, 2008).

How can you use clinical reasoning to plan the organization of a comprehensive exam?

Intuition, cognitive Skills and Critical Thinking Skills.  Being able to think critically and using the clinical reasoning processes that uses hypothesizing, hypothesis testing, re-analysis and differential diagnosis. Collaboration with the patient a significant part of the clinical reasoning practice in producing positive outcomes (Atkinson & Nixon-Cave, 2011). MN566 Unit 2 Discussion Essay

How will you document variations of normal and abnormal assessment findings?

You will document both normal and abnormal values as well as if the abnormal value has been chronic.  Develop action plan/management plan once the problem has been identified for the abnormal values. Document referrals whenever appropriate and necessary.  Responsiveness to decision making and follow through is also imperative (Dunphy, Windland-Brown, Porter, & Thomas, 2015).

What factors influence appropriate tools and tests necessary for a comprehensive assessment?

Diagnostic hypothesis can use screening methods such as diagnostic test to confirm or rule out a condition (Dunphy, Windland-Brown, Porter, & Thomas, 2015).  A comprehensive health assessment contains an examination of social and behavioral influences, epidemiology, health risks and data from the patients and/or families/caregivers. I will look closely at relating data such as age, gender, and health insurance, and examine the problem list, the medication list, and facts such as the records of allergies. The chart frequently offers important information about past diagnoses and treatments. MN566 Unit 2 Discussion Essay.

Reflect on personal strengths, limitations, beliefs, prejudices, and values.

My growth in the profession of nursing has been a process that has been enriched through the experience, education and my training that I have had. Knowledge gained from advanced practice courses will also help me to possess a grounded understanding of normal physiologic and pathologic mechanisms of disease that serve as one primary component of the foundation for clinical assessment, decision making and management and will provide me with a deeper understanding of fundamental theories and concepts in pharmacology that are directly applicable to advanced practice nursing.

How will these impact your ability to collect a comprehensive health history?

Courses in clinical practice will provide me as an advanced practice nurse with the tools to perform a comprehensive health assessment on clients across the lifespan.   I will build my knowledge of anatomy, physiology, pathophysiology and health assessment skills previously attained in my undergraduate nurse education and recent graduate courses. These diagnostic reasoning skills are needed for clinical reasoning in the advanced practice role as I will be able to identify effective and ethical interviewing techniques, document the findings of a comprehensive health assessment and physical examination of my client and integrate those assessment findings into recommendations for health improvement.

How can you develop strong communication skills?

Active listening skills are important but sometimes overlooked, as they can become less sharp over time. I fosters a work environment that consists of open communication, trust, leadership, professional development, and excellence in customer service, shared decision-making, whenever possible, and role clarification. As a leader I must also support the processes that facilitate effective collaboration.

What interviewing techniques will you use to interview the patient to elicit subjective health information about their health history?

Before I begin talking with the patient, I will clarify goals for the interview.   I will balance provider-centered goals with patient-centered goals. MN566 Unit 2 Discussion Essay. I will use sound critical thinking and clinical decision making to develop a comprehensive data base, including complete functional assessment, health history, physical examination, and appropriate diagnostic testing that will allow me to develop an effective and appropriate plan of care for the client which takes into consideration life circumstance and cultural, ethnic, and developmental variations.

What relevant follow-up questions will you use to evaluate patient condition?

According to (Dunphy, Windland-Brown, Porter, & Thomas, 2015), AHRQ inititaves promote effective guidelines to investigate outcomes and evaluating response to care.  The follow-up evaluation is a crucial step in the care process. The follow-up evaluation reinforces your commitment to your patient, supports the therapeutic relationship, and validates your willingness to work with your patient to attain the preferred objectives of treatment.

How will you demonstrate empathy for patient perspectives, feelings, and sociocultural background?

I know that by just listening I can help the person identify and express their feelings and cope with the situation. I learned that motivational interviewing is a powerful strategy to apply in my practice.  To help cultivate empathy, begin with self-examination. Self-awareness includes knowing one’s personal biases, values, desires and concerns which may affect our interactions with others. As a nurse I must be sincere and really care about what happens to others. This is the root of my role as patient advocate. Also cultural competency and safety is an area that must be focused on to help build and establish the patient relationship (Hamric, Hanson, Tracy, & O’Grady, 2014). My personal belief system has always been to be compassionate and caring. In the nursing profession you need to have a vast amount of compassion and caring for your patients and their families. You are not only caring for the patient’s physical health, but also their emotional needs.  I believe a collaborative partnerships allows the provider to distinguish what is truly important to the patient’s health.  As an Advanced Practice Nurse I must understand the patients’ and families’ fears and their coping skills, I need to understand their intention and respond to challenging situations without losing my connection with them.

What opportunities will you take to educate the patient?

Any and every opportunity available about health promotion, new medication, new or current disease processes, disease management. MN566 Unit 2 Discussion Essay.

 

References:

Atkinson, H. L., & Nixon-Cave, K. (2011). A Tool for Clinical Reasoning and Reflection Using the International Classification of Functioning, Disability and Health (ICF) Framework and Patient Management Model.
Physical Therapy
, 416–430.

Benner, P., Hughes, R. G., & Sutphen, M. (2008). Chapter 6 Clinical Reasoning, Decisionmaking, and Action: Thinking Critically and Clinically. In P. Benner, R. G. Hughes, & M. Sutphen,
Patient Safety and Quality: An Evidence-Based Handbook for Nurses
(p. Chapter 6). Rockville: Agency for Healthcare Research and Quality.

Dunphy, L., Windland-Brown, J., Porter, B., & Thomas, D. (2015).
Primary Care: The Art and Science of Advanced Practice Nursing (4th ed.).
Philadelphia, PA: F.A. Davis Company.

Hamric, A., Hanson, C., Tracy, M. F., & O’Grady, E. (2014).
Advanced practice nursing. An integrative approach (5th ed.).
St. Louis, MO.: Elsevier Saunders. MN566 Unit 2 Discussion Essay.

JCI. (2018, March 30).
Use of Codes, Symbols, and Abbreviations.
Retrieved from Joint Commission Internation: https://www.jointcommissioninternational.org/use-of-codes-symbols-and-abbreviations/

Lew, V., & Ghassemzadeh, S. (2019). SOAP Notes.
StatPearls
, 13-15.

Mathioudakis, A., Rousalova, I., Gagnat, A. A., Saad, N., & Hardavella, G. (2016). How to keep good clinical records.
Breathe
, 369–373. MN566 Unit 2 Discussion Essay.

Patricia, done

In healthcare, it is important to adopt and initiate new practice, ideas, and research into our daily process.  APRN’s exert considerable time and energy on a daily basis disbursing interventions to improve well-being and in the long run, the patient’s experience. Management of any medical problem is a multifaceted process, which is greatly aided with a healthcare partnership. Preventative care is significant to all health care (Merzel & D’Afflitti, 2003). The Nurse Practice Act (NPC) holds each individual nurse accountable for the quality of nursing care provided and sets forth minimum standards of practice to which nurses are expected to apply and include into their daily practice (National Council of State Boards of Nursing, 2018). MN566 Unit 2 Discussion Essay.

References:

Merzel, C., & D’Afflitti, J. (2003). Reconsidering Community-Based Health Promotion: Promise, Performance, and Potential. American Journal of Public Health, 93(4): 557–574.

National Council of State Boards of Nursing. (2018, April 12).
Nurse Practice Act, Rules & Regulations
. Retrieved from National Council of State Boards of Nursing: https://www.ncsbn.org/nurse-practice-act.htm

 

Annette, Done

I enjoyed reading your post! Nilsen, (2015) stated that strong, open communication across teams strengthens the chance of firmly embedding change by supporting the development of therapeutic relationships and removing barriers. Good communication is a prominent piece of every phase of the change development and almost all researchers cite it as fundamental to effective implementation. MN566 Unit 2 Discussion Essay Clinicians dedicate a great deal of time to determining diagnoses for illness or abnormalities that their patients are suffering from.

References:

Nilsen, P. (2015). Making sense of implementation theories, models and frameworks.
Implementation Science Journal
, 53-57.

 

The nurse practice act is a guideline that governs nurses through their scope of practice, education standards, licensure requirements, and varies from state to state (Nursing: Scope and Standards of Practice / Edition 2, 2010).  Discovering methods to handle ethical conflicts is perilous not only to the distraught clinicians but also to organizations struggling to progress outcomes, as moral distress can poorly affect patient care.   Support the nursing code of ethics.  Westrick (2013) stated the ANA Code of Ethics gives the framework for practice MN566 Unit 2 Discussion Essay.

References:

Nursing: Scope and Standards of Practice / Edition 2.
(2010). Nursesbooks.org.

Westrick, S. J. (2013 ).
Essentials Of Nursing Law And Ethics.
Burlington, MA: Jones & Bartlett. MN566 Unit 2 Discussion Essay.

Chronic Care Management Essay

After an initial examination of the medication list, I try to envision Mrs. X based on the SPICES assessment and my own 30 years of geriatric experience.  This is an 80-year-old female who has lived her entire life eating rich foods high in cholesterol and fat.  She is probably short and plump.  She has not been sleeping and likely exhibits physical behaviors which have been labeled as “psychotic” in nature.  She hasn’t been eating well and has had a significant weight loss, despite her plump appearance.  She has tremors in her hands which make it hard to hold utensils and cups, but she has lost weight because she has had anorexia, not due to the tremors.  She is incontinent and has constipation.  She is confused, usually agitated, and she probably cries inappropriately.  She is ambulatory, but she is weak. She will have some bruises and skin tears on her arms and legs due to the falls, but she doesn’t have any pressure wounds, yet. Chronic Care Management Essay.

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Although Mrs. X is very ill, there is no question that some of her current ailments are related to her polypharmacy.  There are 21 medications on Mrs. X’s medication list.  Unfortunately, the use of more than five medications daily (polypharmacy) is commonly seen in elderly patients (Masnoon, Shakib, Kalisch-Elliot, & Caughey, 2017).  At first glance, it is notable that many of the medications on Mrs. X’s list work in similar ways and place Mrs. X at higher risk for side effects or adverse reactions.  Also, some of these medications have the same ingredients as others, increasing the risk of overdose. Chronic Care Management Essay Some of the listed medications are even contraindicated for elderly patients (Maher, Hanton, & Hajjar, 2014).

A plan of care is needed that should include medication reconciliation, education regarding her medications, review by a pharmacy consultant, and initiation of gradual dose reductions.  Medication education should include a description of the each medication currently taken.  Altace is an ACE (angiotensin-converting-enzyme) inhibitor and is used to treat high blood pressure (Hypertension) and heart failure (Wolters, 2011).  Adalat is a calcium channel blocker and is used to treat high blood pressure (Wolters, 2011).  Cardizem LA is also a calcium channel blocker and is used to treat high blood pressure (Wolters, 2011). Chronic Care Management Essay Lasix is a diuretic used to treat fluid retention caused by heart failure (Wolters, 2011).  Hydrochlorothiazide is also a diuretic and is used to treat fluid retention and hypertension (Wolters, 2011).  Baby aspirin is a blood thinner, as well as a nonsteroidal anti-inflammatory, and is used to reduce the risk of heart attack by thinning the blood (Wolters, 2011).  Lipitor is a statin drug and is used to treat high cholesterol and triglyceride levels (Wolters, 2011).  Synthroid is a hormone used to treat hypothyroidism (Wolters, 2011).  Tylenol is an analgesic used to treat minor aches and pains (Wolters, 2011).  Benadryl is an antihistamine with a sedating effect that is used to treat seasonal allergies (Wolters, 2011).  Aleve is a nonsteroidal anti-inflammatory drug used to treat arthritis pain (Wolters, 2011).  Amrix is a muscle relaxant used to treat pain and stiffness caused by muscle spasms (Wolters, 2011). Chronic Care Management Essay Glucosamine is an amino sugar and is used to treat arthritis pain.  Amitriptyline is an antidepressant and is used to treat sleeplessness associated with depression (Wolters, 2011).  Paxil is a selective serotonin reuptake inhibitor and is used to treat depression (Wolters, 2011).  Oxazepam is a sedative and is used to treat insomnia associated with depression (Wolters, 2011).  Tylenol PM is a combination drug that contains both Benadryl and Tylenol.  Prilosec is a proton pump inhibitor used to treat gastroesophageal reflux disease (GERD) (Wolters, 2011).  Fiber laxative is a bulk-forming laxative used to treat constipation by increasing the bulk of the stool causing movement in the intestine.  It also increases the amount of water in the stool making the stool softer (Wolters, 2011).  Colace is a sulfonic acid which is also used to increase the amount of water in the stool making it softer and easier to pass (Wolters, 2011).  Multivitamins are prepared with multiple dietary minerals and nutritional elements and are used as dietary supplements and often stimulate the appetite. Chronic Care Management Essay.

Independently medications such as Benadryl, Paxil, Tylenol PM, and others are contraindicated for use in the elderly because they have adverse side effects such as increased delirium, behavioral problems, and increased risk for stroke.  Medications such as Prilosec can cause bone loss, fractures and even bowel infections such as Clostridium Difficile.  Nonsteroidal anti-inflammatory medications such as Aleve and baby aspirin could potentially promote fluid retention and exacerbate heart failure. Chronic Care Management Essay In addition to the side-effects/ adverse reactions that some medications can cause, there is also the potential for medications that work in a similar manner to increase other risks (Beers, 2015).  Antidepressant medications can lower blood pressure and if a patient also receives a fluid pill (diuretic), then this adds to the potential for extremely low blood pressure, which could cause falls or even be fatal.  Muscle relaxants and sedatives both cause increased sleepiness and are poorly tolerated by older adults.  Over-sedation and falls are a huge risk.  Even though CHF causes an excess of fluid, there is still a very real risk of dehydration (Haq, et.al., 2014).  Lasix, hydrochlorothiazide, bulk fiber laxative, and Colace all pull fluid out of the body for elimination either by urine or feces. A person can have edema when fluid is in all the wrong places, but still be dehydrated because the fluid is not in the right places (Haq, et.al., 2014).

It is important that medications are taken strictly as ordered and unnecessary medications should be discontinued (Masnoon, et.al., 2017).  Although there may be some adjustment with medication timing to meet a patient’s individual preferences, it is important that the medication regimen have a structured routine.  A pharmacist should be consulted to review medications monthly or as indicated to ensure that the lowest possible therapeutic dosages are given.  Laboratory monitoring will be critical in assessment of the status of medication levels and their effects on the body.  Other tests may also be needed such as an electrocardiogram, chest x-ray, or arterial doppler studies.  Physical, occupational, and speech therapies – as well as restorative nursing – will be needed to improve physical tolerance and endurance.  Nutrition will also be important.  Calorie intake, salt intake, and other vitamins and minerals will need to be monitored closely.  Daily weights and edema checks will be needed to monitor fluid gains and/ or losses (Haq, et.al., 2014).  Involvement in activities of daily living, social activities, and therapy activities, as well as a regular waking and sleeping routine, will be necessary to improve sleep patterns.  One of the more important interventions needed is the monitoring frequently for adverse reactions, side effects, and/or increased behaviors.  Regular assessments will be needed. Chronic Care Management Essay.

References

Masnoon, N., Shakib, S., Kalisch-Ellett, L., & Caughey, G.  (2017, October 10).  What is polypharmacy? A systematic review of definitions. 
Biomed central geriatrics, 17
, 230.  Retrieved from 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5635569/

Wolters K. (Firm).  (2011).
Nursing 2011 drug handbook
.  Philedephia – Baltimore – New York – London.  Chris Burghardt Chronic Care Management Essay

Beers Criteria Update Expert Panel.  (2015). American geriatrics society 2015 updated Beers criteria for potentially inappropriate medication use in older adults. 
Clinical Investigations.
  Retrieved from 
https://www.sigot.org/allegato_docs/1057_Beers-Criteria.pdf

Maher, Jr, R., Hanlon, J., Hajjar, E.  (2014). Clinical consequences of polypharmacy in elderly. 
Expert opin drug saf.
  Retrieved from 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3864987/

Haq, M., Wong, C., Mutha, V., Anavekar, N., Lim, K., Barlis, P., & Hare, D.  (2014). Therapeutic interventions for heart failure with preserved ejection fraction:  A summary of current evidence. 
World journal of cardiology, 6
(2), 67-76.  Doi:  10.4330/wjc.v6.i2.67 Chronic Care Management Essay

DN703: Scientific Foundations for Practice Doctorate

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In this course, you will examine the evolution of nursing science and the emergence of the DNP degree based on the utilization of evidence to influence the health of populations. You will be introduced to advanced levels of systems thinking with a focus on designing programs to improve patient, population, and health system outcomes based on levels of evidence available. You will appraise new practice approaches based on theories from nursing and other disciplines. During this course, you will analyze a health care problem or relevant clinical inquiry for the DNP project and identify the population focus for the DNP project. This course requires 50 supervised practice hours, which may be applied to the doctoral project. DN703: Scientific Foundations for Practice Doctorate

Quarter Credit Hours: 5 | Prerequisite: None

DN713: Epidemiology and Social Determinants of Population Health

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This course focuses on comprehending, synthesizing, and applying emerging scientific knowledge specific to clinical prevention and population health. You will synthesize trends among epidemiologic, biostatistical, and environmental data to derive solutions to tenacious or new health care problems based on existing health data sets and the scientific literature. Social determinants of health in the processes of conducting risk assessment, intervention development and implementation, health care delivery planning, and evaluation will be considered. Models of clinical prevention and population health care delivery will be evaluated. This course requires 20 supervised practice hours focused on population health. DN713: Epidemiology and Social Determinants of Population Health

Quarter Credit Hours: 5 | Prerequisite: None | Corequisite:
 DN703

You will analyze methods and tools for critical appraisal and application of empirical, reflective, and practice-based information to improve the quality of care and outcomes for specific populations. You will analyze and appraise an identified issue within the population, such as outcomes of practice, practice patterns, policies, or organizational systems of care. The application of evidence-based practice is emphasized for designing and implementing an intervention to influence an identified issue. Methods for evaluating outcomes of the proposed intervention will be explored. You will develop and defend a proposal for a DNP project in this course. This course requires 80 supervised practice hours, which may be applied to the doctoral project.

Quarter Credit Hours: 5 | Prerequisite: 
DN713

This course will prepare you to design and implement culturally proficient health care policies with special consideration of issues of social justice and equity. Legal and ethical challenges encountered in practice leadership, decision making, and the implementation of systems and organizational change processes and policies will be explored. Ethics, health care policy, and advocacy specific to a DNP project will be emphasized. This course requires 50 supervised practice hours, which may be applied to the doctoral project.

Quarter Credit Hours: 5 | Prerequisite: 
DN703 
| Corequisite: 
DN723

In this course, students will analyze current and emerging aggregate-level clinical prevention and population health issues. Students will demonstrate and apply experiential, contextual, and evidence-based best practices, cost/benefits, and systematic plans for quality improvement benchmarks with the end goal of designing aggregate-level clinical prevention and population health interventions. This course requires 50 supervised practice hours, which may be applied to the doctoral project.

Quarter Credit Hours: 5 | Prerequisite: 
DN733

This course provides you with evidence-based organizational and leadership knowledge and skills necessary to appraise practice leadership theories and organizational models. The influence of economics, health policy, stakeholders, information technology, and interprofessional collaboration upon health care organizational operations will be explored. You will identify a practice leadership model that aligns with the DNP project focus. This course requires 50 supervised practice hours, which may be applied to the doctoral project.

Quarter Credit Hours: 5 | Prerequisite: 
DN733
 | Corequisite:
 DN743